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Influence of obstetric management on outcome of extremely preterm growth retarded infants
A H Schaap1, H Wolf, H W Bruinse
1Department of Obstetrics, University of Amsterdam, The Netherlands.
Insights
Long-term outcomes for extremely preterm infants with fetal growth restriction show that disabilities are linked to neonatal complications, not obstetric management. Early identification by two years corrected age is crucial for these high-risk infants.
Area of Science:
- Neonatalogy
- Perinatology
- Developmental Pediatrics
Background:
- Extremely preterm infants with fetal growth retardation face significant long-term challenges.
- Understanding the influence of obstetric management versus perinatal events on outcomes is critical.
Purpose of the Study:
- To evaluate the long-term outcomes of extremely preterm growth-retarded infants.
- To determine the relationship between obstetric management, perinatal events, and neurodevelopmental impairment.
Main Methods:
- A cohort study included infants (26-32 weeks gestation) with fetal growth retardation and distress.
- Follow-up assessments for impairment, disability, or handicap were conducted at 2 years corrected age and school age.
- Data were collected from two tertiary care centers with differing obstetric management protocols.
Main Results:
- 37% of infants experienced impairments, and 9% had disabilities or handicaps by school age.
- No significant differences in outcomes were observed between the two centers.
- All identified disabilities or handicaps were evident by 2 years corrected age.
Conclusions:
- Neonatal complications, such as intracerebral hemorrhage or bronchopulmonary dysplasia, were associated with disability, not antenatal obstetric factors.
- Antenatal prediction of disability or handicap was not possible based on the studied variables.
- The incidence of disability or handicap in this cohort was comparable to other preterm infants.
Aim:
To describe the long term outcome of extremely preterm growth retarded infants in relation to obstetric management and various perinatal events.
Methods:
A cohort study was undertaken in two tertiary care centres with different obstetric management. All infants with fetal growth retardation due to placental insufficiency and resulting in fetal distress at 26 to 32 weeks of gestation, were included for the years 1984-89. Main outcome measures were impairment, disability, or handicap at 2 years corrected age and at school age (4 1/2 to 10 1/2 years).
Results:
One hundred and twenty five (98%) were followed up until 2 years corrected age in the outpatient department; 114 (90%) were assessed at school age. Impairments were found in 37% and disabilities or handicaps in 9% of the assessed infants, with no difference between centres. All disabled or handicapped children had already been identified by 2 years corrected age.
Conclusions:
Disability or handicap were related to neonatal complications (intracerebral haemorrhage or bronchopulmonary dysplasia) and not to obstetric variables, thus making antenatal prediction impossible. The incidence of disability or handicap in these growth retarded infants was comparable with that of other preterm infants.