RISK FACTORS AND COURSE OF THE EARLY NEONATAL PERIOD IN NEWBORNS WITH FETAL GROWTH RESTRICTION
DOI:
https://doi.org/10.11603/24116-4944.2025.2.15821Keywords:
fetal growth restriction, critical condition of a newborn, complications of the early neonatal period, perinatal infections, neonatal asphyxiaAbstract
The aim of the study – to evaluate the main predictors of fetal growth restriction and the structure of neonatal morbidity in relation to the probable risk of critical conditions.
Materials and Methods. A prospective clinical study and assessment of the condition of newborns in two study groups was conducted: group I – 66 pregnant women whose pregnancy was complicated by early fetal growth restriction, and their newborns; group II – 84 women whose pregnancy was complicated by late fetal growth restriction, and their newborns. The control group consisted of 40 conditionally healthy pregnant women with a physiological course of pregnancy and their newborns. The analysis of the obtained parameters was performed using the Statistica 7.0 statistical software package (StatSoft Inc., USA).
Results and Discussion. The main antenatal risk factors included known extragenital causes and complications of pregnancy (anemia, excess weight, hypertension and preeclampsia, gestational diabetes and acute respiratory viral infections, etc.). A number of gestational complications were significantly more common in group I, most notably in cases of prematurity and FGR, where the proportion of neonatal complications dominated at a gestational age of <30 weeks of pregnancy. The average APGAR score at one minute did not exceed 7.0 points in 119 (79.3 %) cases. Statistical differences between groups were demonstrated by parameters such as APGAR score <7 points (χ2=16.97, p<0.001), transient changes in the cardiovascular system (χ2=24.90, p<0.001), acute kidney injury syndrome (χ2=4.82, p<0.001), and metabolic markers (polycythemia, hypoproteinemia, hyperkalemia) (χ2=18.81, p<0.001). Significant factors associated with antenatal and intrapartum fetal distress and pathological course of the neonatal period are early form of fetal growth restriction, prematurity and preterm birth (OR – 16.86), acute respiratory infections during the current pregnancy, especially in the first half (OR – 2.43), anemia in pregnant women (OR – 2.27), changes in the volume of amniotic fluid (oligohydramnios) (OR – 2.12), combination of FGR with gestational hypertension and preeclampsia (OR – 3.12), rapid development of decompensated placental dysfunction and progression of critical Doppler parameters (OR – 4.93).
Conclusions. Fetal growth restriction negatively affects the course of postnatal adaptation, increases the frequency and expands the structure of pathological conditions and metabolic dysfunctions of the neonatal period, especially in the group of newborns with a gestational age of 22–30 weeks, where maladaptation syndromes manifest themselves in a high frequency of neonatal asphyxia, pathological hyperbilirubinemia, perinatal damage to the central nervous system, acute adrenal insufficiency, and perinatal infection. Multivariate statistical analysis allowed us to establish the main predictors of the probability of a critical condition in newborns, where the following factors are important: gestational age at birth of 22–30 weeks (OR – 16.62), early form of fetal growth restriction (OR – 4.17), initial body weight <3 percentile (OR – 2.54), combination with gestational hypertension and preeclampsia (OR – 3.12), delivery against the background of critical Doppler parameters (OR – 4.93).
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