Gaziano E P, Knox H, Ferrera B, Brandt D G, Calvin S E, Knox G E
Perinatology and Neonatology Service, Abbott-Northwestern Hospital, Minneapolis, MN 55407.
Am J Obstet Gynecol. 1994 Jun;170(6):1734-41; discussion 1741-3. doi: 10.1016/s0002-9378(94)70349-3.
Previous studies demonstrate an association between abnormal umbilical artery Doppler velocimetry and the birth of a small-for-gestational-age infant and between abnormal result and adverse neonatal outcome. The hypothesis is that preterm growth-retarded infants with normal antenatal velocimetry have outcomes similar to other preterm infants, whereas preterm small-for-gestational-age infants with abnormal Doppler results define a subgroup with increased morbidity.
For 100 live-born infants, at risk for fetal growth retardation and undergoing antenatal Doppler and targeted ultrasonographic examinations, we assessed a number of complete neonatal outcome parameters.
Ten neonatal deaths occurred in the study population, seven with abnormal Doppler results and three with normal Doppler results. Of the 90 surviving infants, gestational age at delivery was not different between the Doppler normal and abnormal neonates, whereas birth weight (1714 gm vs 1379 gm) was higher in the Doppler normal group (p = 0.006). The presence of intraventricular hemorrhage (20% vs 6%) was higher in the abnormal group (p = 0.05). Abnormal Doppler results defined an infant group destined for prolonged hospitalization, mean intensive care days (21 vs 9), and special care nursery days (25 vs 9). Thirty-eight percent of small-for-gestational-age babies had a normal Doppler result. Analysis of variance indicated small-for-gestational-age infants with abnormal Doppler results (n = 20) had a mean intensive care unit stay of 31 days, significantly different (p = 0.005) from small-for-gestational-age infants with normal Doppler results (n = 14), non-small-for-gestational-age infants with abnormal results (n = 21), and non-small-for-gestational-age infants with normal results (n = 35) whose mean intensive care unit stays were 14, 12, and 7 days, respectively. Gestational age at delivery (33.0 weeks) was not different among these groupings, not accounting for the observed differences.
Normal antenatal velocimetry defines a distinct subgroup of preterm small-for-gestational-age infants at less risk for prolonged hospitalization compared with those with abnormal velocimetry.
既往研究表明，脐动脉多普勒测速异常与小于胎龄儿出生有关，且异常结果与不良新生儿结局有关。假设是产前测速正常的早产生长受限婴儿的结局与其他早产婴儿相似，而多普勒结果异常的早产小于胎龄儿定义了一个发病率增加的亚组。
对于100例有胎儿生长受限风险且接受产前多普勒和靶向超声检查的活产婴儿，我们评估了一些完整的新生儿结局参数。
研究人群中有10例新生儿死亡，7例多普勒结果异常，3例多普勒结果正常。在90例存活婴儿中，多普勒正常和异常的新生儿分娩时的胎龄无差异，而多普勒正常组的出生体重（1714克对1379克）更高（p = 0.006）。异常组的脑室内出血发生率（20%对6%）更高（p = 0.05）。多普勒结果异常定义了一个注定要延长住院时间的婴儿组，平均重症监护天数（21天对9天）和特殊护理病房天数（25天对9天）。38%的小于胎龄儿多普勒结果正常。方差分析表明，多普勒结果异常的小于胎龄儿（n = 20）平均重症监护病房住院时间为31天，与多普勒结果正常的小于胎龄儿（n = 14）、结果异常的非小于胎龄儿（n = 21）和结果正常的非小于胎龄儿（n = 35）有显著差异（p = 0.005），后三组的平均重症监护病房住院时间分别为14天、12天和7天。这些分组之间的分娩胎龄（33.0周）无差异，无法解释观察到的差异。
与测速异常的早产小于胎龄儿相比，产前测速正常定义了一个延长住院风险较低的不同亚组。
