Prediction Of Adverse Neonatal Outcome Research Articles

Value of Glycosylated Hemoglobin at 34 Weeks Gestation in the Prediction of Adverse Neonatal Outcome

Background: Gestational diabetes is diabetes, or high blood sugar levels, that develops during pregnancy. It occurs in about 4% of all pregnancies. It is usually diagnosed in the later stages of pregnancy and often occurs in women who have no prior history of diabetes. Aim of the Work: To assess the predictive value of elevated glycosylated hemoglobin at 34 weeks’ gestation with adverse fetal outcome as regard fetal macrosomia and neonatal hypoglycemia. Patients and Methods: This prospective longitudinal cohort study included 98 pregnant women who were recruited from the obstetric outpatient clinic and department at Al-Galaa Teaching Hospital. Results: HbA1c ≥7.9 has sensitivity of 88.1% and specificity of 66.1%, in prediction of macrosomia and a sensitivity of91.9% and specificity of 63.9% in prediction of Hypoglycemia. Conclusion: HbA1c ≥7.9 has moderate diagnostic characteristics in prediction ofmacrosomia, and hypoglycemia, low diagnostic characteristics in prediction of RDS and NICU. Recommendations: Use of HbA1C is recommended for patients with GDM for screening, follow up and prediction of adverse neonatal outcomes.

Comparison of Umbilical Arterial Doppler and Middle Cerebral Arterial Doppler Assessments of Fetal Well-being in Mothers with Diabetes Mellitus: A Prospective Study

Background: Diabetes mellitus may accompany and complicate a pregnancy, resulting in poor neonatal outcomes. Objectives: The aim of this study was to compare middle cerebral arterial (MCA) and umbilical arterial (UA) Doppler assessments for the evaluation of fetal well-being in mothers with pre-gestational or gestational diabetes mellitus. Methods: This cohort study was performed on 103 pregnant diabetic women, admitted for prenatal care to the department of gynecology and obstetrics of Jame Zanan hospital (Tehran, Iran) in 2015. Sampling was performed, using the convenience method. All women underwent one or more Doppler ultrasound examinations in the third trimester of pregnancy, which included blood flow measurement through umbilical and middle cerebral arteries. Women with abnormal UA or MCA Doppler test results were subjected to labor induction or cesarean section, according to different parameters. The outcomes included neonatal acidosis, one- and five-min Apgar scores, hypoglycemia, hypocalcaemia, neonatal intensive care unit (NICU) admission, gestational age at delivery, and neonatal death. Chi-square test, t-test or Fisher’s exact test, and logistic regression analysis were performed to analyze the data. Results: Based on the findings, poor outcomes were detected in 48 women. Nearly 17.5% and 9.7% of women had abnormal UA and MCA Doppler test results, respectively. In total, 62% of women gave birth via cesarean section. The UA Doppler test results were significantly related with hypoglycemia, respiratory distress syndrome (RDS), one-min Apgar score < 7, five-min Apgar score < 7, and NICU admission, while the MCA Doppler results were significantly associated with RDS and neonatal death (P < 0.05). The sensitivity of both tests ranged between 20% and 60%. Logistic regression analysis revealed that UA Doppler test could predict poor outcomes after fasting blood sugar control (P = 0.028, OR = 3.6, CI: 1.15 - 11.13). Conclusions: Both UA and MCA Doppler tests were associated with some neonatal outcomes. However, sensitivity of both UA and MCA assessments was low in the prediction of adverse neonatal outcomes. By the comparison of these two methods, we found that UA Doppler assessment is a better predictor of neonatal outcomes.

