Perinatal Center, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
Ultrasound Obstet Gynecol. 2010 Aug;36(2):171-7. doi: 10.1002/uog.7627.
To examine the relative importance of antenatal and perinatal variables on short- and long-term outcome of preterm growth restricted fetuses with umbilical artery (UA) Doppler abnormalities.
This was a cohort study of 180 neonates with birth weight < 10(th) percentile, gestational age at delivery < 34 weeks and abnormal Doppler ultrasound examination of the UA. Various antenatal and perinatal variables were studied in relation to short- and long-term outcome.
Neonatal and overall mortality (up to 2 years of age) were predicted by low gestational age at delivery. Neonatal mortality was additionally predicted by absent or reversed UA end-diastolic flow, while the presence of severe neonatal complications and placental villitis were additional predictors of both infant (between 28 days and 1 year of postnatal life) and overall mortality. Placental villitis was found to be the only predictor of necrotizing enterocolitis. Low gestational age at delivery, male sex, abnormal cardiotocography, absent or reversed UA end-diastolic flow and the HELLP syndrome predicted respiratory distress syndrome. Abnormal neurodevelopmental outcome at 2 years was predicted by low birth weight (< 2.3(rd) percentile), fetal acidosis (UA pH < 7.00), and placental villitis.
Less advanced gestation at delivery remains an important predictor of short-term outcome in growth-restricted fetuses. In addition, the presence of placental villitis may aid neonatologists in the early identification of infants at increased risk of necrotizing enterocolitis, death and abnormal neurodevelopment at 2 years of age. Abnormal neurodevelopment was related to low weight and acidosis at birth, indicating that the severity of malnutrition and fetal acidosis affect long-term outcome.
探讨脐动脉（UA）多普勒异常的早产儿生长受限胎儿的产前和围产期变量对短期和长期结局的相对重要性。
这是一项对 180 名出生体重<第 10 百分位数、分娩时胎龄<34 周和 UA 多普勒超声异常的新生儿进行的队列研究。研究了各种产前和围产期变量与短期和长期结局的关系。
新生儿和总死亡率（至 2 岁）由分娩时较低的胎龄预测。新生儿死亡率还可由 UA 舒张末期血流缺失或反流预测，而严重新生儿并发症和胎盘绒毛膜炎的存在是婴儿（出生后 28 天至 1 岁）和总死亡率的额外预测因素。胎盘绒毛膜炎是坏死性小肠结肠炎的唯一预测因素。分娩时较低的胎龄、男性、异常胎心监护、UA 舒张末期血流缺失或反流以及 HELLP 综合征预测呼吸窘迫综合征。2 岁时的神经发育不良结局可由出生体重低（<第 3 百分位数）、胎儿酸中毒（UA pH<7.00）和胎盘绒毛膜炎预测。
分娩时胎龄较低仍然是生长受限胎儿短期结局的重要预测因素。此外，胎盘绒毛膜炎的存在可能有助于新生儿科医生早期识别出生时患有坏死性小肠结肠炎、死亡和 2 岁时神经发育异常风险增加的婴儿。异常的神经发育与出生时体重低和酸中毒有关，表明营养不良和胎儿酸中毒的严重程度影响长期结局。
