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The association of cerebral palsy and death with small-for-gestational-age birthweight in preterm neonates by individualized and population-based percentiles.

Abstract：

OBJECTIVE:The objective of the study was to determine whether an individualized growth standard (IS) improves the identification of preterm small-for-gestational-age (SGA) neonates at risk of developing moderate/severe cerebral palsy (CP) or death. STUDY DESIGN:This study was a secondary analysis of data from a randomized trial of MgSO4 for the prevention of CP or death among anticipated preterm births. Singleton nonanomalous liveborns delivered before 34 weeks' were classified as SGA (less than the 10th percentile for their gestational age) by a population standard (PS) or an IS (incorporating maternal age, height, weight, parity, race/ethnicity, and neonatal sex). The primary outcome was the prediction of moderate or severe CP or death by age 2 years. RESULTS:Of 1588 eligible newborns, 143 (9.4%) experienced CP (n = 33) or death (n = 110). Forty-four (2.8%) were SGA by the PS and 364 (22.9%) by the IS. All PS-SGA newborns also were identified as IS-SGA. SGA newborns by either standard had a similarly increased risk of CP or death (PS: relative risk [RR], 2.4, 95% confidence interval [CI], 1.3-4.3 vs IS: RR, 1.8, 95% CI, 1.3-2.5, respectively). The similarity of RRs remained after stratification by the MgSO4 treatment group. The IS was more sensitive (36% vs 6%, P < .001) but less specific (78% vs 98%, P < .001) for CP or death. The receiver operating characteristic curve analysis revealed a statistically lower area under the curve for the PS, although the ability of either method to predict which neonates would subsequently develop CP or death was poor (PS: 0.55, 95% CI, 0.49-0.60 vs IS: 0.59, 95% CI, 0.54-0.64, P < .001). CONCLUSION:An individualized SGA growth standard does not improve the association with, or prediction of, CP or death by age 2 years.

journal_name

Am J Obstet Gynecol

journal_title

American journal of obstetrics and gynecology

authors

Grobman WA,Lai Y,Rouse DJ,Spong CY,Varner MW,Mercer BM,Leveno KJ,Iams JD,Wapner RJ,Sorokin Y,Thorp JM Jr,Ramin SM,Malone FD,O'Sullivan MJ,Hankins GD,Caritis SN,Eunice Kennedy Shriver National Institute of Child Health and

doi

10.1016/j.ajog.2013.06.007

subject

Has Abstract

pub_date

2013-10-01 00:00:00

pages

340.e1-5

issue

eissn

0002-9378

issn

1097-6868

pii

S0002-9378(13)00615-7

journal_volume

209

pub_type

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The association of cerebral palsy and death with small-for-gestational-age birthweight in preterm neonates by individualized and population-based percentiles.