Placental findings in late-onset small for gestational age births without Doppler signs of placental insufficiency and their impact in neurodevelopmental outcome

AbstractObjectiveTo examine cerebral oxygenation and perfusion in small for gestational age (SGA) compared with appropriate for gestational age (AGA) neonates during the first postnatal week, and to investigate any association with neurodevelopmental outcomes at 24–36 months of age.MethodsA prospective matched case-control study was conducted evaluating cerebral oxygenation and perfusion, using near-infrared spectroscopy (NIRS), between SGA and AGA neonates, during the first postnatal week. A neurodevelopmental assessment with Bayley-III was performed at 24–36 months of age.ResultsForty-eight SGA and 48 AGA neonates of similar gestation (32.8 ± 2.1 vs. 32.5 ± 1.9) were enrolled. On the first postnatal day, the cerebral oxygenation was equal between SGA and AGA neonates (71 ± 7% vs. 72 ± 8%); however, in the subgroup analysis, males had higher oxygenation compared to female SGA neonates (73 ± 7% vs. 69 ± 7%, P = 0.04). Cerebral perfusion was significantly higher in SGA neonates on the first postnatal day (1.4 ± 0.6 vs. 1.1 ± 0.5, P = 0.04), but this difference was diminished on subsequent measurements. There were no significant differences between the SGA and AGA infants regarding the composite cognitive, communication and motor index scores. The length of mechanical ventilation and late-onset sepsis were significant risk factors affecting the cognitive and communication composite index scores, respectively.ConclusionCerebral oxygenation was equal between SGA and AGA neonates, while cerebral perfusion was transiently increased in SGA neonates during the first postnatal day. There was no significant association of cerebral oxygenation and perfusion with neurodevelopmental outcomes.

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Perinatal Outcome and its Prediction Using Longitudinal Feto-Maternal Doppler Follow-Up in Late Onset Small for Gestational Age Fetuses – A Prospective Cohort Study

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/a-1493-2367 ◽

2021 ◽

Author(s):

Silvia M. Lobmaier ◽

Oliver Graupner ◽

Javier U. Ortiz ◽

Bernhard Haller ◽

Christina Ried ◽

...

Keyword(s):

Gestational Age ◽

Small For Gestational Age ◽

Prospective Cohort ◽

Perinatal Outcome ◽

Late Onset ◽

Induction Of Labor ◽

University Hospital ◽

Operative Delivery ◽

Longitudinal Measurements ◽

Cesarean Delivery Rate

Abstract Purpose To describe the perinatal outcome of a prospective cohort of late-onset small-for-gestational-age (SGA) fetuses and to test adverse perinatal outcome (APO) prediction using Doppler measurements. Methods Singleton pregnancies from 32 weeks with suspicion of SGA (followed-up each 2 weeks) and randomly selected healthy controls at a university hospital were included. The whole SGA group was divided into the FGR subgroup or SGA percentile 3–10 subgroup. The following Doppler measurements were evaluated prospectively: umbilical artery (UA) pulsatility index (PI), middle cerebral artery (MCA) PI, cerebro-placental ratio (CPR), and mean uterine artery (mUtA) PI. APO was defined as arterial cord blood pH ≤ 7.15 and/or 5-minute Apgar ≤ 7 and/or emergency operative delivery and/or admission to the neonatal unit. Induction of labor was indicated according to a stage-based protocol. Results A total of 149 SGA and 143 control fetuses were included. The number of operative deliveries was similar between both groups (control: 29 %, SGA: 28 %), especially the cesarean delivery rate after the onset of labor (11 % vs. 10 %). Most SGA cases ended up in induction of labor (61 % vs. 31 %, p < 0.001). The areas under the curve (AUC) for APO prediction were similar using the last UA PI, MCA PI, CPR, and mUtA PI and barely reached 0.60. The AUC was best for the FGR subgroup, using the minimal CPR or maximum mUtA PI z-score of all longitudinal measurements (AUC = 0.63). Conclusion SGA fetuses do not have a higher rate of operative delivery if managed according to a risk stratification protocol. Prediction of APO is best for SGA and FGR using the “worst” CPR or mUtA PI but it remains moderate.

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Comparison of neonatal outcomes of small for gestational age and appropriate for gestational age preterm infants born at 28–36 weeks of gestation: a multicentre study in Ethiopia

BMJ Paediatrics Open ◽

10.1136/bmjpo-2020-000740 ◽

2020 ◽

Vol 4 (1) ◽

pp. e000740

Author(s):

Netsanet Workneh Gidi ◽

Robert L Goldenberg ◽

Assaye K Nigussie ◽

Elizabeth McClure ◽

Amha Mekasha ◽

...

Keyword(s):

Preterm Infants ◽

Gestational Age ◽

Small For Gestational Age ◽

Late Onset ◽

Early Recognition ◽

Neonatal Outcomes ◽

P Value ◽

Prolonged Hospitalisation ◽

Increased Risk ◽

Appropriate For Gestational Age

PurposeThe aim of this study was to assess morbidity and mortality pattern of small for gestational age (SGA) preterm infants in comparison to appropriate for gestational age (AGA) preterm infants of similar gestational age.MethodWe compared neonatal outcomes of 1336, 1:1 matched, singleton SGA and AGA preterm infants based on their gestational age using data from the study ‘Causes of Illness and Death of Preterm Infants in Ethiopia (SIP)’. Data were analysed using SPSS V.23. ORs and 95% CIs and χ2 tests were done, p value of <0.05 was considered statistically significant.ResultThe majority of the infants (1194, 89%) were moderate to late preterm (32–36 weeks of gestation), 763 (57%) were females. Male preterm infants had higher risk of being SGA than female infants (p<0.001). SGA infants had increased risk of hypoglycaemic (OR and 95% CI 1.6 (1.2 to 2.0), necrotising enterocolitis (NEC) 2.3 (1.2 to 4.1), polycythaemia 3.0 (1.6 to 5.4), late-onset neonatal sepsis (LOS) 3.6 (1.1 to 10.9)) and prolonged hospitalisation 2.9 (2.0 to 4.2). The rates of respiratory distress syndrome (RDS), apnoea and mortality were similar in the SGA and AGA groups.ConclusionNeonatal complications such as hypoglycaemic, NEC, LOS, polycythaemia and prolonged hospitalisation are more common in SGA infants, while rates of RDS and mortality are similar in SGA and AGA groups. Early recognition of SGA status, high index of suspicion and screening for complications associated and timely intervention to prevent complications need due consideration.

