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Am J Perinatol 2000; Volume 17(Number 02): 073-082
DOI: 10.1055/s-2000-9273
Copyright © 2000 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

DOES THE ANTENATAL DETECTION OF SMALL-FOR-GESTATIONAL-AGE BABIES INFLUENCE THEIR TWO-YEAR OUTCOMES?

Enitan M. Ogundipe1 , Charles D.A. Wolfe, F.F.P.H.M., F.R.C.O.G.,1 Paul Seed1 , Harold R. Gamsu2
  • 1Department of Public Health Sciences, Guy's King's & St. Thomas's School of Medicine and Dentistry, London, United Kingdom
  • 2Department of Neonatology, Guy's King's & St. Thomas's School of Medicine and Dentistry, London, United Kingdom
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Publication History

Publication Date:
31 December 2000 (online)

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ABSTRACT

The aim of this paper is to determine whether antenatal detection of small-for-gestational-age (SGA) babies influences 2-year outcomes. All low-birth-weight (<2500g) infants born in South-East Thames region, England from September 1, 1992 to August 31, 1993 were identified at birth. Antenatal ``suspicion'' and ultrasound assessment confirming growth restriction was categorized as ``detection'' of SGA. Postnatally, infants were classified as SGA if they had a birth weight for given gestation below the 10th centile. At 2 years, those below 32 weeks' gestation and a random 25% sample of infants of 32 weeks' gestation or more underwent pediatric assessments. Of 49,787 births, 3456 (6.9%) were of low birth weight. One thousand four hundred and fifty one (42.5%) were SGA, of whom 611 (42%) were detected antenatally by ultrasound scan. At 2 years, 1008 (75.8%) of 1358 expected infants were assessed, 379 (37.6%) were SGA at birth, and 188 (49.6%) were confirmed antenatally. Although undetected infants had higher mean birth weights and gestational ages, they had a higher proportion of perinatal deaths (12.6 vs. 6.4%, RR 1.96: CI 1.32-2.86) than detected infants. At 2 years, detected SGA infants had smaller head circumferences (p = 0.026), a higher prevalence of febrile convulsions (8.0 vs. 3.1%: p = 0.040) and lower scores on the locomotor (DQA) scale of Griffith's developmental test (p = 0.021) compared with undetected SGA infants. Despite detected SGA fetuses having lower weights and gestation at birth than undetected fetuses, they had significantly lower mortality without a parallel increase in severe 2-year neuro-developmental, clinical, or growth morbidity.

