Can we predict adverse neonatal outcome in fetal growth restriction near term?

To assess whether we can identify cases of fetal growth restriction (FGR) approaching term who are at risk for adverse neonatal outcome. From a cohort of 508 FGR cases delivered at ≥34 weeks, fetal biometry, Doppler indices at uterine, umbilical and middle cerebral arteries, in addition to demographic and obstetrical variables available within 2 weeks of delivery were related to adverse neonatal outcome, defined as admission to the NICU for indications other than low birth weight alone. Stepwise regression analysis showed that gestational age at delivery (OR = 0.62, 95% CI 0.53-0.72), fetal abdominal circumference centile (OR = 0.72, 95% CI 0.62-0.84), and umbilical artery pulsatility index centile (OR = 1.02, 95% CI 1.01-1.04) independently predicted occurrence of adverse neonatal outcome. Receiver operating characteristic curve analysis demonstrated that a formula inclusive of these variables predicted 80% of adverse outcomes with 22% false positive rate. In FGR cases delivered at ≥34 weeks, a formula inclusive of gestational age at delivery, abdominal circumference centile and umbilical artery Doppler achieves 80% sensitivity for the prediction of neonatal morbidity.