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OC20.04: An integrated model with classification criteria to differentiate late-onset fetal growth restriction vs. small-for-gestational age

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.13593 ◽

2014 ◽

Vol 44 (S1) ◽

pp. 47-47 ◽

Cited By ~ 2

Author(s):

F. Figueras ◽

S. Savchev ◽

S. Triunfo ◽

F. Crovetto ◽

E. Gratacós

Keyword(s):

Fetal Growth ◽

Gestational Age ◽

Small For Gestational Age ◽

Fetal Growth Restriction ◽

Late Onset ◽

Integrated Model ◽

Classification Criteria ◽

Growth Restriction

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Low Serum Levels of HtrA3 at 15 Weeks of Gestation Are Associated with Late-Onset Preeclampsia Development and Small for Gestational Age Birth

Fetal Diagnosis and Therapy ◽

10.1159/000497144 ◽

2019 ◽

Vol 46 (6) ◽

pp. 392-401 ◽

Cited By ~ 1

Author(s):

Sonia Soo Yee Teoh ◽

Yao Wang ◽

Ying Li ◽

Shalem Yiner-Lee Leemaqz ◽

Gus A. Dekker ◽

...

Keyword(s):

Gestational Age ◽

Small For Gestational Age ◽

Late Onset ◽

Serum Levels ◽

Low Serum

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OP23.04: Rate of conversion of normal to abnormal umbilical, middle cerebral and uterine arteries in late-onset small-for-gestational-age fetuses

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.6879 ◽

2009 ◽

Vol 34 (S1) ◽

pp. 136-136

Author(s):

M. Munmany ◽

F. Figueras ◽

E. Meler ◽

R. Cruz-Martinez ◽

D. Oros ◽

...

Keyword(s):

Gestational Age ◽

Small For Gestational Age ◽

Late Onset ◽

Uterine Arteries

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Neurodevelopmental outcome of full-term small-for-gestational-age infants with normal placental function

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.12391 ◽

2013 ◽

Vol 42 (2) ◽

pp. 201-206 ◽

Cited By ~ 55

Author(s):

S. Savchev ◽

M. Sanz-Cortes ◽

R. Cruz-Martinez ◽

A. Arranz ◽

F. Botet ◽

...

Keyword(s):

Gestational Age ◽

Small For Gestational Age ◽

Neurodevelopmental Outcome ◽

Full Term ◽

Placental Function

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Low Plgf and Ultrasound Defined Fetal Growth Restriction in Late-Onset Small-For-Gestational Age Pregnancies

Journal of Paediatrics and Child Health ◽

10.1111/jpc.13882_11 ◽

2018 ◽

Vol 54 ◽

pp. 7-7

Keyword(s):

Fetal Growth ◽

Gestational Age ◽

Small For Gestational Age ◽

Fetal Growth Restriction ◽

Late Onset ◽

Growth Restriction

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Comparison of cardiac morphology and function in small for gestational age fetuses and fetuses with late-onset fetal growth retardation

Journal of Perinatal Medicine ◽

10.1515/jpm-2021-0345 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Ezgi Turgut ◽

Halis Özdemir ◽

Gökçe Turan ◽

Merih Bayram ◽

Deniz Karcaaltincaba

Keyword(s):

Fetal Growth ◽

Gestational Age ◽

Small For Gestational Age ◽

Neonatal Intensive Care ◽

Late Onset ◽

Morphological Changes ◽

Left Ventricular ◽

Left Ventricular Wall ◽

Control Group ◽

Ventricular Wall

Abstract Objectives To compare cardiac structural and functional findings of fetuses with fetal growth restriction (FGR) and small for gestational age (SGA). Methods In this prospective cohort study, patients were classified into three groups using Delphi procedure according to fetal weight, umbilical, uterine artery Doppler and cerebroplacental ratio. Fetal cardiac ultrasonographic morphology and Doppler examination was performed to all pregnant women at 36 weeks of gestation. Results Seventy three patients were included in the study. There were one (6.7%) patient in the control group, 2 (13.3%) in the SGA group and 12 (80%) in the FGR group who needed neonatal intensive care unit (NICU) and NICU requirement was significantly higher in FGR fetuses (p<0.001). Left spherical index was found to be lower only among FGR fetuses (p=0.046). Left ventricular wall thickness was decreased and the right/left ventricular wall ratio was increased in FGR fetuses (p=0.006, p<0.001). Tricuspid/mitral valve ratio and mitral annular plane systolic excursion value was lower in FGR fetuses (p=0.034, p=0.024 respectively). Also, myocardial performance index was remarkably higher in FGR group (p=0.002). Conclusions We detected cardiac morphological changes in cases of both SGA and FGR—more pronounced in the FGR cases. Findings related to morphological changes on the left side in FGR cases were considered secondary to volume increase in FGR cases as an indicator of a brain-protective effect. In the FGR group, both systolic and diastolic dysfunctions were detected in the left heart.

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