Optimal Gestational Age and Birth-weight Cutoffs to Predict Neonatal Morbidity (original) (raw)
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BMC pediatrics, 2017
Compared to very low gestational age (<32 weeks, VLGA) cohorts, very low birth weight (<1500 g; VLBW) cohorts are more prone to selection bias toward small-for-gestational age (SGA) infants, which may impact upon the validity of data for benchmarking purposes. Data from all VLGA or VLBW infants admitted in the 3 Networks between 2008 and 2011 were used. Two-thirds of each network cohort was randomly selected to develop prediction models for mortality and composite adverse outcome (CAO: mortality or cerebral injuries, chronic lung disease, severe retinopathy or necrotizing enterocolitis) and the remaining for internal validation. Areas under the ROC curves (AUC) of the models were compared. VLBW cohort (24,335 infants) had twice more SGA infants (20.4% vs. 9.3%) than the VLGA cohort (29,180 infants) and had a higher rate of CAO (36.5% vs. 32.6%). The two models had equal prediction power for mortality and CAO (AUC 0.83), and similarly for all other cross-cohort validations (AUC...
BMJ open, 2015
Construct an ethnic-specific chart and compare the prediction of adverse outcomes using this chart with the clinically recommended UK-WHO and customised birth weight charts using cut-offs for small-for-gestational age (SGA: birth weight <10th centile) and large-for-gestational age (LGA: birth weight >90th centile). Prospective cohort study. Born in Bradford (BiB) study, UK. 3980 White British and 4448 Pakistani infants with complete data for gestational age, birth weight, ethnicity, maternal height, weight and parity. Prevalence of SGA and LGA, using the three charts and indicators of diagnostic utility (sensitivity, specificity and area under the receiver operating characteristic (AUROC)) of these chart-specific cut-offs to predict delivery and neonatal outcomes and a composite outcome. In White British and Pakistani infants, the prevalence of SGA and LGA differed depending on the chart used. Increased risk of SGA was observed when using the UK-WHO and customised charts as op...
The Impact of Small-for-gestational-age on Neonatal Outcome Among Very-low-birth-weight Infants
Pediatrics & Neonatology, 2015
Background: This study aimed to evaluate the impact of small-for-gestational-age (SGA) on mortality and morbidity in very-low-birth-weight (VLBW) infants. Methods: We conducted a retrospective cohort study on VLBW infants registered at the Premature Baby Foundation of Taiwan between 2007 and 2011. All 21 neonatal departments in Taiwan participated in the data collection, and a total of 4636 VLBW infants were registered during the study period. The SGA group (n Z 560) was selected from the database on the basis of birth weight below the 10 th percentile for gestational age, whereas the appropriate-weight-for-gestational-age (AGA) group (n Z 1120) included infants randomly selected via incidence density sampling with a 2:1 match for each SGA case. The association of SGA with individual outcome variables including mortality, respiratory distress syndrome, necrotizing enterocolitis, retinopathy of prematurity (ROP), intraventricular hemorrhage, periventricular leukomalacia, and bronchopulmonary dysplasia (BPD) was evaluated after adjustment for potential confounders. Results: The SGA group was associated with increased risks of mortality [odds ratio (OR) 1.89; 95% confidence interval (CI) 1.39-2.58], severe ROP (OR 1.56; 95% CI 1.13e2.14), and BPD (OR 2.08; 95% CI 1.58e2.75) compared to the AGA group. Further subgroup analysis showed that SGA had significant effects on mortality in the VLBW infants with a gestational age of 24e29
What we have learned about antenatal prediction of neonatal morbidity and mortality
Seminars in Perinatology, 2003
When extremely preterm birth is anticipated, a reliable estimate of neonatal outcome is essential for the parents and health care providers who face difficult management decisions. Estimates of birth weight and gestational age are most commonly used for this purpose. The National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (NICHD MFMU) Network performed an observational study of data available before delivery of infants with birth weights <1000 g. Ultrasonographic variables (estimated fetal weight, obstetrically estimated gestational age, femur length, and biparietal diameter) and clinical variables (maternal race, antenatal care, substance abuse, medical treatment, reason for delivery, fetal gender, and presentation) were studied as predictors of intrapartum stillbirth, neonatal death, survival to 120 days after birth or to discharge, and with markers of "serious" morbidity (high-grade intraventricular hemorrhage, retinopathy of prematurity, necrotizing enterocolitis, oxygen dependence at discharge or 120 days, and seizures). Survival without serious morbidity was considered "intact." Logistic regression was used to evaluate the influence of the obstetrician's opinion of viability and willingness to perform cesarean delivery for fetal distress, birth weight, growth, gender, presentation, and ethnicity on outcomes. Fetal femur length and estimated gestational age predicted survival better than did biparietal diameter or estimated fetal weight. Antenatal ultrasound and clinical data did not distinguish those infants who would suffer serious morbidity or be considered intact. Willingness to perform cesarean delivery was associated with increased likelihood of both survival and intact survival by virtually eliminating intrapartum stillbirth and reducing neonatal mortality. However, such practice was associated with an increased chance of serious morbidity among survivors below 800 g or 26 weeks'. Although obstetricians were willing to intervene for fetal indications in most cases by 24 weeks', willingness to perform cesarean delivery was associated with twice the risk for serious morbidity in survivors at that gestational age.
