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Morbidity and mortality among very-low-birth-weight neonates with intrauterine growth restriction. The Vermont Oxford Network.
Am J Obstet Gynecol. 2000 Jan; 182(1 Pt 1):198-206.AJ

Abstract

OBJECTIVE

We sought to determine the associations between intrauterine growth restriction and neonatal morbidity and mortality, as well as the impact of prenatal glucocorticoid administration on the frequency of specific complications of prematurity among neonates with intrauterine growth restriction.

STUDY DESIGN

We examined the association between intrauterine growth restriction and adverse neonatal outcomes in a population of 19,759 singleton very-low-birth-weight neonates without major birth defects. We included neonates from 25 to 30 weeks' gestation entered in the Vermont Oxford Network database between 1991 and 1996 by 196 institutions. Intrauterine growth restriction was defined as the 10th percentile for birth weight according to the 1993 US national statistics. Odds ratios were estimated according to stepwise logistic regression for each neonatal outcome. Potential explanatory variables included gestational age, intrauterine growth restriction, race, prenatal care, prenatal glucocorticoid administration, route of delivery, fetal sex, and birth within versus postnatal transfer to a network institution.

RESULTS

There was a statistically significant association of intrauterine growth restriction with neonatal death (odds ratio, 2.77; 95% confidence interval, 2.31-3. 33), necrotizing enterocolitis (odds ratio, 1.27; 95% confidence interval, 1.05-1.53), and respiratory distress syndrome (odds ratio, 1.19; 95% confidence interval, 1.03-1.36). There was a trend (P <. 10) toward association of intrauterine growth restriction with increased risks of intraventricular hemorrhage (odds ratio, 1.13; 95% confidence interval, 0.99-1.29) and severe intraventricular hemorrhage (grades III and IV; odds ratio, 1.25; 95% confidence interval, 0.98-1.59). Maternal prenatal glucocorticoid administration was associated with significantly lower risks of respiratory distress syndrome (odds ratio, 0.51; 95% confidence interval, 0.44-0.58), intraventricular hemorrhage (odds ratio, 0.67; 95% confidence interval, 0.61-0.73), severe intraventricular hemorrhage (odds ratio, 0.50; 95% confidence interval, 0.43-0.57), and death (odds ratio, 0.54; 95% confidence interval, 0.48-0.62). The benefits of prenatal glucocorticoid therapy for growth-restricted newborns were similar to those among normally grown infants.

CONCLUSIONS

Intrauterine growth restriction within the range of 501 to 1500 g birth weight is associated with increased risks of neonatal death, necrotizing enterocolitis, and respiratory distress syndrome. Prenatal corticosteroid use was associated with decreased risks of all outcomes studied except necrotizing enterocolitis. We found no evidence that this benefit was dependent on fetal size.

Authors+Show Affiliations

Departments of Obstetrics and Gynecology, University of Vermont College of Medicine, Burlington, VT 05401, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

10649179

Citation

Bernstein, I M., et al. "Morbidity and Mortality Among Very-low-birth-weight Neonates With Intrauterine Growth Restriction. the Vermont Oxford Network." American Journal of Obstetrics and Gynecology, vol. 182, no. 1 Pt 1, 2000, pp. 198-206.
Bernstein IM, Horbar JD, Badger GJ, et al. Morbidity and mortality among very-low-birth-weight neonates with intrauterine growth restriction. The Vermont Oxford Network. Am J Obstet Gynecol. 2000;182(1 Pt 1):198-206.
Bernstein, I. M., Horbar, J. D., Badger, G. J., Ohlsson, A., & Golan, A. (2000). Morbidity and mortality among very-low-birth-weight neonates with intrauterine growth restriction. The Vermont Oxford Network. American Journal of Obstetrics and Gynecology, 182(1 Pt 1), 198-206.
Bernstein IM, et al. Morbidity and Mortality Among Very-low-birth-weight Neonates With Intrauterine Growth Restriction. the Vermont Oxford Network. Am J Obstet Gynecol. 2000;182(1 Pt 1):198-206. PubMed PMID: 10649179.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Morbidity and mortality among very-low-birth-weight neonates with intrauterine growth restriction. The Vermont Oxford Network. AU - Bernstein,I M, AU - Horbar,J D, AU - Badger,G J, AU - Ohlsson,A, AU - Golan,A, PY - 2000/1/29/pubmed PY - 2000/2/19/medline PY - 2000/1/29/entrez SP - 198 EP - 206 JF - American journal of obstetrics and gynecology JO - Am J Obstet Gynecol VL - 182 IS - 1 Pt 1 N2 - OBJECTIVE: We sought to determine the associations between intrauterine growth restriction and neonatal morbidity and mortality, as well as the impact of prenatal glucocorticoid administration on the frequency of specific complications of prematurity among neonates with intrauterine growth restriction. STUDY DESIGN: We examined the association between intrauterine growth restriction and adverse neonatal outcomes in a population of 19,759 singleton very-low-birth-weight neonates without major birth defects. We included neonates from 25 to 30 weeks' gestation entered in the Vermont Oxford Network database between 1991 and 1996 by 196 institutions. Intrauterine growth restriction was defined as the 10th percentile for birth weight according to the 1993 US national statistics. Odds ratios were estimated according to stepwise logistic regression for each neonatal outcome. Potential explanatory variables included gestational age, intrauterine growth restriction, race, prenatal care, prenatal glucocorticoid administration, route of delivery, fetal sex, and birth within versus postnatal transfer to a network institution. RESULTS: There was a statistically significant association of intrauterine growth restriction with neonatal death (odds ratio, 2.77; 95% confidence interval, 2.31-3. 33), necrotizing enterocolitis (odds ratio, 1.27; 95% confidence interval, 1.05-1.53), and respiratory distress syndrome (odds ratio, 1.19; 95% confidence interval, 1.03-1.36). There was a trend (P <. 10) toward association of intrauterine growth restriction with increased risks of intraventricular hemorrhage (odds ratio, 1.13; 95% confidence interval, 0.99-1.29) and severe intraventricular hemorrhage (grades III and IV; odds ratio, 1.25; 95% confidence interval, 0.98-1.59). Maternal prenatal glucocorticoid administration was associated with significantly lower risks of respiratory distress syndrome (odds ratio, 0.51; 95% confidence interval, 0.44-0.58), intraventricular hemorrhage (odds ratio, 0.67; 95% confidence interval, 0.61-0.73), severe intraventricular hemorrhage (odds ratio, 0.50; 95% confidence interval, 0.43-0.57), and death (odds ratio, 0.54; 95% confidence interval, 0.48-0.62). The benefits of prenatal glucocorticoid therapy for growth-restricted newborns were similar to those among normally grown infants. CONCLUSIONS: Intrauterine growth restriction within the range of 501 to 1500 g birth weight is associated with increased risks of neonatal death, necrotizing enterocolitis, and respiratory distress syndrome. Prenatal corticosteroid use was associated with decreased risks of all outcomes studied except necrotizing enterocolitis. We found no evidence that this benefit was dependent on fetal size. SN - 0002-9378 UR - https://www.unboundmedicine.com/medline/citation/10649179/Morbidity_and_mortality_among_very_low_birth_weight_neonates_with_intrauterine_growth_restriction__The_Vermont_Oxford_Network_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9378(00)70513-8 DB - PRIME DP - Unbound Medicine ER -