2 year neurodevelopmental and intermediate perinatal outcomes in infants with very preterm fetal growth restriction (TRUFFLE): a randomised trial

Lees, C.; Marlow, Neil; Wassenaer-Leemhuis, Aleid van; Arabin, Birgit; Bilardo, Caterina M.; Brezinka, Christoph; Calvert, Sandy; Derks, Jan; Diemert, Anke; Duvekot, Johannes J.; Ferrazzi, E.; Frusca, T.; Ganzevoort, Wessel; Hecher, Kurt; Martinelli, Pasquale; Ostermayer, E.; Papageorghiou, Aris T.; Schlembach, Dietmar; Schneider, K. T. M.; Thilaganathan, B.; Todros, Tullia; Valcamonico, Adriana; Visser, Gerard H.A.; Wolf, Hans

doi:10.1016/s0140-6736(14)62049-3

Cited by 378 publications

(369 citation statements)

References 28 publications

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“…After 26 weeks the best results in terms of short term and 2-year outcomes were reported by the TRUFFLE group [3,87], with 8% overall mortality (3% beyond 30 weeks), 24% severe neonatal morbidity, and low rates of bronchopulmonary dysplasia and poor neurodevelopmental outcome despite including fetuses who were on average 1 week younger and 300 g lighter if compared to the other RCT (GRIT) conducted on FGR fetuses [88]. Overall 69% of the 503 included fetuses survived without severe neonatal morbidity and these results were explained as a consequence of a more detailed and standardized protocol of surveillance.…”

Section: Discussionmentioning

confidence: 98%

“…Regarding the mode of delivery, 97% of women in TRUFFLE had Caesarean deliveries, compared with 98 and 85% in the cohorts reported by Baschat and GRIT, respectively [3,87,88,100,101]. It is of note that no studies have evaluated the optimal mode of delivery in early FGR fetuses.…”

Section: Timing Of Deliverymentioning

confidence: 96%

“…DV has been demonstrated to be the single strongest Doppler parameter to predict the short term risk of fetal death in early onset FGR [64] and there is good correlation between abnormal DV waveform and late stage acidemia. Absent or reversed A-wave have been reported to be associated with increased risk of intrauterine fetal death (40-70%) independently of the gestational age at delivery; DV PI >95th centile also confers higher risk of adverse outcome, although at lesser extent than that of reversed or absent Awave [87]. According to Hecher et al [76] DV is, together with computerized cardiotocography (cCTG), the parameter which last modifies before delivery, and the TRUFFLE group has demonstrated the benefits of a longer stay in utero, especially with regard to long term outcomes.…”

Section: Managementmentioning

confidence: 99%

“…Despite being one of the most relevant and most commonly studied conditions in modern obstetrics, there has not been consensus among International Guidelines regarding the optimal management of early onset FGR in terms of monitoring and recommended gestational age at delivery, which can be due to the lack of comparability among studies and the paucity of randomized controlled trials available [3,65,87,88]. Nevertheless, more recent data suggest that reliable protocols of surveillance and management are emerging now [3,88].…”

Section: Managementmentioning

confidence: 99%

“…The "late" DV group (absent or reversed Awave) was associated with significant improval in the rate of survival without impairment when compared to computerized CTG, and delivery was recommended in case of umbilical artery REDF between 30 and 32 weeks, umbilical artery AEDF between 32 and 34 weeks, or umbilical artery PI >95 th centile beyond 34 weeks. Safety nets for the computerised CTG were used in the TRUFFLE protocol, and may have contributed to the excellent outcomes in term of mortality and survival without impairment [3,87].…”

Section: Timing Of Deliverymentioning

confidence: 99%

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Early onset fetal growth restriction

Nawathe

Lees

2017

Best Practice & Research Clinical Obstetrics & Gynaecol

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Fetal growth restriction (FGR) diagnosed before 32 weeks is identified by fetal smallness associated with Doppler abnormalities and is associated with significant perinatal morbidity and mortality and maternal complications. Recent studies have provided new insights into pathophysiology, management options and postnatal outcomes of FGR. In this paper we review the available evidence regarding diagnosis, management and prognosis of fetuses diagnosed with FGR before 32 weeks of gestation.

