Bahado-Singh R O, Dashe J, Deren O, Daftary G, Copel J A, Ehrenkranz R A
Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut 06520-8063, USA.
Am J Obstet Gynecol. 1998 Mar;178(3):462-8. doi: 10.1016/s0002-9378(98)70421-1.
Our goal was to identify prenatally available parameters that correlate with neonatal outcome and could be used for predicting such outcome in the extremely low-birth-weight pregnancy.
From 1990 through 1995, obstetric and neonatal data of live-born nonanomalous singleton infants with birth weights between 400 and 1000 gm were reviewed. Only cases in which ultrasonographic biometry, including biparietal diameter, abdominal circumference, and femur length, was performed < or =3 days before delivery were included. Overall survival (defined as alive at discharge) and survival without specific severe neonatal morbidities (namely, retinopathy of prematurity [stage 3 or 4], intraventricular hemorrhage [grade 3 or 4], periventricular leukomalacia, chronic lung disease, and deafness) were ascertained. The best combination of prenatal parameters for the prediction of overall survival and survival without severe morbidity was determined by backward stepwise logistic regression analyses.
The most significant prenatal predictors of overall survival were the obstetric estimate of gestational age and the abdominal circumference (chi2 = 11.8036, p = 0.0006 and chi2 = 8.1862, p < 0.005, respectively). Survival without severe morbidity was also predicted by the same combination of parameters (chi2 = 21.9079, p = 0.0001 and chi2 = 6.538, p = 0.01, respectively). The estimated fetal weight was not a significant independent predictor of either category of outcome (chi2 = 0.1249, p = 0.72 and chi2 = 0.0361, p = 0.85, respectively). On the basis of the regression formulas, curves displaying the probabilities of overall survival and survival without severe morbidity with any combination of gestational age and abdominal circumference were developed.
The combination of gestational age and the abdominal circumference measurements appears to be superior to any combination that included estimated fetal weight data for predicting neonatal outcome in the neonates weighing < or =1000 gm. We developed a mechanism for predicting neonatal outcome in this weight category on the basis of prenatally available parameters. This information could prove useful for both parental counseling and obstetric decision making.
我们的目标是确定与新生儿结局相关且可用于预测极低出生体重儿结局的产前可用参数。
回顾1990年至1995年出生体重在400至1000克之间的存活、无畸形单胎婴儿的产科和新生儿数据。仅纳入在分娩前≤3天进行超声生物测量（包括双顶径、腹围和股骨长度）的病例。确定总体生存率（定义为出院时存活）以及无特定严重新生儿疾病（即早产儿视网膜病变[3或4期]、脑室内出血[3或4级]、脑室周围白质软化、慢性肺病和耳聋）的生存率。通过向后逐步逻辑回归分析确定预测总体生存率和无严重疾病生存率的最佳产前参数组合。
总体生存率最显著的产前预测因素是孕周的产科估计值和腹围（分别为χ2 = 11.8036，p = 0.0006和χ2 = 8.1862，p < 0.005）。相同的参数组合也可预测无严重疾病的生存率（分别为χ2 = 21.9079，p = 0.0001和χ2 = 6.538，p = 0.01）。估计胎儿体重不是这两种结局类型的显著独立预测因素（分别为χ2 = 0.1249，p = 0.72和χ2 = 0.0361，p = 0.85）。根据回归公式，绘制了显示孕周和腹围任意组合下总体生存率和无严重疾病生存率概率的曲线。
孕周和腹围测量值的组合在预测体重≤1000克新生儿的新生儿结局方面似乎优于任何包含估计胎儿体重数据的组合。我们基于产前可用参数建立了一种预测该体重类别新生儿结局的机制。这些信息可能对家长咨询和产科决策都有用。
