Clinical factors that enhance morbidity and mortality in intrauterine growth restricted foetuses delivered between 23 and 30 weeks of gestation.

OBJECTIVE

To find clinical factors that are associated with poor outcome (death and brain damage) in premature intrauterine growth restricted (IUGR) infants.

METHODS

A retrospective study was performed to compare the incidence of poor outcome between 45 IUGR and 203 appropriate-for-gestational-age (AGA) infants born before 30 weeks of gestation. Foetal tests included foetal heart rate monitoring, Doppler flow, amniotic fluid, and head circumference. Growth for gestational age was categorised as 10th through 3rd, third through first, and below first percentiles.

RESULTS

In infants below 25 weeks of gestation, the incidence of poor outcome was not different between IUGR and AGA. In infants between 25 and 30 weeks of gestation, the incidence of poor outcome was significantly increased in IUGR compared with AGA (12/40, 30% versus 11/136, 8.1%, p<0.01). Univariate analysis showed that abnormality in foetal heart rate monitoring [odds ratio (OR) 8.3, 95% confidence interval (CI) 1.58-43.6], head circumference (OR 7.0, 95%CI 1.42-34.4), and Doppler flow (OR 10.9, 95%CI 1.83-64.6) was significantly associated with poor outcome in IUGR infants. However, no foetal tests were significantly associated with poor outcome after adjusting for the 3-grade birthweight percentiles.

CONCLUSIONS

Immaturity outweighs clinical problem associated with IUGR in infants below 25 weeks of gestation. Between 25 and 30 weeks of gestation, there was a growth threshold below third percentile where foetal tests were not significant predictors of poor outcome, but that was primarily determined by birthweight.