Fetal growth restriction and other factors associated with neonatal death in New Zealand

Battin, Malcolm; McCowan, Lesley; George-Haddad, Maha; Thompson, John M. D.

doi:10.1111/j.1479-828x.2007.00779.x

Cited by 8 publications

(4 citation statements)

References 42 publications

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“…Recent studies in France and New Zealand found that 17% and 13% of all neonatal deaths were below the tenth percentiles of national standards [27], [28]. This compared to studies of stillbirth where between 40% and 60% are associated with growth restriction [29].…”

Section: Discussionmentioning

confidence: 99%

International Comparisons of Fetal and Neonatal Mortality Rates in High-Income Countries: Should Exclusion Thresholds Be Based on Birth Weight or Gestational Age?

et al. 2013

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BackgroundFetal and neonatal mortality rates are essential indicators of population health, but variations in recording of births and deaths at the limits of viability compromises international comparisons. The World Health Organization recommends comparing rates after exclusion of births with a birth weight less than 1000 grams, but many analyses of perinatal outcomes are based on gestational age. We compared the effects of using a 1000-gram birth weight or a 28-week gestational age threshold on reported rates of fetal and neonatal mortality in Europe.MethodsAggregated data from 2004 on births and deaths tabulated by birth weight and gestational age from 29 European countries/regions participating in the Euro-Peristat project were used to compute fetal and neonatal mortality rates using cut-offs of 1000-grams and 28-weeks (2.8 million total births). We measured differences in rates between and within countries using the Wilcoxon signed rank test and 95% confidence intervals, respectively.Principal FindingsFor fetal mortality, rates based on gestational age were significantly higher than those based on birth weight (p<0.001), although these differences varied between countries. The use of a 1000-gram threshold included 8823 fetal deaths compared with 9535 using a 28-week threshold (difference of 712). In contrast, the choice of a cut-off made little difference for comparisons of neonatal deaths (difference of 16). Neonatal mortality rates differed minimally, by under 0.1 per 1000 in most countries (p = 0.370). Country rankings were comparable with both thresholds.ConclusionsNeonatal mortality rates were not affected by the choice of a threshold. However, the use of a 1000-gram threshold underestimated the health burden of fetal deaths. This may in part reflect the exclusion of growth restricted fetuses. In high-income countries with a good measure of gestational age, using a 28-week threshold may provide additional valuable information about fetal deaths occurring in the third trimester.

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Section: Discussionmentioning

confidence: 99%

International Comparisons of Fetal and Neonatal Mortality Rates in High-Income Countries: Should Exclusion Thresholds Be Based on Birth Weight or Gestational Age?

et al. 2013

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“…There are two possible explanations for especially large differences in growth between survivors and non‐survivors in the youngest individuals. On one hand, this could be due to factors impacting health and growth in the gestational periods, as maternal factors are known to be a major driver of mortality in the first month of life (Abdullah et al, 2016 ; Battin et al, 2007 ; Bourgeois, 1951 ). However, in part because the study design excluded deaths due to severe prematurity or gestational deaths, those where cause of death was unknown, and sudden deaths in infancy, sample size is small in this age group, particularly in the accidental death group.…”

Section: Discussionmentioning

confidence: 99%

Biological mortality bias in diaphyseal growth of contemporary children: Implications for paleoauxology

Spake

Hoppa

Blau

et al. 2022

American Journal of Biological Anthropology

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Objectives: Biological mortality bias is the idea that individuals who comprise skeletal samples (non-survivors) are a specific subset of the overall population, who may have been exposed to greater stress during life. Because of this, it is possible that studying growth in a skeletal population misrepresents the growth and health of survivors in that population. Using a modern sample, this study investigates whether biological mortality bias in growth may be present in archaeological skeletal samples.Materials and methods: Postmortem computed tomography scans of 206 children aged under 13 years were collected from two institutions in the United States and Australia. The sample was separated into children who died from natural causes as proxies for non-survivors and from accidental causes as proxies for survivors. Differences in long bone length for age were assessed through analysis of covariance (ANCOVA) and z-score analysis, and these results were compared with studies linking anthropometrics and mortality risk in nonindustrialized societies.Results: Differences in growth favoring survivors were greater for girls than for boys and seemed to increase over age. The effect in nonindustrialized societies was 1.5 to 5 times the magnitude of that in our contemporary sample.Conclusions: A greater growth delay in girls than in boys has been documented in historical identified collections, and skeletal samples consistently become more stunted relative to modern standards over the course of growth. Our findings on biological mortality bias could explain part of these growth delays and impact interpretations of past ontogenetic environments.bioarchaeology, growth and development, long bone, osteological paradox, skeletal growth profiles | INTRODUCTIONIn The Osteological Paradox, Wood et al. (1992) outline a series of scenarios in which bioarchaeological conclusions drawn from skeletal samples might not reflect the health of the surviving segment of the population. Shortly after, Saunders and Hoppa (1993, p. 129) coined the term biological mortality bias, referring to the "physiological and morphological difference between those who die and those who survive." Biological mortality bias is a problem for all bioarchaeological analysis, but it is especially problematic for paleoauxology, or the study of growth in the past (Tillier, 1995), because growth is known to be environmentally sensitive (Bogin, 1999). This property has made

