Prediction of fetal lung immaturity using gestational age, patient characteristics and fetal lung maturity tests: a probabilistic approach
The lecithin/sphingomyelin (L/S) ratio and the lamellar body count (LBC) can be used to predict respiratory distress syndrome (RDS).
We performed a retrospective cohort study among consecutive women who underwent amniotic fluid sampling for the assessment of fetal lung maturity. Logistic regression was used to construct models for the prediction of RDS in three gestational age categories, with models based on clinical characteristics only, clinical characteristics and the LBC, and on clinical characteristics and L/S ratio.
When amniotic fluid was collected <30 weeks, the specificity of the LBC was 30% and the sensitivity 100%. Addition of the L/S ratio increased the specifity to 60%, for a sensitivity of 100%. When amniocentesis was performed between 30 and 33 weeks, addition of the L/S ratio only marginally improved the performance of the LBC.
At a gestational age <30 weeks, the L/S ratio has additional value over the LBC. Above 30 weeks of gestation, single use of the LBC seems sufficient.
- Gluck, L, Kulovich, MV (1973) Lecithin/sphinogmyelin ratios in amniotic fluid in normal and abnormal pregnancy. Am J Obstet Gynecol 15: pp. 539-546
- Dubin, SB (1998) Assessment of fetal lung maturity. Practice parameter. Am J Clin Pathol 110: pp. 723-732
- Neerhof, MG, Dohnal, JC, Ashwood, ER, Lee, IS, Anceschi, MM (2001) Lamellar body counts: a consensus on protocol. Obstet Gynecol 97: pp. 318-320 CrossRef
- Wijnberger, LDE, Huisjes, AJ, Voorbij, HA, Franx, A, Bruinse, HW, Mol, BW (2001) The accuracy of lamellar body count and lecithin/sphingomyelin ratio in the prediction of neonatal respiratory distress syndrome: a meta-analysis. BJOG 108: pp. 583-588 CrossRef
- Richardson, DK, Heffner, LJ (2001) Fetal-lung maturity: tests mature, interpretation not. Lancet 358: pp. 684-686 CrossRef
- Giedion, A, Haefliger, H, Dangel, P (1973) Acute pulmonary X-ray changes in hyaline membrane disease treated with artificial ventilation and positive end-expiratory pressure (PEP). Pediatr Radiol 1: pp. 145-152 CrossRef
- Wijnberger, LD, Kleine, M, Voorbij, HA, Arabin, B, Leur, JJ, Bruinse, HW, Visser, GH, Bossuyt, PM, Mol, BW (2003) The effect of clinical characteristics on the lecithin/sphingomyelin ratio and lamellar body count: a cross-sectional study. J Matern Fetal Neonatal Med 14: pp. 373-382 CrossRef
- Begg, CB, McNeil, BJ (1988) Assessment of radiological tests: control of bias and other design considerations. Radiology 167: pp. 565-569
- Hunink, MG, Richardson, DK, Doubilet, PM, Begg, CB (1990) Testing for fetal pulmonary maturity: ROC analysis involving covariates, verification bias, and combination testing. Med Decis Making 10: pp. 201-211 CrossRef
- Steyerberg EW (1996) Prognostic modeling for clinical decision making. Scientific Thesis. Erasmus University, Rotterdam, pp 19–40
- Graziosi, GC, Bakker, CM, Brouwers, HA, Bruinse, HW (1998) Elective cesarean section is preferred after the completion of a minimum of 38 weeks of pregnancy. Ned Tijdschr Geneeskd 142: pp. 2300-2303
- Karcher, R, Sykes, E, Batton, D, Uddin, Z, Ross, G, Hockman, E, Shade, GH (2005) Gestational age-specific predicted risk of neonatal respiratory distress syndrome using lamellar body count and surfactant-to-albumin ratio in amniotic fluid. Am J Obstet Gynecol 193: pp. 1680-1684 CrossRef
- Prediction of fetal lung immaturity using gestational age, patient characteristics and fetal lung maturity tests: a probabilistic approach
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Archives of Gynecology and Obstetrics
Volume 281, Issue 1 , pp 15-21
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- Fetal lung maturity
- Lamellar body count
- L/S ratio
- Respiratory distress sydrome (RDS)
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- Author Affiliations
- 1. Department of Obstetrics, Neonatology and Gynaecology, University Medical Center Utrecht, KJ02.507.0 Wilhelmina Children’s Hospital, PO Box 85090, 3508 AB, Utrecht, The Netherlands
- 2. Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
- 3. Departments of Clinical Chemistry, University Medical Center Utrecht, Utrecht, The Netherlands
- 4. Departments of Obstetrics, Isala Clinics, Location Sophia, Zwolle, The Netherlands
- 5. Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands
- 6. Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands