Fetal Medicine Research Institute, King's College Hospital, London, UK.
Institute of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK.
Ultrasound Obstet Gynecol. 2023 Aug;62(2):195-201. doi: 10.1002/uog.26285.
First, to investigate the association between adverse neonatal outcomes and birth weight and gestational age at delivery. Second, to describe the distribution of adverse neonatal outcomes within different risk strata derived by a population stratification scheme based on the midgestation risk assessment for small-for-gestational-age (SGA) neonates using a competing-risks model.
This was a prospective observational cohort study in women with a singleton pregnancy attending a routine hospital visit at 19 + 0 to 23 + 6 weeks' gestation. The incidence of neonatal unit (NNU) admission for ≥ 48 h was evaluated within different birth-weight-percentile subgroups. The pregnancy-specific risk of delivery with SGA < 10 percentile at < 37 weeks was estimated by the competing-risks model for SGA, combining maternal factors and the likelihood functions of Z-score of sonographically estimated fetal weight and uterine artery pulsatility index multiples of the median. The population was stratified into six risk categories: > 1 in 4, > 1 in 10 to ≤ 1 in 4, > 1 in 30 to ≤ 1 in 10, > 1 in 50 to ≤ 1 in 30, > 1 in 100 to ≤ 1 in 50 and ≤ 1 in 100. The outcome measures were admission to the NNU for a minimum of 48 h, perinatal death and major neonatal morbidity. The incidence of each adverse outcome was estimated in each risk stratum.
In the study population of 40 241 women, 0.8%, 2.5%, 10.8%, 10.2%, 19.0% and 56.7% were in the risk strata > 1 in 4, > 1 in 10 to ≤ 1 in 4, > 1 in 30 to ≤ 1 in 10, > 1 in 50 to ≤ 1 in 30, > 1 in 100 to ≤ 1 in 50 and ≤ 1 in 100, respectively. Women in higher-risk strata were more likely to deliver a baby that suffered an adverse outcome. The incidence of NNU admission for ≥ 48 h was highest in the > 1 in 4 risk stratum (31.9% (95% CI, 26.9-36.9%)) and it gradually decreased until the ≤ 1 in 100 risk stratum (5.6% (95% CI, 5.3-5.9%)). The mean gestational age at delivery in SGA cases with NNU admission for ≥ 48 h was 32.9 (95% CI, 32.2-33.7) weeks for risk stratum > 1 in 4 and progressively increased to 37.5 (95% CI, 36.8-38.2) weeks for risk stratum ≤ 1 in 100. The incidence of NNU admission for ≥ 48 h was highest for neonates with birth weight below the 1 percentile (25.7% (95% CI, 23.0-28.5%)) and decreased progressively until the 25 to < 75 percentile interval (5.4% (95% CI, 5.1-5.7%)). Preterm SGA neonates < 10 percentile had significantly higher incidence of NNU admission for ≥ 48 h compared with preterm non-SGA neonates (48.7% (95% CI, 45.0-52.4%) vs 40.9% (95% CI, 38.5-43.3%); P < 0.001). Similarly, term SGA neonates < 10 percentile had significantly higher incidence of NNU admission for ≥ 48 h compared with term non-SGA neonates (5.8% (95% CI, 5.1-6.5%) vs 4.2% (95% CI, 4.0-4.4%); P < 0.001).
Birth weight has a continuous association with the incidence of adverse neonatal outcomes, which is affected by gestational age. Pregnancies at high risk of SGA, estimated at midgestation, are also at increased risk for adverse neonatal outcomes. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
首先，探讨不良新生儿结局与出生体重和分娩时的胎龄之间的关系。其次，描述基于中孕期小胎龄儿（SGA）风险评估的人群分层方案，使用竞争风险模型，在不同的风险分层内描述不良新生儿结局的分布。
这是一项前瞻性观察性队列研究，纳入在 19+0 至 23+6 孕周常规医院就诊的单胎妊娠妇女。在不同的出生体重百分位数亚组内评估新生儿重症监护病房（NNU）入住≥48 小时的发生率。通过 SGA 的竞争风险模型，结合母亲因素和超声估计胎儿体重 Z 评分的似然函数和子宫动脉搏动指数倍数的中位数，估计妊娠特异性 SGA<10 百分位数且<37 孕周时的分娩风险。人群分为六个风险类别：>1/4、>1/10 至≤1/4、>1/30 至≤1/10、>1/50 至≤1/30、>1/100 至≤1/50 和≤1/100。主要结局指标为入住 NNU 至少 48 小时、围产儿死亡和主要新生儿发病率。估计每个风险分层的每种不良结局的发生率。
在研究人群 40241 名妇女中，分别有 0.8%、2.5%、10.8%、10.2%、19.0%和 56.7%处于>1/4、>1/10 至≤1/4、>1/30 至≤1/10、>1/50 至≤1/30、>1/100 至≤1/50 和≤1/100 风险分层。处于较高风险分层的女性更有可能分娩出不良结局的新生儿。入住 NNU≥48 小时的发生率在>1/4 风险分层中最高（31.9%（95%CI，26.9-36.9%）），逐渐下降至≤1/100 风险分层（5.6%（95%CI，5.3-5.9%））。入住 NNU≥48 小时的 SGA 病例的平均分娩孕周为>1/4 风险分层 32.9（95%CI，32.2-33.7）周，逐渐增加至≤1/100 风险分层 37.5（95%CI，36.8-38.2）周。入住 NNU≥48 小时的发生率在出生体重低于第 1 百分位数的新生儿中最高（25.7%（95%CI，23.0-28.5%）），逐渐下降至第 25 至<75 百分位间隔（5.4%（95%CI，5.1-5.7%））。与非 SGA 早产儿相比，<10 百分位数的早产 SGA 新生儿入住 NNU≥48 小时的发生率显著更高（48.7%（95%CI，45.0-52.4%）比 40.9%（95%CI，38.5-43.3%）；P<0.001）。同样，与非 SGA 足月新生儿相比，<10 百分位数的足月 SGA 新生儿入住 NNU≥48 小时的发生率也显著更高（5.8%（95%CI，5.1-6.5%）比 4.2%（95%CI，4.0-4.4%）；P<0.001）。
出生体重与不良新生儿结局的发生率呈连续相关，受胎龄的影响。中孕期估计的高危 SGA 妊娠也有更高的不良新生儿结局风险。© 2023 年国际妇产科超声学会。
