Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Department of Obstetrics, Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands.
BMC Pregnancy Childbirth. 2022 Apr 30;22(1):375. doi: 10.1186/s12884-022-04680-5.
To identify neonatal risk for severe adverse perinatal outcomes across birth weight centiles in two Dutch and one international birth weight chart.
Growth restricted newborns have not reached their intrinsic growth potential in utero and are at risk of perinatal morbidity and mortality. There is no golden standard for the confirmation of the diagnosis of fetal growth restriction after birth. Estimated fetal weight and birth weight below the 10 percentile are generally used as proxy for growth restriction. The choice of birth weight chart influences the specific cut-off by which birth weight is defined as abnormal, thereby triggering clinical management. Ideally, this cut-off should discriminate appropriately between newborns at low and at high risk of severe adverse perinatal outcomes and consequently correctly inform clinical management.
This is a secondary analysis of the IUGR Risk Selection (IRIS) study. Newborns (n = 12 953) of women with a low-risk status at the start of pregnancy and that received primary antenatal care in the Netherlands were included. We examined the distribution of severe adverse perinatal outcomes across birth weight centiles for three birth weight charts (Visser, Hoftiezer and INTERGROWTH) by categorizing birth weight centile groups and comparing the prognostic performance for severe adverse perinatal outcomes. Severe adverse perinatal outcomes were defined as a composite of one or more of the following: perinatal death, Apgar score < 4 at 5 min, impaired consciousness, asphyxia, seizures, assisted ventilation, septicemia, meningitis, bronchopulmonary dysplasia, intraventricular hemorrhage, periventricular leukomalacia, or necrotizing enterocolitis.
We found the highest rates of severe adverse perinatal outcomes among the smallest newborns (< 3 percentile) (6.2% for the Visser reference curve, 8.6% for the Hoftiezer chart and 12.0% for the INTERGROWTH chart). Discriminative abilities of the three birth weight charts across the entire range of birth weight centiles were poor with areas under the curve ranging from 0.57 to 0.61. Sensitivity rates of the various cut-offs were also low.
The clinical utility of all three charts in identifying high risk of severe adverse perinatal outcomes is poor. There is no single cut-off that discriminates clearly between newborns at low or high risk.
Netherlands Trial Register NTR4367 . Registration date March 20, 2014.
在两个荷兰和一个国际出生体重图表中，确定新生儿在各个出生体重百分位的严重不良围产结局风险。
生长受限的新生儿在宫内未达到其内在生长潜能，有围产期发病率和死亡率的风险。出生后，胎儿生长受限的确诊没有金标准。估计胎儿体重和出生体重低于第 10 百分位通常被用作生长受限的代理。出生体重图表的选择会影响定义异常出生体重的具体截止值，从而触发临床管理。理想情况下，该截止值应适当区分低风险和高风险的新生儿，以正确指导临床管理。
这是 IUGR 风险选择（IRIS）研究的二次分析。纳入了荷兰低风险孕妇的新生儿（n=12953），并接受了初级产前保健。我们通过将出生体重百分位分组来检查三种出生体重图表（Visser、Hoftiezer 和 INTERGROWTH）的严重不良围产结局分布，并比较严重不良围产结局的预测性能。严重不良围产结局定义为以下一种或多种的复合结果：围产期死亡、5 分钟时 Apgar 评分<4、意识障碍、窒息、癫痫发作、辅助通气、败血症、脑膜炎、支气管肺发育不良、颅内出血、脑室周围白质软化或坏死性小肠结肠炎。
我们发现，在最小的新生儿中（<3 百分位），严重不良围产结局的发生率最高（Visser 参考曲线为 6.2%，Hoftiezer 图表为 8.6%，INTERGROWTH 图表为 12.0%）。三种出生体重图表在整个出生体重百分位范围内的区分能力都很差，曲线下面积范围为 0.57 至 0.61。各种截止值的敏感性也较低。
在识别严重不良围产结局的高风险方面，三种图表的临床实用性都较差。没有单一的截止值可以明确区分低风险和高风险的新生儿。
荷兰试验注册 NTR4367。注册日期 2014 年 3 月 20 日。
