Neonatal Morbidity and Mortality in Intrauterine Growth Restricted (IUGR) Pregnancies Is Predicated Upon Prenatal Diagnosis of Clinical Severity

Marconi, Anna Maria; Ronzoni, Stefania; Vailati, Simona; Bozzetti, Patrizia; Morabito, Alberto; Battaglia, Frederick C.

doi:10.1177/1933719108327591

Cited by 19 publications

(12 citation statements)

References 18 publications

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“…However, as reported above, only recently the question of the growth standards to be used in comparing different populations and the criteria for diagnosis of intrauterine growth restriction prenatally has begun to be addressed. The results of the present prospective study are in agreement with the results of larger retrospective studies (3, 19) in showing not only that IUGR increases perinatal morbidity and mortality, but also that perinatal outcome is correlated to the degree of clinical severity (10). It also reinforces the conclusion that neonatal birthweight/gestational age percentile curves are misleading in detecting low birthweight infants and should be utilized only when obstetrical data are unavailable.…”

Section: Discussionsupporting

confidence: 91%

“…In the past, we have shown that there are significant differences in oxygenation and acid base balance (5, 6) as well in glucose (7) and amino acid metabolism (8, 9) for IUGR fetuses compared to appropriately grown fetuses, and that the magnitude of these changes tracks with the clinical severity of IUGR. More recently we have shown that severity of IUGR determines differences in perinatal outcome (10) as have others (11). In previous studies, we included only antenatally diagnosed IUGR who were also small for gestational age at birth.…”

Section: Introductionmentioning

confidence: 82%

“…Furthermore, to avoid growth restriction based solely upon biometry which could have included “normal small” babies, we have included in our study only fetuses with abnormal pulsatility index of the umbilical artery, i.e. the more severe, as we have shown previously (5, 10, 21). These dual criteria should have avoided the interference of potential confounding factors such as maternal height, weight, ethnicity, parity and newborn’s gender (4).…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Fetal and Neonatal Growth Curves in Detecting Growth Restriction

Marconi¹,

Ronzoni²,

Bozzetti³

et al. 2008

Obstetrics &Amp; Gynecology

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Objective To evaluate the outcome of intrauterine growth restriction (IUGR) infants with abnormal pulsatility index of the umbilical artery according to the neonatal birth weight/gestational age standards and the intrauterine growth charts. Methods We analyzed 53 pregnancies with severe IUGR classified as Group 2 (22 IUGR: abnormal pulsatility index and normal fetal heart rate) and Group 3 (31 IUGR: abnormal pulsatility index and fetal heart rate). Neonatal birth weight/gestational age distribution, body size measurements, maternal characteristics and obstetric outcome, and neonatal major and minor morbidity and mortality were compared with those obtained in 79 singleton pregnancies with normal fetal growth and pulsatility index, matched for gestational age [appropriate for gestational age (AGA) group]. Differences were analyzed with the χ2 test and the Student’s t test. Differences between means corrected for gestational age in the different groups were assessed by analysis of covariance test. A P value <0.05 was considered significant. Results At delivery, utilizing the neonatal standards, 25/53 (47%) IUGR showed a birthweight above the 10th percentile (IUGRAGA) whereas in 28, birthweight was below the 10th percentile (IUGRSGA). All body size measurements were significantly higher in AGA than in IUGRAGA and IUGRSGA. Forty-nine out of 79 (62%) AGA and 49/53 (92%) IUGR were admitted in the neonatal intensive care unit (p<0.001). One out of 79 (1%) AGA and 6/53 (11%) IUGR newborns died within 28 days (p<0.02). Major and minor morbidity was not different. Conclusion This study shows that neonatal outcome is similar in IUGR of the same clinical severity, whether or not they could be defined AGA or SGA according to the neonatal standards. Neonatal curves are misleading in detecting low birthweight infants and should be utilized only when obstetrical data are unavailable.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Comparison of Fetal and Neonatal Growth Curves in Detecting Growth Restriction

Marconi¹,

Ronzoni²,

Bozzetti³

et al. 2008

Obstetrics &Amp; Gynecology

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“…A non-significant trend was observed for late IUGR subgroups. Differences between early and late onset forms should be interpreted in line with previous findings in which glucose levels were inversely correlated to the clinical severity of IUGR [50,51,54]. As to the mechanisms involved in these findings, it is known that growth restricted fetuses maintain lower glucose concentrations to increase transplacental glucose gradient, which will keep the glucose uptake across the placenta of limited size [51].…”