Cord blood erythropoietin and cord blood nucleated red blood cells for prediction of adverse neonatal outcome associated with maternal obesity in term pregnancy: prospective cohort study

Objective: To determine the adverse pregnancy outcomes associated with maternal pre-pregnancy overweight and obesity and we measure cord blood erythropoietin and NRBC count as indices of hypoxia and predictors of neonatal outcome.Study design: This prospective cohort study was done in Minia University Hospital, carried out from May 2015 to April 2016. Two hundred and seventy full-term neonates born to mothers of various body mass indices were included. Excluded were neonates with major factors known to be associated with a potential increase in fetal erythropoiesis. Pre-pregnancy maternal BMI was calculated from maternally reported weight and height. Cord blood erythropoietin and nucleated red blood cells were measured.Results: There is a significant increase of various adverse pregnancy outcomes as cesarean section. Postpartum hemorrhage and macrosomia with the increase of maternal pre-pregnancy BMI. Significant positive correlations between cord blood erythropoietin and nucleated red blood cells with maternal BMI.Conclusion: The increase in the maternal pre-pregnancy BMI is associated with poor pregnancy outcomes. Cord blood erythropoietin and nucleated red blood cells can predict the poor neonatal outcome.

P28.07: The prediction of adverse neonatal outcome is improved by longitudinal analysis of fetal biometric parameters and uterine artery Doppler velocimetry

P28.07: The prediction of adverse neonatal outcome is improved by longitudinal analysis of fetal biometric parameters and uterine artery Doppler velocimetry

Re: Prediction of adverse perinatal outcome of small-for-gestational-age pregnancy using size centiles and conditional growth centiles. H. O. Karlsen, S. L. Johnsen, S. Rasmussen and T. Kiserud. Ultrasound Obstet Gynecol 2016; 48: 217-223.

Re: Prediction of adverse perinatal outcome of small-for-gestational-age pregnancy using size centiles and conditional growth centiles. H. O. Karlsen, S. L. Johnsen, S. Rasmussen and T. Kiserud. Ultrasound Obstet Gynecol 2016; 48: 217-223.

Does gender of the fetus have any relation with fetal heart monitoring during the first and second stage of labor?

Objective: To investigate fetal gender and its influences on neonatal outcomes, taking into consideration the available tools for the assessment of fetal well-being.Methods: We conducted a retrospective study comparing maternal, fetal and neonatal outcomes according to fetal gender, in women carrying a singleton gestation.A multivariate analysis was performed for the prediction of adverse neonatal outcomes according to fetal gender, after adjustment for gestational age, maternal age and fetal weight.Results: A total of 682 pregnancies were included in the study, of them 56% (n = 383) were carrying a male fetus and 44% (n = 299) a females fetus. Male gender was associated with a significant higher rate of abnormal fetal heart tracing patterns during the first (67.7% versus 55.1, p = 0.001) and the second stage (77.6 versus 67.7, p = 0.01) of labor. Male gender was also significantly associated with lower Apgar scores at 1' (19.1% versus 10.7%, p < 0.01), as well as lower pH values (7.18 ± 0.15 versus 7.23 ± 0.18, p < 0.001), and significant differences in cord blood components (PCO2, PO2) compared with female fetuses. In the multivariate analysis, male gender was found to be significantly associated with first (OR 1.76, 95% CI 1.28–2.43, p = 0.001) and second stage (OR 1.73, 95% CI 1.20–2.50, p < 0.01) pathological fetal heart tracing patterns, pH < 7.1, and for Apgar scores at 1'< 7.Conclusions: The present study confirms the general trend of a lower clinical performance of male neonates compared with females. In addition, the relation between fetal heart rate patterns during all stages of labor and fetal gender showed an independent association between male fetal gender and abnormal fetal heart monitoring during labor.

Neonatal outcome in women with preterm premature rupture of membranes (PPROM) between 18 and 26 weeks

