Role of ultrasound parameters and clinical anamnestic data in late-onset fetal growth restriction as potential risk factors for neonatal admission to the intensive care unit

I n t r o d u c t i o n . Fetal growth restriction (FGR) is one of the major obstetric syndromes which leads to a high incidence of neonatal admission to the intensive care unit (ICU). Timely delivery is the only method to improve perinatal outcomes. However, no predictors have yet been identified to determine the optimal timing and mode of delivery, conside ing an individualized approach.

A i m . To identify the relationship between clinical and anamnestic data, ultrasound parameters and neonatal ICU admission with late-onset FGR.

M a t e r i a l s a n d m e t h o d s . A continuous cohort study was carried out at the Perinatal Center of the Arkhangelsk Regional Clinical Hospital from 2018 to 2022. The sample included 314 women with suspected FGR. Multi-variate Poisson regression was used to assess the association between neonatal ICU admission and diferent variables, including ultrasound, clinical data, and medical data. Unadjusted and adjusted relative risks (RR) with 95% confidence intervals (CI) were also calculated.

R e s u l t s . In 111 cases, which are 35,4% of the total, late-onset FGR was detected. Of these, in 41 cases (36,9%), newborns subsequently required ICU admission. Four statistically significant risk factors were included in the parsimonious model. Abnormalities of the uterine artery pulsatility index (UtA PI) (RR = 1,28; 95% CI: 1,04–1,57), varicose veins of the lower extremities (RR = 1,90; 95% CI: 1,12–3,26) and recurrent FGR (RR = 1,67; 95% CI: 1,03–2,71) were associated with poor status of the newborn at birth. Changes in the umbilical artery pulsatility index (UmA PI) were associated with a lower risk of neonatal ICU admission (RR = 0,78; 95% CI: 0,61–0,99).

C o n c l u s i o n . Abnormal UtA PI values revealed during Doppler ultrasound examination, varicose vein disease in the mother, and recurrent FGR may have a predictive value for deciding on the timing and mode of delivery to improve perinatal outcomes. Abnormal UmA PI values were associated with a lower risk of neonatal ICU admission. It is necessary to reproduce the results in further larger multicenter studies to create valid models with appropriate levels of sensitivity and specificity for predicting perinatal complications.

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