Section: Discussionsupporting

confidence: 77%

Metabolomic Profile of Umbilical Cord Blood Plasma from Early and Late Intrauterine Growth Restricted (IUGR) Neonates with and without Signs of Brain Vasodilation

et al. 2013

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ObjectivesTo characterize via NMR spectroscopy the full spectrum of metabolic changes in umbilical vein blood plasma of newborns diagnosed with different clinical forms of intrauterine growth restriction (IUGR).Methods23 early IUGR cases and matched 23 adequate-for-gestational-age (AGA) controls and 56 late IUGR cases with 56 matched AGAs were included in this study. Early IUGR was defined as a birth weight <10th centile, abnormal umbilical artery (UA) Doppler and delivery <35 weeks. Late IUGR was defined as a birth weight <10th centile with normal UA Doppler and delivery >35 weeks. This group was subdivided in 18 vasodilated (VD) and 38 non-VD late IUGR fetuses. All AGA patients had a birth weight >10th centile. 1H nuclear magnetic resonance (NMR) metabolomics of the blood samples collected from the umbilical vein at delivery was obtained. Multivariate statistical analysis identified several metabolites that allowed the discrimination between the different IUGR subgroups, and their comparative levels were quantified from the NMR data. ResultsThe NMR-based analysis showed increased unsaturated lipids and VLDL levels in both early and late IUGR samples, decreased glucose and increased acetone levels in early IUGR. Non-significant trends for decreased glucose and increased acetone levels were present in late IUGR, which followed a severity gradient when the VD and non-VD subgroups were considered. Regarding amino acids and derivatives, early IUGR showed significantly increased glutamine and creatine levels, whereas the amounts of phenylalanine and tyrosine were decreased in early and late-VD IUGR samples. Valine and leucine were decreased in late IUGR samples. Choline levels were decreased in all clinical subforms of IUGR.ConclusionsIUGR is not associated with a unique metabolic profile, but important changes are present in different clinical subsets used in research and clinical practice. These results may help in characterizing comprehensively specific alterations underlying different IUGR subsets.

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“…Previous guidelines have suggested that the late-preterm IUGR fetus should be delivered if there is any evidence of maternal hypertension [61]. However, the high risk of complication related to preterm delivery in the late-preterm infant, as well as the apparent negligible effect of mild preeclampsia on fetal growth and maternal health, highlight the importance of carefully selecting the appropriate time of delivery in pregnancies complicated by IUGR [64]. …”

Section: Effects Of Preeclampsia On Late-preterm Infant Outcomesmentioning

confidence: 99%

Maternal Preeclampsia and Neonatal Outcomes

Backes

Markham

Moorehead

et al. 2011

Journal of Pregnancy

381

293

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Preeclampsia is a multiorgan, heterogeneous disorder of pregnancy associated with significant maternal and neonatal morbidity and mortality. Optimal strategies in the care of the women with preeclampsia have not been fully elucidated, leaving physicians with incomplete data to guide their clinical decision making. Because preeclampsia is a progressive disorder, in some circumstances, delivery is needed to halt the progression to the benefit of the mother and fetus. However, the need for premature delivery has adverse effects on important neonatal outcomes not limited to the most premature infants. Late-preterm infants account for approximately two thirds of all preterm deliveries and are at significant risk for morbidity and mortality. Reviewed is the current literature in the diagnosis and obstetrical management of preeclampsia, the outcomes of late-preterm infants, and potential strategies to optimize fetal outcomes in pregnancies complicated by preeclampsia.

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Neonatal Morbidity and Mortality in Intrauterine Growth Restricted (IUGR) Pregnancies Is Predicated Upon Prenatal Diagnosis of Clinical Severity

Cited by 19 publications

References 18 publications

Comparison of Fetal and Neonatal Growth Curves in Detecting Growth Restriction

Comparison of Fetal and Neonatal Growth Curves in Detecting Growth Restriction

Metabolomic Profile of Umbilical Cord Blood Plasma from Early and Late Intrauterine Growth Restricted (IUGR) Neonates with and without Signs of Brain Vasodilation

Maternal Preeclampsia and Neonatal Outcomes

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