Related Experiment Video
Updated: Jul 30, 2025
Fetal Echocardiography and Pulsed-wave Doppler Ultrasound in a Rabbit Model of Intrauterine Growth Restriction
Published on: June 29, 2013
Neonatal outcomes following early fetal growth restriction: a subgroup analysis of the EVERREST study
Ingran Lingam1,2, Jade Okell3, Katarzyna Maksym3
1EGA Institute for Women's Health, University College London, London, UK ingranlingam@nhs.net.
Insights
Extreme preterm fetal growth restriction (EP-FGR) is linked to high mortality rates. Survivors face significant neonatal health issues, including bronchopulmonary dysplasia and necrotizing enterocolitis, compared to appropriate for gestational age infants.
Area of Science:
- Perinatal Medicine
- Neonatology
- Fetal Development
Background:
- Extreme preterm fetal growth restriction (EP-FGR) presents significant risks.
- Understanding the outcomes of EP-FGR is crucial for clinical management.
- The EVERREST study investigated outcomes in EP-FGR.
Purpose of the Study:
- To quantify mortality, morbidity, and postnatal characteristics in infants with EP-FGR.
- To compare outcomes of EP-FGR infants with appropriate for gestational age (AGA) preterm infants.
Main Methods:
- Prospective multicentre study (EVERREST) including women with EP-FGR (EFW <3rd percentile, <600g, 20-26 weeks gestation).
- UK subgroup of EP-FGR infants (<36 weeks) were sex- and gestation-matched to AGA controls (1:2 ratio).
- Outcomes assessed included mortality, bronchopulmonary dysplasia (BPD), sepsis, necrotizing enterocolitis (NEC), and retinopathy of prematurity (ROP).
Main Results:
- EP-FGR was associated with increased rates of BPD (43% vs 26%), surgical NEC (6% vs 0%), and treated ROP (11% vs 0%).
- Mortality was higher in EP-FGR infants (9% vs 2%).
- EP-FGR infants required more invasive ventilation, longer time to full feeds, and longer neonatal stays.
Conclusions:
- Mortality following diagnosis of EP-FGR is high.
- Survivors of EP-FGR experience significantly increased neonatal morbidity compared to AGA preterm infants.
- These findings highlight the severe impact of EP-FGR on infant outcomes.
Objective:
To quantify the risks of mortality, morbidity and postnatal characteristics associated with extreme preterm fetal growth restriction (EP-FGR).
Design:
The EVERREST (Do s ascular endothelial growth factor gene therapy saf ly imp ove outcome in seve e arly-onset fetal growth re riction?) prospective multicentre study of women diagnosed with EP-FGR (singleton, estimated fetal weight (EFW) <3rd percentile, <600 g, 20+0-26+6 weeks of gestation). The UK subgroup of EP-FGR infants (<36 weeks) were sex-matched and gestation-matched to appropriate for age (AGA) infants born in University College London Hospital (1:2 design, EFW 25th-75th percentile).
Setting:
Four tertiary perinatal units (UK, Germany, Spain, Sweden).
Main Outcomes:
Antenatal and postnatal mortality, bronchopulmonary dysplasia (BPD), sepsis, surgically treated necrotising enterocolitis (NEC), treated retinopathy of prematurity (ROP).
Results:
Of 135 mothers recruited with EP-FGR, 42 had a stillbirth or termination of pregnancy (31%) and 93 had live births (69%). Postnatal genetic abnormalities were identified in 7/93 (8%) live births. Mean gestational age at birth was 31.4 weeks (SD 4.6). 54 UK-born preterm EP-FGR infants (<36 weeks) were matched to AGA controls. EP-FGR was associated with increased BPD (43% vs 26%, OR 3.6, 95% CI 1.4 to 9.4, p=0.01), surgical NEC (6% vs 0%, p=0.036) and ROP treatment (11% vs 0%, p=0.001). Mortality was probably higher among FGR infants (9% vs 2%, OR 5.0, 95% CI 1.0 to 25.8, p=0.054). FGR infants more frequently received invasive ventilation (65% vs 50%, OR 2.6, 95% CI 1.1 to 6.1, p=0.03), took longer to achieve full feeds and had longer neonatal stays (median difference 6.1 days, 95% CI 3.8 to 8.9 and 19 days, 95% CI 9 to 30 days, respectively, p<0.0001).
Conclusions:
Mortality following diagnosis of EP-FGR is high. Survivors experience increased neonatal morbidity compared with AGA preterm infants.
Trial Registration Number:
NCT02097667.