Paediatric and perinatal epidemiology, 2016
Controversy exists as to whether birthweight-for-gestational age references used to classify infants as small for gestational age (SGA) should be country specific or based on an international (common) standard. We examined whether different birthweight-for-gestational age references affected the association of SGA with adverse outcomes among very preterm neonates. Singleton infants (n = 23 788) of 24(0) -28(6) weeks' gestational age in nine high-resource countries were classified as SGA (<10th centile) using common and country-specific references based on birthweight and estimated fetal weight (EFW). For each reference, the adjusted relative risk (aRR) for the association of SGA with composite outcome of mortality or major morbidity was estimated. The percentage of infants classified as SGA differed slightly for common compared with country specific for birthweight references [9.9% (95% CI 9.5, 10.2) vs. 11.1% (95% CI 10.7, 11.5)] and for EFW references [28.6% (95% CI 28.0, 2...
Antenatal prediction of neonatal mortality in very premature infants
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2014
Preterm birth is the leading cause of neonatal morbidity and mortality in high income countries [1], and is estimated to be responsible for a million neonatal deaths worldwide each year [2]. The consequences of preterm birth arise from the fact that the immature organ systems of the neonate are not yet prepared to support extrauterine life. This is expressed in respiratory insufficiency, intracranial hemorrhage and infections. The impact of very preterm birth, defined as birth before 32 completed weeks of gestation, on neonatal morbidity and mortality risk is dependent on the actual length of gestation, as the risk decreases when pregnancy progresses [3-5]. The risk of neonatal complications in very preterm birth influences antenatal clinical decision-making concerning the administration of tocolytics/corticosteroids and/or referral to a 3rd level perinatal centre [6,7]. Prediction models can be a helpful tool for clinicians working in perinatal care [8-10]. To assess the risk of neonatal mortality in infants born very preterm there are around 40 prediction models available to clinicians [11]. Medlock et al. systematically reviewed all these prediction models and found that besides gestational age and birth weight, several other variables were recurrently found to be independent predictors for neonatal mortality after very preterm birth. These predictors were: being small for gestational age (SGA), male gender, white ethnicity, congenital anomalies, no use of antenatal corticosteroids, lower Apgar score, neonatal hypoor hyper-thermia at time of admission and clinical or biochemical signs of respiratory insufficiency [11]. The majority of these prediction models were only applicable after birth as they included predictors that are not known antenatally, like birth weight, SGA
Prediction and prevention of small-for-gestational-age neonates: evidence from SPREE and ASPRE
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 2018
To examine the effect of first trimester screening for preeclampsia (PE) on the prediction of small for gestational age (SGA) neonates and the effect of prophylactic use of aspirin on the prevention of SGA. The data for this study were derived from two multicentre studies. In SPREE we investigated the performance of screening for PE by a combination of maternal characteristics and biomarkers at 11-13 weeks' gestation. In ASPRE women with singleton pregnancies identified by combined screening as being at high risk for preterm-PE (>1 in 100) participated in a trial of aspirin (150 mg/day from 11 to 14 until 36 weeks' gestation), compared to placebo. In this study we used the data from the ASPRE trial to estimate the effect of aspirin on the incidence of SGA with birthweight <10 , <5 and <3 percentile for gestational age. We also used the data from SPREE to estimate the proportion of SGA in the pregnancies with a risk for preterm-PE of >1 in 100. In SPREE, screen...