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Fetal and Neonatal Outcomes in Fetuses with an Estimated Fetal Weight Percentile of 10–20 in the Early Third Trimester: A Retrospective Cohort Study
(MDPI AG, 2025)
Mendez-Piña, Miguel A.
;
Lumbreras-Márquez, Mario Isaac
;
Acevedo-Gallegos, Sandra
;
Velázquez-Torres, Berenice
;
Rodriguez-Sibaja, Maria J.
first_pagesettingsOrder Article Reprints Open AccessArticle Fetal and Neonatal Outcomes in Fetuses with an Estimated Fetal Weight Percentile of 10–20 in the Early Third Trimester: A Retrospective Cohort Study by Miguel A. Mendez-Piña 1ORCID,Mario I. Lumbreras-Marquez 1,2,Sandra Acevedo-Gallegos 1,Berenice Velazquez-Torres 1ORCID,Maria J. Rodriguez-Sibaja 1,Dulce M. Camarena-Cabrera 1 andJuan M. Gallardo-Gaona 1,*ORCID 1 Maternal-Fetal Medicine Department, Instituto Nacional de Perinatologia, Mexico City 11000, Mexico 2 Department of Epidemiology and Public Health, Universidad Panamericana School of Medicine, Mexico City 03920, Mexico * Author to whom correspondence should be addressed. Diagnostics 2025, 15(17), 2251; https://doi.org/10.3390/diagnostics15172251 Submission received: 12 June 2025 / Revised: 1 August 2025 / Accepted: 1 August 2025 / Published: 5 September 2025 (This article belongs to the Special Issue Diagnosis and Management of Contemporary Issues in Maternal-Fetal Medicine) Downloadkeyboard_arrow_down Browse Figures Review Reports Versions Notes Abstract Background: Fetal size is often dichotomized as normal or abnormal using the 10th percentile of estimated fetal weight (EFW) or abdominal circumference as a cutoff. While the risk of adverse perinatal outcomes decreases with increasing fetal weight percentile, no percentile completely eliminates that risk. Objective: The aim of this study was to compare perinatal outcomes between fetuses with an EFW between the 10th and 20th percentiles and those with an EFW between the 20th and 90th percentiles (i.e., >20 and <90) at the beginning of the accelerated growth stage (28.0–30.0 weeks’ gestation). Methods: We conducted a retrospective cohort study of singleton pregnancies managed at a quaternary center in Mexico City (2017–2024). Outcomes were compared based on EFW percentiles at 28.0–30.0 weeks. The primary outcome was adverse neonatal outcome (ANeO), defined as the presence of at least one of the following: umbilical artery pH ≤ 7.1, 5 min Apgar ≤ 7, NICU admission, early neonatal hypoglycemia, non-reassuring fetal status, respiratory distress syndrome, intraventricular hemorrhage, hypoxic–ischemic encephalopathy, or perinatal death. Secondary outcomes included progression to fetal growth restriction (FGR) and low birth weight. Modified Poisson regression was used to estimate adjusted risk ratios (aRRs) with 95% confidence intervals (CIs). Results: Among 650 cases, ANeO occurred in 45.8% of fetuses in the 10th–20th percentile group vs. 29.4% in the 20th–90th percentile group (aRR: 1.51, 95% CI: 1.22–1.86; p < 0.001). FGR and low birth weight were also more frequent in the 10th–20th percentile group (21.1% and 27.6% vs. 6.4% and 5.8%, respectively; p < 0.001). Conclusions: Fetuses between the 10th and 20th percentiles at 28–30 weeks have increased risks of neonatal morbidity, FGR, and low birth weight. ©The authors ©Diagnostics © MDPI AG.
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Survival assessment in extremely preterm neonates in a middle-income setting
(Frontiers Media SA, 2025)
Rodriguez-Sibaja, Maria J.
;
Herrera-Ortega, Olivo
;
Lumbreras-Márquez, Mario Isaac
;
Morales-Barquet, Deneb
;
Acevedo-Gallegos, Sandra
Introduction: Globally, an estimated 15.1 million preterm neonates are born annually, with 1% classified as extremely preterm (i.e., <28.0 weeks of gestation). The survival and outcomes of this vulnerable population are influenced by multiple factors, particularly gestational age, birth weight, and available medical resources. This study aimed to describe the hospital discharge survival of extremely preterm infants born in a middle-income setting. As a secondary objective, we assessed the neonatal morbidity associated with this group.Material and methods: In this cross-sectional study of singleton pregnancies, neonatal survival following extremely preterm birth was determined using three different denominators and expressed as prevalence (i.e., percentages): (1) the total number of extremely preterm births, including intrapartum fetal deaths; (2) the total number of all live births, including neonatal deaths in the delivery room, and (3) the total number of preterm neonates admitted to the neonatal intensive care unit (NICU). Neonatal morbidity was assessed as a secondary outcome.Results: There were no live births between 22.0 and 23.6 weeks of gestation. Overall mortality decreased with increasing gestational age, from 100% (22/22) at <24.0 weeks of gestation to 87% (14/16), 42% (16/38), and 21% (11/52) at a gestational age of 25, 26, and 27 weeks, respectively. The survival rate to NICU discharge among extremely preterm infants was 49% (65/132), 67% (65/97), and 69% (65/93), depending on whether survival was calculated based on all births, all live births, or NICU admissions, respectively. None of the neonates born before 24.6 weeks of gestation survived to discharge. Notably, 97.0% of NICU survivors were diagnosed with major morbidity.Conclusion: The survival rate at NICU discharge exceeds 50% from 26 weeks onwards in a middle-income setting. Importantly, survival rates varied significantly depending on the denominator used, highlighting the need to carefully select inclusion criteria in neonatal survival analyses. Notably, survival after extremely preterm birth was associated with significant morbidity. ©The authors ©Frontiers in Pediatrics.

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