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Section: Discussionmentioning

confidence: 98%

Section: Timing Of Deliverymentioning

confidence: 96%

Section: Managementmentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

Section: Timing Of Deliverymentioning

confidence: 99%

See 3 more Smart Citations

Early onset fetal growth restriction

Nawathe

Lees

2017

Best Practice & Research Clinical Obstetrics & Gynaecol

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Analysis of Factors Associated With Body Mass Index at Ages 18 and 36 Months Among Infants Born Extremely Preterm

et al. 2021

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IMPORTANCEThe development of neonatology has been associated with improved survival among infants born extremely preterm, and understanding their long-term outcomes is becoming increasingly important. However, there is little information on body mass index (BMI) among these children.OBJECTIVE To determine factors associated with BMI at ages 18 months and 36 months among infants born extremely preterm. DESIGN, SETTING, AND PARTICIPANTSThis retrospective, multicenter cohort study was conducted using data from the Neonatal Research Network Japan database for 8838 infants born at gestational ages 23 to 28 weeks with data on BMI at 18 months and 36 months. Data were analyzed from April 2018 through June 2021. EXPOSURES BMI and BMI z score at ages 18 months and 36 months were regressed with gestational age, intrauterine growth restriction (IUGR) status, and complications during pregnancy and the neonatal period separately by presence of multiple pregnancy and sex. MAIN OUTCOMES AND MEASURES BMI and BMI z score at ages 18 months and 36 months. RESULTS Among 16 791 eligible infants born extremely preterm, 8838 infants were included in the analysis. There were 7089 infants born from single pregnancies (mean [SD] gestational age, 26.0 [1.6] weeks; 3769 [53.2%] boys; mean [SD] birth weight, 847 [228] g) and 1749 infants born from multiple pregnancies (mean [SD] gestational age, 26.3 [1.5] weeks; 903 [51.6%] boys; mean [SD]birth weight, 860 [217] g). In single pregnancies, every week of increased gestational age was associated with an increase in BMI of 0.21 (95% CI, 0.17-0.25) among boys and 0.20 (95% CI, 0.15-0.25) among girls at age 18 months and 0.21 (95% CI, 0.18-0.24) among boys and 0.21 (95% CI, 0.18-0.24) among girls at age 36 months. There was an interaction association between gestational age and IUGR among boys at age 36 months, with a decrease in the change associated with gestational age of 0.12 (95% CI, 0.05-0.19). Every week of increased gestational age in single pregnancies was associated with an increase in BMI z score of 0.14 (95% CI, 0.17-0.21) among boys and 0.17 (95% CI, 0.13-0.21) among girls at age 18 months and 0.19 (95% CI, 0.16-0.22) among boys and 0.17 (95% CI, 0.15-0.20) among girls at age 36 months. Among single pregnancies, IUGR was associated with a decrease in BMI among boys (0.59 [95% CI, 0.23-0.95]) and girls (0.75 [95% CI,]) and BMI z score among boys 0.85 [95% CI, 0.25-0.95)] and girls (0.67 [95% CI, 0.36-0.97] at age 18 months and BMI among boys (0.44 [95% CI, 0.17-0.18]) and girls (0.84 [95% CI, 0.55-1.12]) and BMI z score among boys (0.46 [95% CI, 0.21-0.71]) and girls (0.77 [95% CI, 0.53-1.01]) at age 36 months. In multiple pregnancies, IUGR was associated with a decrease in BMI z score at age 36 months among boys (0.26 [95% CI, 0.42-0.89]) and girls (0.29 [95% CI, 0.22-0.79]). In single pregnancies (continued) Key Points Question What factors are associated with body mass index (BMI) in the first 36 months of life among infants born at gestational age less than 28 weeks? Findings In t...

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