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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 LU ; Ley, David LU and Singer, Dominique , et al. (2023) In Archives of disease in childhood. Fetal and neonatal edition 108(6). p.599-606
Abstract

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,... (More)

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.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Archives of disease in childhood. Fetal and neonatal edition
volume
108
issue
6
pages
599 - 606
publisher
BMJ Publishing Group
external identifiers
  • scopus:85160230209
  • pmid:37185272
ISSN
1359-2998
DOI
10.1136/archdischild-2022-325285
language
English
LU publication?
yes
additional info
© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.
id
f8e5ccb1-8bec-4261-8331-ae7f18f9e7ac
date added to LUP
2023-10-19 12:14:42
date last changed
2024-04-19 02:34:38
@article{f8e5ccb1-8bec-4261-8331-ae7f18f9e7ac,
  abstract     = {{<p>OBJECTIVE: To quantify the risks of mortality, morbidity and postnatal characteristics associated with extreme preterm fetal growth restriction (EP-FGR).</p><p>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) &lt;3rd percentile, &lt;600 g, 20+0-26+6 weeks of gestation). The UK subgroup of EP-FGR infants (&lt;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).</p><p>SETTING: Four tertiary perinatal units (UK, Germany, Spain, Sweden).</p><p>MAIN OUTCOMES: Antenatal and postnatal mortality, bronchopulmonary dysplasia (BPD), sepsis, surgically treated necrotising enterocolitis (NEC), treated retinopathy of prematurity (ROP).</p><p>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 (&lt;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&lt;0.0001).</p><p>CONCLUSIONS: Mortality following diagnosis of EP-FGR is high. Survivors experience increased neonatal morbidity compared with AGA preterm infants.</p><p>TRIAL REGISTRATION NUMBER: NCT02097667.</p>}},
  author       = {{Lingam, Ingran and Okell, Jade and Maksym, Katarzyna and Spencer, Rebecca and Peebles, Donald and Buquis, Gina and Ambler, Gareth and Morsing, Eva and Ley, David and Singer, Dominique and Tenorio, Violeta and Dyer, Jade and Ginsberg, Yuval and Weissbach, Tal and Huertas-Ceballos, Angela and Marlow, Neil and David, Anna}},
  issn         = {{1359-2998}},
  language     = {{eng}},
  month        = {{04}},
  number       = {{6}},
  pages        = {{599--606}},
  publisher    = {{BMJ Publishing Group}},
  series       = {{Archives of disease in childhood. Fetal and neonatal edition}},
  title        = {{Neonatal outcomes following early fetal growth restriction : a subgroup analysis of the EVERREST study}},
  url          = {{http://dx.doi.org/10.1136/archdischild-2022-325285}},
  doi          = {{10.1136/archdischild-2022-325285}},
  volume       = {{108}},
  year         = {{2023}},
}