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Analyses of premature birth: Weight percentiles of extremely premature newborns and prognostic significance of birth weight and sonographically estimated fetal weight



Analyses of premature birth: Weight percentiles of extremely premature newborns and prognostic significance of birth weight and sonographically estimated fetal weight



Geburtshilfe und Frauenheilkunde 58(9): 491-496



Purpose: Estimated fetal weight in very-low-birth-weight infants (VLBWI) frequently serves as a prognostic factor and as an aid for planning management of delivery. However, few data are available on the normal range of birth weight prior to the 32nd gestational week. Moreover, estimated fetal weight is subject to a mean error of 15-20%. Material and Method: Thus we calculated percentiles of birth weight, analyzed the prognostic significance of birth weight, and estimated fetal weight for the survival of VLBWI in 437 unselected single births. Results: The 3rd, 10th. 50th, 90th and 97th percentiles between 24 and 32 week's gestation were 514-997g, 526-1106g, 710-1590g, 888-1964g and 1106-2082g, respectively. Thus, a 1 000 g newborn could be of a gestational age of 24-32 gestational weeks (95th and 10th percentile, respectively). The estimated fetal weight had a mean error of +-15%. The highest deviation of -560 g corresponds to a variation of 5 gestational weeks (estimated 1100 g. acutal 1660 g). The uncorrected and corrected neonatal mortality rates were 16.5% and 7%, respectively (corrected by malformations and abortions). The uncorrected mortality rate decreased from 61 % (wk 23/24) through 29% (wk 25/26), 13% (wk 27/28), 9% (wk 29/30) to 8% (wk 31/32), respectively. The respective corrected mortality rate decreased continuously from 25% to 3%. In contrast, the mortality rate was inconsistent between a birth weight of < 750 g and > 1 500 g after weight stratification in 250 g steps (54%, 19%, 21%, 6%, 6%). While there was a significant correlation between gestational age and neonatal mortality rates (R = 0,94; p < 0,02), no correlation could be shown between birth weight and the mortality rate (R = 0.8; p = 0.11). Conclusion: Because of the lack of specificity of birth weight for gestational age and consequently fetal maturity, and because of the large systematic error in estimating fetal weight, the management of VLBWI should be based on the gestational age rather than on the estimated birth weight.

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