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Multicenter Study
. 2023 Nov;108(6):599-606.
doi: 10.1136/archdischild-2022-325285. Epub 2023 Apr 26.

Neonatal outcomes following early fetal growth restriction: a subgroup analysis of the EVERREST study

Ingran Lingam  1   2 , Jade Okell  3 , Katarzyna Maksym  3 , Rebecca Spencer  3   4 , Donald Peebles  5   6 , Gina Buquis  3 , Gareth Ambler  7 , Eva Morsing  8 , David Ley  8 , Dominique Singer  9 , Violeta Tenorio  10 , Jade Dyer  3 , Yuval Ginsberg  3   11 , Tal Weissbach  3   12 , Angela Huertas-Ceballos  5 , Neil Marlow  3 , Anna David  3 ; EVERREST consortium
Collaborators, Affiliations
Free article
Multicenter Study

Neonatal outcomes following early fetal growth restriction: a subgroup analysis of the EVERREST study

Ingran Lingam et al. Arch Dis Child Fetal Neonatal Ed. 2023 Nov.
Free article

Abstract

Objective: To quantify the risks of mortality, morbidity and postnatal characteristics associated with extreme preterm fetal growth restriction (EP-FGR).

Design: The EVERREST (Do e s v ascular endothelial growth factor gene therapy saf e ly imp r ove outcome in seve r e e arly-onset fetal growth re st riction?) prospective multicentre study of women diagnosed with EP-FGR (singleton, estimated fetal weight (EFW) <3rd percentile, <600 g, 20+0-26+6 weeks of gestation). The UK subgroup of EP-FGR infants (<36 weeks) were sex-matched and gestation-matched to appropriate for age (AGA) infants born in University College London Hospital (1:2 design, EFW 25th-75th percentile).

Setting: Four tertiary perinatal units (UK, Germany, Spain, Sweden).

Main outcomes: Antenatal and postnatal mortality, bronchopulmonary dysplasia (BPD), sepsis, surgically treated necrotising enterocolitis (NEC), treated retinopathy of prematurity (ROP).

Results: Of 135 mothers recruited with EP-FGR, 42 had a stillbirth or termination of pregnancy (31%) and 93 had live births (69%). Postnatal genetic abnormalities were identified in 7/93 (8%) live births. Mean gestational age at birth was 31.4 weeks (SD 4.6). 54 UK-born preterm EP-FGR infants (<36 weeks) were matched to AGA controls. EP-FGR was associated with increased BPD (43% vs 26%, OR 3.6, 95% CI 1.4 to 9.4, p=0.01), surgical NEC (6% vs 0%, p=0.036) and ROP treatment (11% vs 0%, p=0.001). Mortality was probably higher among FGR infants (9% vs 2%, OR 5.0, 95% CI 1.0 to 25.8, p=0.054). FGR infants more frequently received invasive ventilation (65% vs 50%, OR 2.6, 95% CI 1.1 to 6.1, p=0.03), took longer to achieve full feeds and had longer neonatal stays (median difference 6.1 days, 95% CI 3.8 to 8.9 and 19 days, 95% CI 9 to 30 days, respectively, p<0.0001).

Conclusions: Mortality following diagnosis of EP-FGR is high. Survivors experience increased neonatal morbidity compared with AGA preterm infants.

Trial registration number: NCT02097667.

Keywords: intensive care units, neonatal; neonatology; paediatrics.

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Conflict of interest statement

Competing interests: None declared.

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