Objective: The aim of this study was to identify adverse neonatal outcomes and identifies the predictors of adverse neonatal outcomes in premature rupture of membranes before 26 weeks.Methods: Data were collected between January 2005 and December 2011 from all pregnant women who presented preterm premature rupture of membranes (PPROM) between 18 and 26 complete weeks of gestation and were admitted to one of three Brazilian institutes. The adverse outcomes included mortality or the development of a severe morbidity during the length of stay in the neonatal intensive care unit (NICU). The descriptive statistics of the population were reported. A multiple logistic regression was performed for each predictor of neonatal adverse outcomes. The area under the receiver operating characteristics curves for the birth weight was calculated.Results: Composite adverse outcomes during the NICU stay occurred in 82.1% (n = 23) of the cases and included 33 (54%) neonatal deaths, 19 (67.8%) cases of retinopathy of prematurity (ROP), 13 (46.4%) cases of pulmonary hypoplasia (BPD), 8 (28.5%) cases of periventricular-intraventricular hemorrhage (PIH) and 3 (10.7%) cases of periventricular leukomalacia (PVL). Only 17.8% (n = 5) of the neonates survived without morbidity. The area under the curve for the birth weight was 0.90 (95% IC: 0.81–0.98) for the prediction of mortality.Conclusions: PPROM before 26 weeks has a high morbidity and mortality, and the significant predictors of neonatal mortality and adverse outcomes were antibiotic prophylaxis, latency period, GA at birth and birth weight. Nevertheless, the only independent significant predictor of survival rate was birth weight.

Predictors of adverse neonatal outcomes in intrahepatic cholestasis of pregnancy

We sought to determine predictors of adverse neonatal outcomes in women with intrahepatic cholestasis of pregnancy (ICP). This study was a multicenter retrospective cohort study of all women diagnosed with ICP across 5 hospital facilities from January 2009 through December 2014. Obstetric and neonatal complications were evaluated according to total bile acid (TBA) level. Multivariable logistic regression models were developed to evaluate predictors of composite neonatal outcome (neonatal intensive care unit admission, hypoglycemia, hyperbilirubinemia, respiratory distress syndrome, transient tachypnea of the newborn, mechanical ventilation use, oxygen by nasal cannula, pneumonia, and stillbirth). Predictors including TBA level, hepatic transaminase level, gestational age at diagnosis, underlying liver disease, and use of ursodeoxycholic acid were evaluated. Of 233 women with ICP, 152 women had TBA levels 10-39.9 μmol/L, 55 had TBA 40-99.9 μmol/L, and 26 had TBA ≥100 μmol/L. There was no difference in maternal age, ethnicity, or prepregnancy body mass index according to TBA level. Increasing TBA level was associated with higher hepatic transaminase and total bilirubin level (P < .05). TBA levels ≥100 μmol/L were associated with increased risk of stillbirth (P < .01). Increasing TBA level was also associated with earlier gestational age at diagnosis (P < .01) and ursodeoxycholic acid use (P = .02). After adjusting for confounders, no predictors were associated with composite neonatal morbidity. TBA 40-99.9 μmol/L and TBA ≥100 μmol/L were associated with increased risk of meconium-stained amniotic fluid (adjusted odds ratio, 3.55; 95% confidence interval, 1.45-8.68 and adjusted odds ratio, 4.55; 95% confidence interval, 1.47-14.08, respectively). In women with ICP, TBA level ≥100 μmol/L was associated with increased risk of stillbirth. TBA ≥40 μmol/L was associated with increased risk of meconium-stained amniotic fluid.

592: Predictors of adverse neonatal outcomes in intrahepatic cholestasis of pregnancy

