The association of cerebral palsy and death with small-for-gestational-age birthweight in preterm neonates by individualized and population-based percentiles

William A. Grobman, Yinglei Lai, Dwight J. Rouse, Catherine Y. Spong, Michael W. Varner, Brian M. Mercer, Kenneth J. Leveno, Jay D. Iams, Ronald J. Wapner, Yoram Sorokin, John M. Thorp, Susan M. Ramin, Fergal D. Malone, Mary J. O'Sullivan, Gary Hankins, Steve N. Caritis

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Objective The objective of the study was to determine whether an individualized growth standard (IS) improves the identification of preterm small-for-gestational-age (SGA) neonates at risk of developing moderate/severe cerebral palsy (CP) or death. Study Design This study was a secondary analysis of data from a randomized trial of MgSO4 for the prevention of CP or death among anticipated preterm births. Singleton nonanomalous liveborns delivered before 34 weeks' were classified as SGA (less than the 10th percentile for their gestational age) by a population standard (PS) or an IS (incorporating maternal age, height, weight, parity, race/ethnicity, and neonatal sex). The primary outcome was the prediction of moderate or severe CP or death by age 2 years. Results Of 1588 eligible newborns, 143 (9.4%) experienced CP (n = 33) or death (n = 110). Forty-four (2.8%) were SGA by the PS and 364 (22.9%) by the IS. All PS-SGA newborns also were identified as IS-SGA. SGA newborns by either standard had a similarly increased risk of CP or death (PS: relative risk [RR], 2.4, 95% confidence interval [CI], 1.3-4.3 vs IS: RR, 1.8, 95% CI, 1.3-2.5, respectively). The similarity of RRs remained after stratification by the MgSO4 treatment group. The IS was more sensitive (36% vs 6%, P <.001) but less specific (78% vs 98%, P <.001) for CP or death. The receiver operating characteristic curve analysis revealed a statistically lower area under the curve for the PS, although the ability of either method to predict which neonates would subsequently develop CP or death was poor (PS: 0.55, 95% CI, 0.49-0.60 vs IS: 0.59, 95% CI, 0.54-0.64, P <.001). Conclusion An individualized SGA growth standard does not improve the association with, or prediction of, CP or death by age 2 years.

Original languageEnglish (US)
JournalAmerican Journal of Obstetrics and Gynecology
Volume209
Issue number4
DOIs
StatePublished - Oct 2013

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Cerebral Palsy
Gestational Age
Newborn Infant
Population
Growth
Confidence Intervals
Premature Birth
Maternal Age
Parity
ROC Curve
Area Under Curve

Keywords

  • cerebral palsy death small for gestational age

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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The association of cerebral palsy and death with small-for-gestational-age birthweight in preterm neonates by individualized and population-based percentiles. / Grobman, William A.; Lai, Yinglei; Rouse, Dwight J.; Spong, Catherine Y.; Varner, Michael W.; Mercer, Brian M.; Leveno, Kenneth J.; Iams, Jay D.; Wapner, Ronald J.; Sorokin, Yoram; Thorp, John M.; Ramin, Susan M.; Malone, Fergal D.; O'Sullivan, Mary J.; Hankins, Gary; Caritis, Steve N.

In: American Journal of Obstetrics and Gynecology, Vol. 209, No. 4, 10.2013.

Research output: Contribution to journalArticle

Grobman, WA, Lai, Y, Rouse, DJ, Spong, CY, Varner, MW, Mercer, BM, Leveno, KJ, Iams, JD, Wapner, RJ, Sorokin, Y, Thorp, JM, Ramin, SM, Malone, FD, O'Sullivan, MJ, Hankins, G & Caritis, SN 2013, 'The association of cerebral palsy and death with small-for-gestational-age birthweight in preterm neonates by individualized and population-based percentiles', American Journal of Obstetrics and Gynecology, vol. 209, no. 4. https://doi.org/10.1016/j.ajog.2013.06.007
Grobman, William A. ; Lai, Yinglei ; Rouse, Dwight J. ; Spong, Catherine Y. ; Varner, Michael W. ; Mercer, Brian M. ; Leveno, Kenneth J. ; Iams, Jay D. ; Wapner, Ronald J. ; Sorokin, Yoram ; Thorp, John M. ; Ramin, Susan M. ; Malone, Fergal D. ; O'Sullivan, Mary J. ; Hankins, Gary ; Caritis, Steve N. / The association of cerebral palsy and death with small-for-gestational-age birthweight in preterm neonates by individualized and population-based percentiles. In: American Journal of Obstetrics and Gynecology. 2013 ; Vol. 209, No. 4.
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abstract = "Objective The objective of the study was to determine whether an individualized growth standard (IS) improves the identification of preterm small-for-gestational-age (SGA) neonates at risk of developing moderate/severe cerebral palsy (CP) or death. Study Design This study was a secondary analysis of data from a randomized trial of MgSO4 for the prevention of CP or death among anticipated preterm births. Singleton nonanomalous liveborns delivered before 34 weeks' were classified as SGA (less than the 10th percentile for their gestational age) by a population standard (PS) or an IS (incorporating maternal age, height, weight, parity, race/ethnicity, and neonatal sex). The primary outcome was the prediction of moderate or severe CP or death by age 2 years. Results Of 1588 eligible newborns, 143 (9.4{\%}) experienced CP (n = 33) or death (n = 110). Forty-four (2.8{\%}) were SGA by the PS and 364 (22.9{\%}) by the IS. All PS-SGA newborns also were identified as IS-SGA. SGA newborns by either standard had a similarly increased risk of CP or death (PS: relative risk [RR], 2.4, 95{\%} confidence interval [CI], 1.3-4.3 vs IS: RR, 1.8, 95{\%} CI, 1.3-2.5, respectively). The similarity of RRs remained after stratification by the MgSO4 treatment group. The IS was more sensitive (36{\%} vs 6{\%}, P <.001) but less specific (78{\%} vs 98{\%}, P <.001) for CP or death. The receiver operating characteristic curve analysis revealed a statistically lower area under the curve for the PS, although the ability of either method to predict which neonates would subsequently develop CP or death was poor (PS: 0.55, 95{\%} CI, 0.49-0.60 vs IS: 0.59, 95{\%} CI, 0.54-0.64, P <.001). Conclusion An individualized SGA growth standard does not improve the association with, or prediction of, CP or death by age 2 years.",
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T1 - The association of cerebral palsy and death with small-for-gestational-age birthweight in preterm neonates by individualized and population-based percentiles