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“…IUGR is more difficult to define and measure but approximately 10% of all infants will be born small for gestational (SGA) defined as birthweight < 10 th customised birthweight centile and at least two thirds of these have evidence of abnormal uterine and umbilical Doppler waveforms if diagnosed prior to birth suggesting significant utero-placental disease and fetal growth restriction [2]. Infants who are born growth restricted with or without maternal preeclampsia are at increased risk of morbidity and mortality during the perinatal period [3–5], and this risk continues into childhood and adult life with higher rates of neurosensory disability, cognitive impairment, short stature, hypertension, diabetes and long term cardiovascular disease [6–11]. Women with preeclampsia and/or IUGR fetuses are more likely to require preterm delivery, with over one third of women with preeclampsia and 15% of SGA infants delivering <37 weeks [12].…”

Section: Introductionmentioning

confidence: 99%

“…Women with preeclampsia and/or IUGR fetuses are more likely to require preterm delivery, with over one third of women with preeclampsia and 15% of SGA infants delivering <37 weeks [12]. Iatrogenic preterm birth often results in operative delivery and therefore has inherent risks to the mother and results in the significant additional risks of prematurity for an already compromised infant [3, 13–15]. …”

Section: Introductionmentioning

confidence: 99%

Enoxaparin for the prevention of preeclampsia and intrauterine growth restriction in women with a prior history – an open-label randomised trial (the EPPI trial): study protocol

Groom

McCowan

Stone

et al. 2016

BMC Pregnancy Childbirth

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BackgroundPreeclampsia and intrauterine fetal growth restriction (IUGR) are two of the most common causes of maternal and perinatal morbidity and mortality. Current methods of predicting those at most risk of these conditions remain relatively poor, and in clinical practice past obstetric history remains the most commonly used tool. Aspirin and, in women at risk of preeclampsia only, calcium have been demonstrated to have a modest effect on risk reduction. Several observational studies and randomised trials suggest that low molecular weight heparin (LMWH) therapy may confer some benefit.Methods/designThis is a multicentre open label randomised controlled trial to determine the effect of the LMWH, enoxaparin, on the prevention of recurrence of preeclampsia and/or IUGR in women at high risk due to their past obstetric history in addition to standard high risk care for all participants.Inclusion criteria: A singleton pregnancy >6+0 and <16+0 weeks gestation with most recent prior pregnancy with duration >12 weeks having; (1) preeclampsia delivered <36+0 weeks, (2) Small for gestational age (SGA) infant <10th customised birthweight centile delivered <36+0 weeks or, (3) SGA infant ≤3rd customised birthweight centile delivered at any gestation. Randomisation is stratified for maternal thrombophilia status and women are randomly assigned to ‘standard high risk care’ or ‘standard high risk care’ plus enoxaparin 40 mg from recruitment until 36+0 weeks or delivery, whichever occurs sooner. Standard high risk care includes the use of aspirin 100 mg daily and calcium 1000–1500 mg daily (unless only had previous SGA with no preeclampsia).The primary outcome is preeclampsia and/or SGA <5th customised birthweight centile. Analysis will be by intention to treat.DiscussionThe EPPI trial has more focussed and clinically relevant inclusion criteria than other randomised trials with a more restricted composite primary outcome. The inclusion of standard use of aspirin (and calcium) for all participants will help to ensure that any differences observed in outcome are likely to be related to enoxaparin use. These data will make a significant contribution to future meta-analyses and systematic reviews on the use of LMWH for the prevention of placental mediated conditions.Trial registration ACTRN12609000699268 Australian New Zealand Clinical Trials Registry. Date registered 13/Aug/2009 (prospective registration).

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Fetal growth restriction and other factors associated with neonatal death in New Zealand

Abstract: This study emphasises the importance of suboptimal fetal growth as an important risk factor for neonatal death especially when customised centiles are used.

Cited by 8 publications

References 42 publications

International Comparisons of Fetal and Neonatal Mortality Rates in High-Income Countries: Should Exclusion Thresholds Be Based on Birth Weight or Gestational Age?

International Comparisons of Fetal and Neonatal Mortality Rates in High-Income Countries: Should Exclusion Thresholds Be Based on Birth Weight or Gestational Age?

Biological mortality bias in diaphyseal growth of contemporary children: Implications for paleoauxology

Enoxaparin for the prevention of preeclampsia and intrauterine growth restriction in women with a prior history – an open-label randomised trial (the EPPI trial): study protocol

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