To determine the predictors of adverse neonatal outcomes in patients with intrahepatic cholestasis of pregnancy (ICP). We conducted a multicenter retrospective cohort study of all women diagnosed with ICP across four hospital facilities from 2006 to 2013. ICP was diagnosed by maternal pruritis associated with total bile acid (TBA) levels > 10 μmol/L. We calculated the rate of severe neonatal morbidity (composite of neonatal intensive care unit admission, neonatal hyperbirilubinemia, hypoglycemia, respiratory distress syndrome, transient tachypnea of the newborn, mechanical ventilation use, need for neonatal oxygen with nasal cannula, pneumonia, and stillbirth) according to severity of bile acid elevation (mild ICP, TBA 10 to 39.9 μmol/L; moderate ICP, TBA 40 to 99.9 μmol/L; severe ICP, TBA >100 μmol/L). Mild ICP was used as a reference. Chi-Square and Fisher’s exact tests were used to compare outcomes. One-way analysis of variance (ANOVA), logistic regression, and receiver operating characteristic (ROC) curve were also used to predict neonatal complications. A total of 95 women with documented ICP were identified. There was no difference in maternal age, race, parity, or pre-pregnancy body mass index according to TBA level. There were 56 women with mild ICP, 25 with moderate ICP, and 14 with severe ICP. The rate of severe neonatal morbidity in mild, moderate and severe ICP was 22%, 48%, and 43% respectively (p=0.04) (Table). Women with moderate or severe IPC were more likely to deliver preterm at less than 37 weeks gestation compared to women with mild ICP (p=0.02). TBA above 39.8 μmol/L was associated with severe neonatal morbidity (p= 0.01, RR 2.12, 95%CI=1.16-3.87, AUC 0.67). There were two stillbirths at 29 and 35 weeks of gestation, both observed in women with severe ICP. Moderate and severe ICP were associated with severe neonatal morbidity and preterm delivery. TBA level above 39.8 μmol/L was associated with severe neonatal morbidity. Stillbirth was associated with severe ICP.

377: CVR at the time of mid-trimester diagnosis of congenital lung lesions as a predictor of adverse neonatal outcomes

377: CVR at the time of mid-trimester diagnosis of congenital lung lesions as a predictor of adverse neonatal outcomes

P16.21: Fetal weight and neonatal outcomes in pre‐viable rupture of membranes

The aim of this study was to identify the adverse neonatal outcomes, with an emphasis on mortality, morbidity (considered here as pulmonary hypoplasia, ROP, PVL and PIH) and morbimortality, and to analyze fetal weight as a predictors of adverse neonatal outcomes in pre-viable premature rupture of membranes. Data were collected between January, 2005 and December, 2011 from all of the pregnant women who presented premature rupture of membranes (PROM) between 18 and 26 complete weeks and who were admitted to one of three Brazilian institutes. The adverse outcomes included mortality or the development of a severe morbidity during the lengh of stay in the neonatal intensive care unit (NICU). The descriptive statistics of the population were reported. A multiple logistic regression was performed for fetal weight of neonatal adverse outcomes. The area under the receiver operating characteristics curves for the fetal weight was calculated. Adverse outcomes during the NICU stay occurred in 82.1% (n = 23) of the cases and included 33 (54%) deaths, 19 (67.8%) cases of retinopathy of prematurity (ROP), 13 (46.4%) cases of pulmonary hypoplasia (BPD), 8 (28.5%) cases of periventricular-intraventricular hemorrhage (PIH) and 3 (10.7%) cases of periventricular leukomalacia (PVL). Only 17.8% (n = 5) of the neonates survived without morbidity. The area under the curve for the fetal weight was 0,90 (95% IC: 0.81-0.98) for the prediction of mortality. Fetal weight was identified as an important predictor of neonatal outcome, leading us to conclude that when we choose conservative management for a pre-viable PROM pregnancy, all of the efforts should be focused on prolonging the latency period (for example, through the use of antibiotic prophylaxis) and increasing the birthweight. However, it should be noted that the fetal weight only influences the neonatal mortality and not the morbidity, which remains a concern for these neonates.

Prediction of neonatal outcome in women with gestational hypertension or mild preeclampsia after 36 weeks of gestation

