Kofman Roie, Farkash Rivka, Rottenstreich Misgav, Samueloff Arnon, Wasserteil Netanel, Kasirer Yair, Grisaru Granovsky Sorina
Department of Internal Medicine, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, POB 12000, Jerusalem 91120, Israel.
Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel.
J Clin Med. 2022 May 30;11(11):3097. doi: 10.3390/jcm11113097.
Objective: To investigate the impact of parity-customized versus population-based birth weight charts on the identification of neonatal risk for adverse outcomes in small (SGA) or large for gestational age (LGA) infants compared to appropriate for gestational age (AGA) infants. Study design: Observational, retrospective, cohort study based on electronic medical birth records at a single center between 2006 and 2017. Neonates were categorized by birth weight (BW) as SGA, LGA, or AGA, with the 10th and 90th centiles as boundaries for AGA in a standard population-based model adjusted for gestational age and gender only (POP) and a customized model adjusted for gestational age, gender, and parity (CUST). Neonates defined as SGA or LGA by one standard and not overlapping the other, are SGA/LGA CUST/POP ONLY. Analyses used a reference group of BW between the 25th and 75th centile for the population. Results: Overall 132,815 singleton, live, term neonates born to mothers with uncomplicated pregnancies were included. The customized model identified 53% more neonates as SGA-CUST ONLY who had significantly higher rates of morbidity and mortality compared to the reference group (OR = 1.33 95% CI [1.16−1.53]; p < 0.0001). Neonates defined as LGA by the customized model (LGA-CUST) and AGA by the population-based model LGA-CUST ONLY had a significantly higher risk for morbidity compared to the reference (OR = 1.36 95% CI [1.09−1.71]; p = 0.007) or the LGA POP group. Neonatal mortality only occurred in the SGA and AGA groups. Conclusions: The application of a parity-customized only birth weight chart in a population of singleton, term neonates is a simple platform to better identify birth weight related neonatal risk for morbidity and mortality.
探讨与适于胎龄（AGA）婴儿相比，根据胎次定制的出生体重图表与基于总体人群的出生体重图表对识别小于胎龄（SGA）或大于胎龄（LGA）婴儿不良结局的新生儿风险的影响。研究设计：基于2006年至2017年单一中心电子医学出生记录的观察性、回顾性队列研究。新生儿根据出生体重（BW）分为SGA、LGA或AGA，在仅根据胎龄和性别调整的标准基于总体人群的模型（POP）以及根据胎龄、性别和胎次调整的定制模型（CUST）中，以第10和第90百分位数作为AGA的界限。由一种标准定义为SGA或LGA且不与另一种标准重叠的新生儿为仅SGA/LGA CUST/POP。分析使用总体人群中第25至75百分位数之间的BW作为参考组。结果：共纳入132,815例单胎、活产、足月且母亲妊娠无并发症的新生儿。定制模型识别出多53%的仅SGA-CUST新生儿，与参考组相比，其发病率和死亡率显著更高（OR = 1.33，95% CI [1.16−1.53]；p < 0.0001）。与参考组（OR = 1.36，95% CI [1.09−1.71]；p = 0.007）或LGA POP组相比，由定制模型定义为LGA（LGA-CUST）且由基于总体人群的模型定义为AGA（仅LGA-CUST）的新生儿发病风险显著更高。新生儿死亡仅发生在SGA和AGA组。结论：在单胎、足月新生儿群体中应用仅根据胎次定制的出生体重图表是一个简单的平台，可更好地识别与出生体重相关的新生儿发病和死亡风险。
