Can fetal distress and neonatal intensive care requirement be predicted for the small for gestational age fetuses?

Abstract

Objective: To predict fetal distress and neonatal intensive care requirements of small for gestational age fetuses to discriminate those to be referred to tertiary care institutions.Materials and Methods: Sixty eight gestations with birth weight under the 25th percentile, referred to and delivered in our institution within the time frame January 2003-August 2005 were included in the study. Fetal distress was defined as severe persistent fetal bradycardia, severe decelaration or biophysical profile scores less than or equal to 4. Neonatal intensive care unit (NICU) requirement was decided upon a 5th minute Apgar score below 7. Statistical analysis was performed by Student-t test, ANOVA, correlation analysis, logistic regression analysis and ROC analysis. Statistical significance was considered whenever p<0.05.Results: In the presence of abnormal findings in the umbilical artery Doppler (high resistance, absent end-diastolic flow, reverse flow); birth weight (1453 +/- 666 g vs. 1940 +/- 683 g), 1st minute Apgar scores (4.7 +/- 2.6 vs. 7.4 +/- 2.8) and 5th minute Apgar scores were (7.8 +/- 2.4 vs. 9.2 +/- 2.3) significantly lower. Logistic regression analysis showed that the only parameter independently associated with fetal distress was birth weight (below 1593 g at a sensitivity of 60%). Logistic regression showed that the only parameters independently associated with neonatal intensive care requirement were gestational age when the small fetus was first detected and the estimated fetal birth weight: the gestational age when the small fetus was first detected predicted neonatal intensive care requirement at a sensivity and specificity of 63% (< 33.9 weeks); and the estimated fetal birth weight predicted this outcome at a sensitivity of 71% and a specificity of 73.3% ( below 1848 g).Discussion: Estimated fetal birth weights (below 1848 g) and gestational weeks of age (< 33.9 weeks) when the small for gestational age fetus is detected predicted NICU requirement at sensitivities of 71% and 63%, respectively. Estimated birth weights below 1593 g predicts fetal distress at a sensitivity of 60%. In these conditions, the patients should be referred for tertiary care.