Background: There is little knowledge about neonatal complications in GH and PE and induction at term, we aim to assess whether they can be predicted from clinical data.Methods: We used data of the HYPITAT trial and evaluated whether adverse neonatal outcome (Apgar score < 7, pH < 7.05, NICU admission) could be predicted from clinical data. Logistic regression, ROC analysis and calibration were used to identify predictors and evaluate the predictive capacity in an antepartum and intrapartum model.Results: We included 1153 pregnancies, of whom 76 (6.6%) had adverse neonatal outcome. Parity (primipara OR 2.75), BMI (OR 1.06), proteinuria (dipstick +++ OR 2.5), uric acid (OR 1.4) and creatinine (OR 1.02) were independent antepartum predictors; In the intrapartum model, meconium stained amniotic fluid (OR 2.2), temperature (OR 1.8), duration of first stage of labour (OR 1.15), proteinuria (dipstick +++ OR 2.7), creatinine (OR 1.02) and uric acid (OR 1.5) were predictors of adverse neonatal outcome. Both models showed good discrimination (AUC 0.75 and 0.78), but calibration was limited (Hosmer–Lemeshow p = 0.41, and p = 0.20).Conclusions: In women with GH or PE at term, it is difficult to predict neonatal complications, possibly since they are rare in the term pregnancy. However, the identified individual predictors may guide physicians to anticipate requirements for neonatal care.

Adverse neonatal outcomes in women with pre-eclampsia in Mulago Hospital, Kampala, Uganda: a cross-sectional study.

IntroductionPre-eclampsia, which is more prevalent in resource-limited settings, contributes significantly to maternal, fetal and neonatal morbidity and mortality. However, the factors associated with these adverse outcomes are poorly understood in low resource settings. In this paper we examine the risk factors for adverse neonatal outcomes among women with pre-eclampsia at Mulago Hospital in Kampala, Uganda.MethodsPre-eclampsia, which is more prevalent in resource-limited settings, contributes significantly to maternal, fetal and neonatal morbidity and mortality. However, the factors associated with these adverse outcomes are poorly understood in low resource settings. In this paper we examine the risk factors for adverse neonatal outcomes among women with pre-eclampsia at Mulago Hospital in Kampala, Uganda.ResulsPredictors of adverse neonatal outcomes were: preterm delivery (OR 5.97, 95% CI: 2.97-12.7) and severe pre-eclampsia (OR 5.17, 95% CI: 2.36-11.3).ConclusionPredictors of adverse neonatal outcomes among women with pre-eclampsia were preterm delivery and severe pre-eclampsia. Health workers need to identify women at risk, offer them counseling and, refer them if necessary to a hospital where they can be managed successfully. This may in turn reduce the neonatal morbidity and mortality associated with pre-eclampsia.

Adverse neonatal outcomes in women with pre-eclampsia in Mulago Hospital, Kampala, Uganda: a cross-sectional study

INTRODUCTION: Pre-eclampsia, which is more prevalent in resource-limited settings, contributes significantly to maternal, fetal and neonatal morbidity and mortality. However, the factors associated with these adverse outcomes are poorly understood in low resource settings. In this paper we examine the risk factors for adverse neonatal outcomes among women with pre-eclampsia at Mulago Hospital in Kampala, Uganda. METHODS: A cross-sectional study was conducted at Mulago Hospital. Participants were 171 pregnant women diagnosed with pre-eclampsia in the Department of Obstetrics and Gynecology. Women were recruited from May 2008 to May 2009 and followed until they delivered. Bivariate and multivariate analyses were done to examine the correlates of adverse neonatal outcomes among this group of women. RESULTS: Predictors of adverse neonatal outcomes were: preterm delivery (OR 5.97, 95% CI: 2.97-12.7) and severe pre-eclampsia (OR 5.17, 95% CI: 2.36-11.3). CONCLUSION: Predictors of adverse neonatal outcomes among women with pre-eclampsia were preterm delivery and severe pre-eclampsia. Health workers need to identify women at risk, offer them counseling and, refer them if necessary to a hospital where they can be managed successfully. This may in turn reduce the neonatal morbidity and mortality associated with pre-eclampsia.

Gastroschisis: antenatal sonographic predictors of adverse neonatal outcome.

