Neonatal outcomes following early fetal growth restriction: a subgroup analysis of the EVERREST study
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Neonatal outcomes following early fetal growth restriction: a subgroup analysis of the EVERREST study. / Lingam, Ingran; Okell, Jade; Maksym, Katarzyna; Spencer, Rebecca; Peebles, Donald; Buquis, Gina; Ambler, Gareth; Morsing, Eva; Ley, David; Singer, Dominique; Dyer, Jade; Ginsberg, Yuval; Weissbach, Tal; Huertas-Ceballos, Angela; Marlow, Neil; David, Anna; EVERREST Consortium.
In: ARCH DIS CHILD-FETAL, Vol. 108, No. 6, 11.2023, p. 599-606.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Neonatal outcomes following early fetal growth restriction: a subgroup analysis of the EVERREST study
AU - Lingam, Ingran
AU - Okell, Jade
AU - Maksym, Katarzyna
AU - Spencer, Rebecca
AU - Peebles, Donald
AU - Buquis, Gina
AU - Ambler, Gareth
AU - Morsing, Eva
AU - Ley, David
AU - Singer, Dominique
AU - Dyer, Jade
AU - Ginsberg, Yuval
AU - Weissbach, Tal
AU - Huertas-Ceballos, Angela
AU - Marlow, Neil
AU - David, Anna
AU - EVERREST Consortium
N1 - © Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2023/11
Y1 - 2023/11
N2 - OBJECTIVE: To quantify the risks of mortality, morbidity and postnatal characteristics associated with extreme preterm fetal growth restriction (EP-FGR).DESIGN: The EVERREST (Do e s v ascular endothelial growth factor gene therapy saf e ly imp r ove outcome in seve r e e arly-onset fetal growth re st 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.
AB - OBJECTIVE: To quantify the risks of mortality, morbidity and postnatal characteristics associated with extreme preterm fetal growth restriction (EP-FGR).DESIGN: The EVERREST (Do e s v ascular endothelial growth factor gene therapy saf e ly imp r ove outcome in seve r e e arly-onset fetal growth re st 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.
KW - Infant
KW - Infant, Newborn
KW - Female
KW - Pregnancy
KW - Humans
KW - Fetal Growth Retardation/epidemiology
KW - Infant, Premature
KW - Prospective Studies
KW - Stillbirth
KW - Gestational Age
KW - Bronchopulmonary Dysplasia
KW - Retinopathy of Prematurity/epidemiology
U2 - 10.1136/archdischild-2022-325285
DO - 10.1136/archdischild-2022-325285
M3 - SCORING: Journal article
C2 - 37185272
VL - 108
SP - 599
EP - 606
JO - ARCH DIS CHILD-FETAL
JF - ARCH DIS CHILD-FETAL
SN - 1359-2998
IS - 6
ER -
