Can we predict adverse neonatal outcome in fetal growth restriction near term?

OBJECTIVES: : To identify independent predictors of adverse neonatal outcome in cases of fetal growth restriction (FGR) at >/=34 weeks. METHODS: : From a cohort of 481 FGR cases delivered at >/=34 weeks, demographic and obstetrical variables, fetal biometry, Doppler indices at uterine, umbilical and middle cerebral arteries available within 2 weeks of delivery, were related to adverse neonatal outcome, defined as admission to the neonatal intensive care unit (NICU) for indications other than low birth weight alone. RESULTS: : Logistic regression analysis showed that gestational age (GA) at delivery (OR =0.59, 95% CI 0.50-0.70), abdominal circumference (AC) centile (OR = 0.69, 95% CI 0.59-0.81), and umbilical artery (UA) pulsatility index (PI) centile (OR = 1.02, 95% CI 1.01-1.04) significantly correlated with adverse neonatal outcome. From this model we calculated a score of adverse neonatal outcome expressed by the formula: (UA PI centile/3)-(10*AC centile)+[10*(40-GA at delivery)]. Receiver operating characteristic (ROC) curve analysis demonstrated that a score >/=25 optimally predicted adverse neonatal outcome (sensitivity of 75%, false positive rate of 25%). A GA at delivery >37.5 weeks optimally predicts adverse outcome independently from AC centile or UA PI centile. CONCLUSION: : In late preterm or term FGR, GA at delivery is the most important predictor of adverse neonatal outcome. At >37.5 weeks, delivery may be the best option to minimize adverse outcome in all FGR cases. At 34-37 weeks, a score based on GA at delivery, UA PI centile, and AC centile optimally predicts adverse neonatal outcome. Copyright (c) 2010 ISUOG. Published by John Wiley & Sons, Ltd.