Objectives. The aim of this review was to identify clinically significant ultrasound predictors of adverse neonatal outcome in fetal gastroschisis. Methods. A quasi-systematic review was conducted in PubMed and Ovid using the key terms “gastroschisis,” “predictors,” “outcome,” and “ultrasound.” Results. A total of 18 papers were included. The most common sonographic predictors were intra-abdominal bowel dilatation (IABD), intrauterine growth restriction (IUGR), and bowel dilatation not otherwise specified (NOS). Three ultrasound markers were consistently found to be statistically insignificant with respect to predicting adverse outcome including abdominal circumference, stomach herniation and dilatation, and extra-abdominal bowel dilatation (EABD). Conclusions. Gastroschisis is associated with several comorbidities, yet there is much discrepancy in the literature regarding which specific ultrasound markers best predict adverse neonatal outcomes. Future research should include prospective trials with larger sample sizes and use well-defined and consistent definitions of the adverse outcomes investigated with consideration given to IABD.

425: Multi-vessel Doppler parameters for the prediction of adverse neonatal outcome in the preterm growth-restricted fetus: does gestational age matter?

with a birthweight less than the 10th percentile without malformations were included. Group A (study group); GRF delivered at term without other clinical signs of PI. Group B, (1st control group); GRF accompanied with clinical signs of PI and delivered at term. Group C, (2nd control group), GRF accompanied with early severe preeclampsia, placental abruption or abnormal Doppler and delivered before 34 weeks. Group D, (3rd control group); term placentas from healthy women who delivered fetuses appropriate for age. Placental lesions examined included maternal and fetal vascular obstructive lesions, villitis and perivillous fibrinoid deposition. Primary outcome was the incidences of placental lesions among the study group compared to the controls. RESULTS: The most frequent placental lesions found among all groups were maternal obstructive lesions (Table). For women in group A, the odds of having any maternal obstruction lesion was 3.3 times higher than women in group D (p 0.0006). There were no differences between groups A and B (p 0.98). The incidence of any obstructive maternal lesion was significantly higher among group C compared to group A (p 0.0004) and B (p 0.0003). The incidence of any placental lesion was significantly higher among all the groups with GRF (A, B and C) compared to group D. The incidence of any lesion among group A (69.4%) was 7.9 times higher than women in group D (22.3%) (p 0.0001) and comparable to group B (61.7%), (p 0.3). CONCLUSION: The incidence of placental lesions among GRF delivered at term was comparable regardless of whether clinical signs of PI exist or not. Antepartum management of GRF at term probably needs to be similar regardless of other signs of PI.

Perinatal Complications in Twin Pregnancies after 34 Weeks: Effects of Gestational Age at Delivery and Chorionicity

To evaluate the perinatal outcome of twins approaching term in relation to chorionicity and gestational age at delivery. We accessed data pertaining to a cohort of 471 twin pregnancies with certain chorionicity delivered at > 34.0 weeks' gestation. Twin gestation per se, estimated fetal weight below the 10th percentile, or any intertwin discordance was not an indication for delivery before 40.0 weeks. Predictors of adverse perinatal outcome were identified using logistic regression analysis. There were no stillbirths. Adverse neonatal outcome occurred in 27% of monochorionic versus 16% of dichorionic gestations. At multivariate analysis, lower gestational age at delivery (odds ratio [OR] 0.70, 95% confidence interval [CI] 0.57 to 0.87), monochorionicity (OR 2.06, 95% CI 1.16-3.63), and either twin being growth-restricted (OR 2.35, 95% CI 1.22 to 4.54) were independent predictors of adverse neonatal outcome. Analysis of adverse neonatal outcome stratified by gestational age and chorionicity identified 36 to 37 weeks as optimal timing for delivery of monochorionic twins, and dichorionic twin pregnancies should be allowed to continue until term. Among twin gestations delivered after 34 weeks with appropriate fetal growth, reassuring fetal status at weekly assessment, and absence of obstetric complications, delivery after 36 weeks for monochorionic twins and at term for dichorionic twins minimizes the risk of stillbirths and neonatal morbidity.