AU - Grobman, William A.

AU - Lai, Yinglei

AU - Rouse, Dwight J.

AU - Spong, Catherine Y.

AU - Varner, Michael W.

AU - Mercer, Brian M.

AU - Leveno, Kenneth J.

AU - Iams, Jay D.

AU - Wapner, Ronald J.

AU - Sorokin, Yoram

AU - Thorp, John M.

AU - Ramin, Susan M.

AU - Malone, Fergal D.

AU - O'Sullivan, Mary J.

AU - Hankins, Gary

AU - Caritis, Steve N.

PY - 2013/10

Y1 - 2013/10

N2 - Objective The objective of the study was to determine whether an individualized growth standard (IS) improves the identification of preterm small-for-gestational-age (SGA) neonates at risk of developing moderate/severe cerebral palsy (CP) or death. Study Design This study was a secondary analysis of data from a randomized trial of MgSO4 for the prevention of CP or death among anticipated preterm births. Singleton nonanomalous liveborns delivered before 34 weeks' were classified as SGA (less than the 10th percentile for their gestational age) by a population standard (PS) or an IS (incorporating maternal age, height, weight, parity, race/ethnicity, and neonatal sex). The primary outcome was the prediction of moderate or severe CP or death by age 2 years. Results Of 1588 eligible newborns, 143 (9.4%) experienced CP (n = 33) or death (n = 110). Forty-four (2.8%) were SGA by the PS and 364 (22.9%) by the IS. All PS-SGA newborns also were identified as IS-SGA. SGA newborns by either standard had a similarly increased risk of CP or death (PS: relative risk [RR], 2.4, 95% confidence interval [CI], 1.3-4.3 vs IS: RR, 1.8, 95% CI, 1.3-2.5, respectively). The similarity of RRs remained after stratification by the MgSO4 treatment group. The IS was more sensitive (36% vs 6%, P <.001) but less specific (78% vs 98%, P <.001) for CP or death. The receiver operating characteristic curve analysis revealed a statistically lower area under the curve for the PS, although the ability of either method to predict which neonates would subsequently develop CP or death was poor (PS: 0.55, 95% CI, 0.49-0.60 vs IS: 0.59, 95% CI, 0.54-0.64, P <.001). Conclusion An individualized SGA growth standard does not improve the association with, or prediction of, CP or death by age 2 years.

AB - Objective The objective of the study was to determine whether an individualized growth standard (IS) improves the identification of preterm small-for-gestational-age (SGA) neonates at risk of developing moderate/severe cerebral palsy (CP) or death. Study Design This study was a secondary analysis of data from a randomized trial of MgSO4 for the prevention of CP or death among anticipated preterm births. Singleton nonanomalous liveborns delivered before 34 weeks' were classified as SGA (less than the 10th percentile for their gestational age) by a population standard (PS) or an IS (incorporating maternal age, height, weight, parity, race/ethnicity, and neonatal sex). The primary outcome was the prediction of moderate or severe CP or death by age 2 years. Results Of 1588 eligible newborns, 143 (9.4%) experienced CP (n = 33) or death (n = 110). Forty-four (2.8%) were SGA by the PS and 364 (22.9%) by the IS. All PS-SGA newborns also were identified as IS-SGA. SGA newborns by either standard had a similarly increased risk of CP or death (PS: relative risk [RR], 2.4, 95% confidence interval [CI], 1.3-4.3 vs IS: RR, 1.8, 95% CI, 1.3-2.5, respectively). The similarity of RRs remained after stratification by the MgSO4 treatment group. The IS was more sensitive (36% vs 6%, P <.001) but less specific (78% vs 98%, P <.001) for CP or death. The receiver operating characteristic curve analysis revealed a statistically lower area under the curve for the PS, although the ability of either method to predict which neonates would subsequently develop CP or death was poor (PS: 0.55, 95% CI, 0.49-0.60 vs IS: 0.59, 95% CI, 0.54-0.64, P <.001). Conclusion An individualized SGA growth standard does not improve the association with, or prediction of, CP or death by age 2 years.

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