Bs. Xu et al., EVALUATION OF TWIN GROWTH STATUS AT BIRTH USING INDIVIDUALIZED GROWTHASSESSMENT - COMPARISON WITH CONVENTIONAL METHODS, Journal of clinical ultrasound, 23(5), 1995, pp. 277-286
Citations number
23
Categorie Soggetti
Radiology,Nuclear Medicine & Medical Imaging",Acoustics
Objective: We sought to evaluate the growth status of twins at birth u
sing individualized growth assessment methods and to compare this asse
ssment with that obtained with conventional methods. Study design: Twe
nty twin pregnancies were studied longitudinally with ultrasound. Meas
urements of the head and abdominal cubes (A,B), head circumference (HC
), abdominal circumference (AC), thigh circumference (ThC), and femur
diaphysis length (FDL) made in the 2nd trimester were used to specify
Rossavik growth models for each parameter in each fetus. These models
were used to predict weight (WT), HC, AC, ThC, and crown-head length (
CHL) at birth. Actual birth measurements made within 24 hours of deliv
ery were compared to predicted values, the latter corrected using sing
leton [corrects for both technical problems (TP)] or twin [corrects fo
r both technical problems (TP) and decreased soft-tissue deposition (D
STD)] correction factors where appropriate. Two sets of growth potenti
al realization index (GPRI) values and their corresponding neonatal gr
owth assessment scores (NGAS) were calculated and compared to previous
ly established normal values. Birth measurements were compared with ap
propriate population age-specific size curves. These data were used to
characterize and classify the growth status of each twin neonate. Res
ults: Individualized growth assessment identified five primary types o
f growth outcomes: normal (Group I, 45%); primarily DSTD (Group II, 22
.5%); IUGR (Group III, 15%); above average soft-tissue deposition (Gro
up IV, 5%); and growth acceleration (Group V, 7.5%). Within Group I wa
s a subgroup with evidence of DSTD (Group Ib, 33.3% of Group I). Group
II could be divided into two subgroups, one with only DSTD (Group IIa
, 44.4% of Group II) and one with both DSTD and other growth abnormali
ties (Group IIb, 55.6% of Group II). Group III had multiple growth abn
ormalities which were more severe than those seen in Group II. All nor
mal neonates were AGA and had virtually all anatomic parameters within
their respective normal ranges. Of the neonates with definite evidenc
e of IUGR (Groups IIb and III), only 4 of 11 (36.4%) were SGA and only
6 of 11 (54.5%) had any of the five anatomic parameters below their r
espective normal ranges. Only 1 of 3 (33.3%) of neonates with growth a
cceleration was LGA and none (0%) of the five anatomic parameters were
above their respective normal ranges. Conclusions: Individualized gro
wth assessment methods provide a more comprehensive assessment of grow
th outcome in twins and detect a decrease in soft-tissue deposition no
t identifiable with conventional growth assessment procedures. The lat
ter procedures are also less sensitive in the detection of both IUGR a
nd growth acceleration. (C) 1995 John Wiley and Sons, Inc.