Obstetric and pediatric growth charts for the detection of fetal growth restriction and neonatal adverse outcomes in preterm newborns before 34 weeks of gestation

Abstract

Introduction

Identification of fetal growth-restricted (FGR) infants depends on the fetal or newborn charts used to identify them. We aimed to compare the prenatal and postnatal diagnosis of FGR and their ability to predict adverse perinatal outcomes.

Methods

Observational retrospective cohort study of 95 consecutive mother–infant pairs with preterm birth between 24 and 34 weeks (study period: January 2014 to December 2015). Prenatal sonographic diagnosis of FGR, based on customized fetal growth standards and fetal Doppler, was compared with the postnatal diagnosis of FGR based on a birthweight < 3rd percentile according to newborn charts (International Newborn size references for the Intergrowth twenty-first century program, and Olsen’s charts). Neonatal mortality and adverse neonatal outcomes were compared among groups.

Results

In 23/95 (24%) cases a prenatal diagnosis of early FGR was made. Postnatal FGR was confirmed in 11/23 (48%) cases using Olsen’s charts and 8/23 (35%) using Intergrowth 21st charts. One postnatal FGR case was missed by prenatal ultrasound. Bronchopulmonary dysplasia, sepsis and hypoglycemia were more frequent in pre- and postnatal FGR versus non-FGR. After adjusting for gestational age and sex, only an increased relative risk of hypoglycemia (2.0, 95%CI 1.0–2.8) was observed in infants with pre- and postnatal FGR diagnosis. Nonsignificant differences on neonatal outcomes were identified between prenatal FGR cases with normal birthweight and the non-FGR group.

Conclusion

Only prenatal FGR cases in which a birthweight below the third percentile is confirmed by means of postnatal charts (Olsen or Intergrowth standard) are at higher risk of adverse postnatal outcome.

Keywords:

• Customization
• fetal growth charts
• fetal growth restriction
• newborn growth charts
• perinatal outcome

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by Spanish Ministry of Health by a grant of the “Fondo de Investigaciones Sanitarias – Instituto de Investigación Carlos III” [FIS Grant PI13/02405].

Notes on contributors

Beatriz Fernandez-Rodriguez

B. Fernandez-Rodriguez: conception and design of the work, analysis, interpretation of data and drafting the work and approval.

Concepcion de Alba

C. de Alba: conception and design, revising the work and article elaboration, final approval.

Cecilia Villalain

C. Villalain: interpretation of data, supervision and review of the text, final approval.

Carmen Rosa Pallás

C. Pallas: contribute to database elaboration, supervision and review of the text, final approval.

Alberto Galindo

A. Galindo: interpretation of data, supervision and review of the text, final approval.

Ignacio Herraiz

I. Herraiz: conception and designing of the work, analysis, interpretation of data and writing test. Article’s review and supervision.