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Detection of small-for-gestational-age infants with poor perinatal outcomes using individualized growth assessment
Insights
Individualized growth assessment using the Rossavik model effectively identifies small-for-gestational-age (SGA) infants at risk for poor perinatal outcomes. This method aids in detecting intrauterine growth restriction and associated complications.
Area of Science:
- Perinatal Medicine
- Fetal Development
- Neonatal Outcomes
Background:
- Small-for-gestational-age (SGA) infants are at increased risk for adverse perinatal outcomes.
- Accurate detection of SGA infants with poor prognoses is crucial for timely intervention.
- Current methods for assessing fetal growth may not fully capture individualized risks.
Purpose of the Study:
- To evaluate the efficacy of the Rossavik growth model for individualized growth assessment.
- To determine if this model can effectively detect SGA infants with poor perinatal outcomes.
- To compare perinatal outcomes between SGA infants classified as normally grown versus growth-restricted by the model.
Main Methods:
- Utilized Rossavik growth models based on second-trimester ultrasound measurements to predict birth characteristics in 47 singleton SGA infants.
- Established individual fetal growth standards for head and abdominal circumference, and weight using two scans before 25 weeks' gestation.
- Calculated the Growth Potential Realization Index (GPRI) and Neonatal Growth Assessment Score (NGAS) to compare actual and predicted birth characteristics.
Main Results:
- The Neonatal Growth Assessment Score (NGAS) classified 27 fetuses as normally grown and 20 as growth-restricted.
- Growth-restricted neonates, identified by NGAS, showed significantly higher rates of mechanical deliveries, abnormal fetal heart rate (FHR) patterns, and meconium staining.
- No significant differences were observed in low Apgar score, neonatal acidosis, NICU admission, or maternal complications between the groups.
Conclusions:
- Individualized growth assessment using the Rossavik model is a valuable tool for identifying SGA infants at risk of poor perinatal outcomes.
- The NGAS classification effectively differentiates growth-restricted SGA infants who experience specific adverse events.
- This approach can aid clinicians in better risk stratification and management of SGA pregnancies.
Objective:
Our objective was to evaluate individualized growth assessment using the Rossavik growth model for detection of small-for-gestational-age (SGA) infants with a poor perinatal outcome.
Methods:
Rossavik growth models derived from second-trimester ultrasound measurements were used to predict birth characteristics of 47 singleton SGA infants. Individual fetal growth curve standards for head and abdominal circumference, and weight were determined from the data of two scans obtained before 25 weeks' menstrual age and separated by an interval of at least 5 weeks. Comparisons between actual and predicted birth characteristics were expressed by the Growth Potential Realization Index (GPRI) and Neonatal Growth Assessment Score (NGAS). The proportions of perinatal outcomes [mechanical delivery, low Apgar score, abnormal fetal heart rate (FHR) patterns, neonatal acidosis, meconium staining of amniotic fluid, neonatal intensive care unit (NICU) admission and maternal complications] were compared between SGA infants with normal NGAS and those with abnormal NGAS.
Results:
Of the 47 fetuses studied, 27 had normal growth outcomes at birth and 20 showed evidence of intrauterine growth restriction, based on NGAS. There were significant increases in mechanical deliveries, abnormal FHR patterns and meconium staining of amniotic fluid in cases of growth-restricted neonates, determined using the NGAS classification, when compared with events related to normally grown infants. However, there were no significant differences in low Apgar score, neonatal acidosis, NICU admission and maternal complications between the 2 groups.
Conclusion:
Individualized growth assessment should be useful for detection of SGA infants with poor perinatal outcomes.