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Conventional birth weight standards obscure fetal growth restriction in preterm infants

Richard W I Cooke1

  • 1School of Reproductive and Developmental Medicine, University of Liverpool, Neonatal Unit, Liverpool Women's Hospital, Liverpool L8 7SS, UK. mc19@liv.ac.uk

Archives of Disease in Childhood. Fetal and Neonatal Edition
|March 21, 2006
PubMed

Insights

Estimated fetal weight (EFW) better identifies fetal growth restriction (FGR) in preterm infants than birth weight. This improved identification of FGR is crucial for understanding neonatal disease risks and outcomes.

Area of Science:

  • Neonatalogy
  • Perinatology
  • Pediatric Research

Background:

  • Fetal growth restriction (FGR) association with fetal maturation is debated, with conflicting evidence on its impact on preterm infant mortality and morbidity.
  • Severe FGR can be detrimental, while excessive fetal growth is also linked to adverse outcomes.
  • Standard birth weight centiles can obscure FGR in preterm infants due to distorted growth patterns.

Purpose of the Study:

  • To investigate if estimated fetal weight (EFW) can reveal the effects of 'hidden' FGR in preterm infants.
  • To compare the utility of EFW z-scores versus birth weight z-scores in assessing FGR and its neonatal implications.

Main Methods:

  • Analysis of a 25-year database of preterm infants (<35 weeks gestation) admitted to a single neonatal unit.
  • Computation of odds ratios (ORs) for mortality and neonatal morbidities based on z-scores for birth weight and EFW.
  • Comparison of ORs derived from birth weight z-scores with those derived from EFW z-scores.

Main Results:

  • Mortality OR was lowest for birth weights 1-3 SD above the mean, but for EFW, it was lowest between -2 SD and 0 SD below the mean.
  • Increasing FGR below the mean reduced the OR for periventricular hemorrhage with both birth weight and EFW.
  • Apparent protective effects of higher birth weights (>1 SD above mean) against certain morbidities (e.g., sepsis, CLD, PDA, NEC) were not observed with EFW; severe FGR (>-3 SD) increased NEC risk.

Conclusions:

  • Estimated fetal weight (EFW) provides a more accurate assessment of FGR incidence and its role in neonatal diseases compared to standard birth weight standards.
  • Utilizing EFW standards is essential for a clearer understanding of FGR's impact on neonatal outcomes.
Abstract

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