Bottoms S F, Paul R H, Mercer B M, MacPherson C A, Caritis S N, Moawad A H, Van Dorsten J P, Hauth J C, Thurnau G R, Miodovnik M, Meis P M, Roberts J M, McNellis D, Iams J D
National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Research Units, Bethesda, Maryland, USA.
Am J Obstet Gynecol. 1999 Mar;180(3 Pt 1):665-9. doi: 10.1016/s0002-9378(99)70270-x.
The aim of the study was to compare clinical and ultrasonographic variables obtained before delivery as predictors of neonatal survival and morbidity in infants weighing </=1000 g at birth.
Maternal data available before the birth of singleton infants with birth weights </=1000 g who were delivered at the 11 tertiary perinatal centers of the National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Research Units were studied. Births that followed extramural delivery, antepartum stillbirths, multiple gestations, induced abortions, infants with major malformations, and fetuses delivered at <20 weeks' gestation were excluded. Ultrasonographic variables, including estimated fetal weight, obstetrically estimated gestational age, femur length, and biparietal diameter, and clinical variables, such as maternal race, antenatal care, substance abuse, medical treatment, reason for delivery, fetal gender, and presentation, were studied with logistic regression as predictors of neonatal outcome, including intrapartum stillbirth, neonatal death, and survival to 120 days after birth or to discharge from the hospital with or without the presence of markers of major morbidity.
Eight hundred eight infants met enrollment criteria; 63 were excluded because of incomplete data and 32 were excluded because of malformations, leaving 713 for analysis, 386 of whom had an ultrasonographic examination within 3 days of delivery that recorded femur length, biparietal diameter, and estimated fetal weight. Forty-two percent of births were the result of preterm labor, 22% were the result of preterm ruptured membranes, 12% were the result of preeclampsia or eclampsia, 9% were the result of fetal distress, 4% were the result of placenta previa or abruptio placentae, and 2% were the result of intrauterine growth restriction. Perinatal mortality before 24 weeks' gestation exceeded 81% (19% stillbirths and 62% neonatal deaths) but declined sharply thereafter. Most survivors born before 26 weeks' gestation had serious morbidity. Fetal femur length and estimated gestational age predicted survival better than did biparietal diameter or estimated fetal weight. Infants who survived with markers of serious long-term morbidity could not be distinguished from those who survived without morbidity markers before delivery by ultrasonography or clinical data. Threshold values for ultrasonographic measurements of biparietal diameter and femur length were developed to distinguish fetuses with no chance of survival.
Ultrasonographic assessment of either fetal femur length or gestational age predicts neonatal mortality better than do other antenatal tests. No tests accurately predicted neonatal morbidity in infants weighing </=1000 g at birth.
本研究旨在比较分娩前获得的临床和超声变量，作为出生体重≤1000g婴儿新生儿存活和发病的预测指标。
对美国国立儿童健康与人类发展研究所母胎医学研究单位网络的11个三级围产期中心分娩的出生体重≤1000g的单胎婴儿出生前的母亲数据进行研究。排除院外分娩、产前死产、多胎妊娠、人工流产、有严重畸形的婴儿以及妊娠<20周分娩的胎儿。研究超声变量，包括估计胎儿体重、产科估计孕周、股骨长度和双顶径，以及临床变量，如母亲种族、产前护理、药物滥用、医疗治疗、分娩原因、胎儿性别和胎位，采用逻辑回归分析作为新生儿结局的预测指标，包括产时死产、新生儿死亡以及出生后120天存活或出院情况（无论有无严重发病标志物）。
808名婴儿符合纳入标准；63名因数据不完整被排除，32名因畸形被排除，剩余713名进行分析，其中386名在分娩后三天内接受了超声检查，记录了股骨长度、双顶径和估计胎儿体重。42%的分娩是早产所致，22%是胎膜早破所致，12%是先兆子痫或子痫所致，9%是胎儿窘迫所致，4%是前置胎盘或胎盘早剥所致，2%是宫内生长受限所致。妊娠24周前围产儿死亡率超过81%（19%为死产，62%为新生儿死亡），但此后急剧下降。大多数妊娠26周前出生的幸存者有严重发病情况。胎儿股骨长度和估计孕周比双顶径或估计胎儿体重更能预测存活情况。在分娩前，通过超声检查或临床数据无法区分有严重长期发病标志物存活的婴儿和无发病标志物存活的婴儿。制定了双顶径和股骨长度超声测量的阈值，以区分没有存活机会的胎儿。
超声评估胎儿股骨长度或孕周比其他产前检查更能预测新生儿死亡率。没有检查能准确预测出生体重≤1000g婴儿的新生儿发病率。
