Perinatal variables and neonatal outcomes in severely growth restricted preterm fetuses

Objective. To investigate the impact of severe preterm intrauterine growth restriction on perinatal and neonatal outcomes. Design. Retrospective cohort study. Setting. Tertiary referral fetal medicine unit in London. Population. A total of 60 pregnancies affected by early onset severe intrauterine growth restriction with fetal abdominal circumference below the third centile and abnormal arterial or venous Dopplers between October 2003 and October 2007, and control cohort of 77 appropriate-for-gestational age preterm neonates. Methods. Cases were identified from the departmental databases. The neonatal outcomes in 44 growth restricted survivors were compared with 77 gestation matched appropriate-for-gestational age preterm neonates. Main outcome measures. Neonatal morbidity and neonatal mortality. Results. Of the 60 pregnancies affected by severe intrauterine growth restriction, seven were terminated, nine resulted in stillbirth and 44 resulted in live births. The growth restricted neonates had increased odds of developing respiratory distress compromise (odds ratio (OR) 2.5, 95% confidence interval (CI) 1.1-6.2) and thrombocytopenia (OR 9.4, 95% CI 2.9-30.8) in comparison to average-for-gestational age cohorts. We also noted an increased risk of neonatal sepsis (OR 2.5, 95% CI 1.1-6.0) and necrotising enterocolitis (OR 9.7, 95% CI 1.1-86.0). Sepsis was the major contributing factor towards neonatal mortality in the growth restricted cohorts. Conclusion. Despite intensive fetal surveillance and tertiary level neonatal care, the survival for growth restricted fetuses before 28 weeks gestation remains poor with neonatal outcome predominantly affected by respiratory morbidity, sepsis and metabolic compromise.