Mortality and severe neurological morbidity in extremely preterm growth-restricted fetuses
Por:
Mazarico-Gallego E, Meler E, Mendoza M, Herraiz I, Llurba E, De Diego R, Comas M, Boada D, Gonzalez-Cuevas MA, Bonacina E, Armengol-Alsina M, Moline E, Hurtado I, Torre N, Gómez-Roig MD, Galindo A and Figueras-Retuerta F
Publicada:
1 dic 2023
Ahead of Print:
16 jun 2023
Resumen:
Objective To develop a model for the prediction of adverse perinatal outcome in growth-restricted fetuses requiring delivery before 28 weeks in order to provide individualized patient counseling.
Methods This was a retrospective multicenter cohort study of singleton pregnancies with antenatal suspicion of fetal growth restriction requiring delivery before 28 weeks' gestation between January 2010 and January 2020 in six tertiary public hospitals in the Barcelona area, Spain. Separate predictive models for mortality only and mortality or severe neurological morbidity were created using logistic regression from variables available antenatally. For each model, predictive performance was evaluated using receiver-operating-characteristics (ROC)-curve analysis. Predictive models were validated externally in an additional cohort of growth-restricted fetuses from another public tertiary hospital with the same inclusion and exclusion criteria.
Results A total of 110 cases were included. The neonatal mortality rate was 37.3% and, among the survivors, the rate of severe neurological morbidity was 21.7%. The following factors were retained in the multivariate analysis as significant predictors of mortality: magnesium sulfate neuroprotection, gestational age at birth, estimated fetal weight, male sex and Doppler stage. This model had a significantly higher area under the ROC curve (AUC) compared with a model including only gestational age at birth (0.810 (95% CI, 0.730-0.889) vs 0.695 (95% CI, 0.594-0.795); P=0.016). At a 20% false-positive rate, the model showed a sensitivity, negative predictive value and positive predictive value of 66%, 80% and 66%, respectively. For the prediction of the composite adverse outcome (mortality or severe neurological morbidity), the model included: gestational age at birth, male sex and Doppler stage. This model had a significantly higher AUC compared with a model including only gestational age at birth (0.810 (95% CI, 0.731-0.892) vs 0.689 (95% CI, 0.588-0.799); P=0.017). At a 20% false-positive rate, the model showed a sensitivity, negative predictive value and positive predictive value of 55%, 63% and 74%, respectively. External validation of both models yielded similar AUCs that did not differ significantly from those obtained in the original sample.
Conclusions Estimated fetal weight, fetal sex and Doppler stage can be combined with gestational age to improve the prediction of death or severe neurological sequelae in growth-restricted fetuses requiring delivery before 28 weeks. This approach may be useful for parental counseling and decision-making. (c) 2023 International Society of Ultrasound in Obstetrics and Gynecology.
Filiaciones:
Mazarico-Gallego E:
Hospital Sant Joan de Déu, BCNatal, Barcelona, Spain
Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS), RD21/0012/0001, Instituto de Salud Carlos III, Madrid, Spain
Meler E:
Hospital Clínic de Barcelona, Seu Maternitat, BCNatal, Barcelona, Spain
Mendoza M:
Department of Obstetrics, Hospital Universitari Vall d'Hebron, Barcelona, Spain
Herraiz I:
Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS), RD21/0012/0024, Instituto de Salud Carlos III, Madrid, Spain
Llurba E:
Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS), RD21/0012/0001, Instituto de Salud Carlos III, Madrid, Spain
Institut d'Investigació Biomèdica Sant Pau - IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
De Diego R:
Hospital Hospital Germans Trias i Pujol, Badalona, Spain
Comas M:
Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (U3PT), Sabadell, Spain
Boada D:
Hospital Clínic de Barcelona, Seu Maternitat, BCNatal, Barcelona, Spain
Gonzalez-Cuevas MA:
Hospital Sant Joan de Déu, BCNatal, Barcelona, Spain
Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS), RD21/0012/0001, Instituto de Salud Carlos III, Madrid, Spain
Bonacina E:
Department of Obstetrics, Hospital Universitari Vall d'Hebron, Barcelona, Spain
Armengol-Alsina M:
Department of Obstetrics, Hospital Universitari Vall d'Hebron, Barcelona, Spain
Moline E:
Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS), RD21/0012/0001, Instituto de Salud Carlos III, Madrid, Spain
Institut d'Investigació Biomèdica Sant Pau - IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Hurtado I:
Hospital Hospital Germans Trias i Pujol, Badalona, Spain
Torre N:
Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (U3PT), Sabadell, Spain
Gómez-Roig MD:
Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS), RD21/0012/0001, Instituto de Salud Carlos III, Madrid, Spain
Hospital Sant Joan de Déu, BCNatal, Barcelona, Spain
Galindo A:
Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS), RD21/0012/0024, Instituto de Salud Carlos III, Madrid, Spain
Figueras-Retuerta F:
Hospital Clínic de Barcelona, Seu Maternitat, BCNatal, Barcelona, Spain
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