KEYWORD

Postneonatal outcomes - antenatal detection - cohort study

REFERENCES

  • 1 Yudkin P L, Aboualfa M, Eyre J A, Redman C WG, Wilkinson A R. New birth weight and head circumference centiles for gestational ages 24 to 42 weeks.  Early Hum Dev . 1987;  15 45-52
    CrossrefPubMedGoogle Scholar
  • 2 Regional Perinatal Monitoring Group (RPMG) Perinatal Profile 1990. Bexhill-on-Sea, South East Thames Regional Health Authority 1992
  • 3 Kurjak A, Kirkinen P, Latin P. Biometric and dynamic ultrasound assessment of small-for-dates infants: report of 260 cases.  Obstet Gynecol . 1980;  56 281-284
    PubMedGoogle Scholar
  • 4 Hepburn M, Rosenberg K. An audit of the detection and management of small-for-gestational-age babies.  Br J Obstet Gynecol . 1986;  93 212-216
    PubMedGoogle Scholar
  • 5 de Courcy-Wheeler R, Wolfe C, Warburton F, Goodman J, Reynolds F, Gamsu H. The association between small size for gestational age and perinatal and neonatal mortality in a Regional Health Authority.  Paed Perinat Epidemiol . 1995;  9 431-440
    PubMedGoogle Scholar
  • 6 Battaglia F, Lubchenco L. A practical classification of newborn infants by weight and gestational age.  J Pediatr . 1996;  71 159-163
    PubMedGoogle Scholar
  • 7 Altman D G, Hytten F E. Intrauterine growth retardation: let's be clear about it.  Br J Obstet Gynaecol . 1989;  96 1127-1132
    PubMedGoogle Scholar
  • 8 Geirsson R T, Patel N B, Christie A D. Efficacy of intrauterine volume, fetal abdominal area and biparietal diameter measurements with ultrasound in screening for small-for-dates babies.  Br J Obstet Gynaecol . 1985;  92 929-935
    PubMedGoogle Scholar
  • 9 Bewley S, Cooper D, Campbell S. Doppler investigation of uteroplacental blood flow resistance in the second trimester: a screening study for pre-eclampsia and intrauterine growth retardation.  Br J Obstet Gynaecol . 1991;  98 871-879
    PubMedGoogle Scholar
  • 10 The International Neonatal Network. The CRIB (clinical risk index for babies) score: a tool for assessing initial neonatal risk and comparing performance of neonatal intensive care units.  Lancet . 1993;  342 193-198
    CrossrefPubMedGoogle Scholar
  • 11 Amiel-Tison C, Stewart A L. Follow up studies during the first five years of life: a pervasive assessment of neurological function.  Arch Dis Child . 1989;  64 496-502
    CrossrefPubMedGoogle Scholar
  • 12 Griffiths R. The abilities of young children. A.R.I.C.D, 1970: 105-170
    Google Scholar
  • 13 SAS, Inc. SAS/STAT User's guide-versions 5, 1985; Version 6, 4th ed., 1993; Vol. 1 & 2
  • 14 Chang T, Robson S, Boys R, Spencer J. Prediction of the small-for-gestational age-baby: which ultrasonic measurement is best?.  Obstet Gynecol . 1992;  80 1030-1038
    PubMedGoogle Scholar
  • 15 Neilson J, Munjana S, Whitfield C. Screening for small for dates fetuses: a controlled trial.  BMJ . 1984;  289 1179-1182
    PubMedGoogle Scholar
  • 16 Beattie R B, Dornan J C. Antenatal screening for intrauterine growth retardation with umbilical artery Doppler ultrasonography.  BMJ . 1989;  298 631-635
    PubMedGoogle Scholar
  • 17 Backe B, Nakling J. Effectiveness of antenatal care: a population based study.  Br J Obstet Gynaecol . 1993;  100 727-732
    PubMedGoogle Scholar
  • 18 Larsen T, Larsen J, Petersen S, Greisen G. Detection of small-for-gestational-age fetuses by ultrasound screening in a high risk population: a randomised controlled trial.  Br J Obstet Gynaecol . 1992;  99 469-474
    PubMedGoogle Scholar
  • 19 Eik-Nes S H, Okland O, Aure J C, Ulstein M C. Ultrasound screening in pregnancy: a randomised controlled trial [letter].  Lancet . 1984;  ii 1347
    PubMedGoogle Scholar
  • 20 Cnattingnius S, Axelsson O, Hammarlund K. Perinatal outcome for small-for-gestational-age infants from an unselected area-based population.  Early Hum Dev . 1987;  15 95-101
    CrossrefPubMedGoogle Scholar
  • 21 Ohel G, Ruach M. Perinatal outcome of idiopathic small for gestational age pregnancies at term: the effect of antenatal diagnosis.  Int J Gynaecol Obstet . 1996;  55 29-32
    CrossrefPubMedGoogle Scholar
  • 22 Palo P. Significance of antenatal detection and the choice of the delivery place of severely small for gestational age fetuses.  Am J Perinat . 1992;  9 135-138
    PubMedGoogle Scholar
  • 23 Lucas A, Cole T J. Breast milk and neonatal necrotising enterocolitis.  Lancet . 1990;  336 1519-1523
    Google Scholar
  • 24 Roche A F, Guo S, Siervogel R M, Khamis H J, Chandra R K. Growth comparison of breast fed and formula fed infants.  Can J Public Health . 1993;  84 132-135
    PubMedGoogle Scholar
      >