Impacto en la morbilidad neonatal del retraso de crecimiento intrauterino precoz moderado-grave definido por criterios doppler: estudio multicéntrico

Abstract

Introduction

In recent years, there has been a change in the conceptualization of fetal growth restriction (FGR), which has gone from being defined solely based on weight criteria to being defined and staged based on Doppler criteria. The aim of our study was to evaluate neonatal risk in a cohort of neonates with moderate to severe early-onset FGR defined by Doppler criteria.

Population and methods

We conducted a multicentre prospective cohort study in a cohort of neonates with early-onset fetal growth restriction and abnormal Doppler findings, and a control cohort without Doppler abnormalities matched for sex and gestational age.

Results

A total of 105 patients (50 cases, 55 controls) were included. We found a higher frequency of respiratory morbidity in the FGR group, with an increased need of surfactant (30 vs. 27.3%; OR 5.3 [95% CI 1.1-26.7]), an increased need for supplemental oxygen (66 vs. 49.1%; OR 5.6 [95% CI 1.5-20.5]), and a decreased survival without bronchopulmonary dysplasia (70 vs. 87.3%; OR 0.16 [95% CI 0.03-0.99]). Patients with FGR required a longer length of stay and more days of parenteral nutrition and had a higher incidence of haematological abnormalities such as neutropenia and thrombopenia. The lactate level at birth was higher in the severe FGR subgroup (6.12 vs. 2.4 mg/dL; P = .02).

Conclusions

The diagnosis of early-onset moderate to severe FGR defined by Doppler criteria carries a greater risk of respiratory, nutritional and haematological morbidity, independently of weight and gestational age. These patients, therefore, should be considered at increased risk compared to constitutionally small for gestational age preterm infants or preterm infants without FGR.