Predictive value of the baseline T‐QRS ratio of the fetal electrocardiogram in intrapartum fetal monitoring: a prospective cohort study

To evaluate the added value of the baseline T/QRS ratio to other known risk factors in predicting adverse outcome and interventions for suspected fetal distress. Prospective cohort study. Three academic and six non-academic teaching hospitals in the Netherlands. Laboring women with a high-risk cephalic singleton pregnancy beyond 36 weeks of gestation. We obtained STAN(®) recordings (ST-analysis, Neoventa, Sweden) from two previous studies. Three patient groups were defined: cases with adverse outcome, cases with emergency delivery because of suspected fetal distress without adverse outcome, and a reference group of uncomplicated cases. Baseline T/QRS ratios among the adverse outcome and intervention for suspected fetal distress cases were compared to those of the uncomplicated cases. The ability of baseline T/QRS to predict adverse outcome and suspected fetal distress was determined using a multivariable logistic model. The added value of the baseline T/QRS to other known risk factors in the prediction of adverse outcome and interventions for suspected fetal distress. From 3462 recordings, 2459 were available for analysis. Median baseline T/QRS for uncomplicated cases, adverse outcome and interventions for suspected fetal distress were 0.12 (range 0.00-0.52), 0.12 (0.00-0.42) and 0.13 (0.00-0.39), respectively. There was no statistical difference between these groups. Multivariable analysis showed no added value of baseline T/QRS in the prediction of either adverse outcome or interventions for suspected fetal distress. Baseline T/QRS has no added value in the prediction of adverse neonatal outcome or interventions for suspected fetal distress.

Can adverse neonatal outcome be predicted in late preterm or term fetal growth restriction?

To identify independent predictors of adverse neonatal outcome in cases of fetal growth restriction (FGR) at > or = 34 weeks. From a cohort of 481 FGR cases delivered at > or = 34 weeks, demographic and obstetric variables, fetal biometry and Doppler indices of the uterine, umbilical and fetal middle cerebral arteries available within 2 weeks of delivery, were related to adverse neonatal outcome, defined as admission to the neonatal intensive care unit for indications other than low birth weight alone. Logistic regression analysis showed that gestational age (GA) at delivery (odds ratio (OR) = 0.59; 95% CI, 0.50-0.70), abdominal circumference (AC) centile (OR = 0.69; 95% CI, 0.59-0.81) and umbilical artery (UA) pulsatility index (PI) centile (OR = 1.02; 95% CI, 1.01-1.04) significantly correlated with adverse neonatal outcome. From this model we calculated a score of adverse neonatal outcome expressed by the formula: (UA-PI centile/3) - (10 x AC centile) + (10 x (40 - GA at delivery in weeks)). Receiver-operating characteristics curve analysis demonstrated that a score of > or = 25 optimally predicted adverse neonatal outcome (sensitivity of 75%, false-positive rate of 18%). Beyond 37.5 weeks, gestational age no longer had an independent impact on outcome. In late preterm or term FGR, GA at delivery is the most important predictor of adverse neonatal outcome. At > 37.5 weeks, delivery may be the best option to minimize adverse outcome in all FGR cases. At 34-37 weeks, a score based on GA at delivery, UA-PI centile and AC centile optimally predicts adverse neonatal outcome.

Predicting adverse neonatal outcomes in fetuses with abdominal wall defects using prenatal risk factors

The aim of this study was to determine whether prenatal variables can predict adverse neonatal outcomes in fetuses with abdominal wall defects. A retrospective cohort study that used ultrasound and neonatal records for all cases of gastroschisis and omphalocele seen over a 16-year period. Cases with adverse neonatal outcomes were compared with noncases for multiple candidate predictive factors. Univariable and multivariable statistical methods were used to develop the prediction models, and effectiveness was evaluated using the area under the receiver operating characteristic curve. Of 80 fetuses with gastroschisis, 29 (36%) had the composite adverse outcome, compared with 15 of 33 (47%) live neonates with omphalocele. Intrauterine growth restriction was the only significant variable in gastroschisis, whereas exteriorized liver was the only predictor in omphalocele. The areas under the curve for the prediction models with gastroschisis and omphalocele are 0.67 and 0.74, respectively. Intrauterine growth restriction and exteriorization of the liver are significant predictors of adverse neonatal outcome with gastroschisis and omphalocele.