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OC22.02: Combination of the aortic isthmus with ductus venosus improves the prediction of neurological damage in early‐onset intrauterine growth restricted fetuses

Objectives: To evaluate the neurobehavioral outcome of earlyonset intrauterine growth restricted (IUGR) fetuses with abnormal umbilical artery (UA) Doppler and to compare the groups with and without brain sparing. Methods: A cohort of consecutive IUGR fetuses (birth weight < 10th centile) with abnormal UA Doppler (pulsatility index > 95th centile) and requiring delivery before 34 weeks was created and compared to a group of appropriate-for-gestational age (AGA) infants matched with cases by gestational age at delivery. Middle cerebral artery (MCA) was assessed by Doppler in all cases within 72 hours of delivery. Neonatal behavior was evaluated at 40-week corrected age with the Neonatal Behavioral Assessment Scale (NBAS). The effects of the study group and brain sparing (MCA pulsatility index < 5th centile) on each NBAS area were adjusted by multiple analysis of covariance or logistic regression for smoking during pregnancy, socioeconomic level, mode of delivery and gender. Results: A total of 126 fetuses (64 IUGR and 62 AGA) were included. Among IUGR fetuses, the proportion with abnormal MCA was 55%. All the neurobehavioral areas studied were poorer in the IUGR group, significantly in habituation, motor and socialinteractive. Abnormal habituation (36.2 vs. 16.3%; P = 0.027), motor (40.3 vs. 15.6%; P = 0.002) and social-interactive (25.8 vs. 8.2%; P = 0.009) scores were more frequent in IUGR than in AGA newborns. All the neurobehavioral areas studied were poorer in IUGR fetuses with brain sparing, significantly in habituation, motor, social-interactive and attention. Abnormal MCA identified IUGR fetuses with the highest risks of abnormal NBAS in motor (odds ratio 3.6; P = 0.011), social-interactive (odds ratio 4.1; P = 0.019) and attention (odds ratio 3.7; P = 0.011) areas. Conclusions: Early-onset IUGR with abnormal umbilical artery Doppler have poorer neurobehavioral competencies, which suggest a delayed neurological maturation. Abnormal MCA Doppler discriminates those cases at highest risk for abnormal neurobehavior.