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Ossification Sequence in Infants Who Die during the Perinatal Period: Population-based References¹

¹ From the Departments of Radiology (Ø.E.O., K.R.) and Pathology (H.M.M.), Haukeland University Hospital, Bergen, Norway; Section for Medical Statistics and Medical Birth Registry of Norway, University of Bergen, Norway (R.T.L.); and International Skeletal Dysplasia Registry, Cedars-Sinai Medical Center, Los Angeles, Calif (R.S.L.). Received June 28, 2001; revision requested August 16; revision received October 1; accepted April 25, 2002. Supported by the Sigrun and Haakon Ødegaard Foundation. Address correspondence to Ø.E.O., Department of Radiology, Great Ormond Street Hospital for Children, Great Ormond St, London WC1N 3JH, England (e-mail: oeol@start.no).

View larger version (133K): [in a new window]   Figure 1. Portions of radiographs in different fetuses show ossification centers of interest in the perinatal period. Upper left: Both ischial rami (*) and one superior pubic ramus (arrow) are visible. Lower left: Two ossification centers (arrows) are visible in the hindfoot. Right: Two ossification centers (arrows) are visible in the knee.

View larger version (53K): [in a new window]   Figure 2. Graphs show the median and Tukey test values for gestational age and femur length within ossification stages. Dotted overlays represent mean and 10th-, 25th-, 75th- and 90th-percentile ranges of femur length by gestational age calculated earlier from the same data. w = weeks. Upper left: Ossification stages in pelvis by gestational age ( = 0.737, P < .001) and femur length ( = 0.761, P < .001). 0 = neither ischial rami nor superior pubic rami ossified, 1 = one or both ischial rami but no superior pubic ramus ossified, 2 = both ischial rami and at least one superior pubic ramus ossified. Upper right: Ossification stages in hindfeet by gestational age ( = 0.674, P < .001) and femur length ( = 0.735, P < .001). 0 = no hindfoot ossification centers visible, 1 = one visible ossification center in at least one hindfoot, 2 = two visible centers in at least one hindfoot, 3 = three visible centers in at least one hindfoot. Lower left: Ossification stages in knees by gestational age ( = 0.546, P < .001) and femur length ( = 0.573, P < .001). 0 = no knee ossification centers visible, 1 = one visible ossification center in at least one knee, 2 = two visible centers in at least one knee. Lower right: Ossification clusters by gestational age ( = 0.783, P < .001) and femur length ( = 0.871, P < .001). See Table for cluster definitions.

View larger version (42K): [in a new window]   Figure 3. Graphs show ossification clusters among infants with lower () and higher () probability of growth restriction by gestational age (upper left), weight (upper right), mean length variable (ie, the arithmetic mean of humerus, radius, femur, tibia, and lumbar spine lengths) (lower left), and ratio of weight to mean length (lower right). The two groups did not differ (Wilks = 0.958, P = .481). See Table for cluster definitions. w = weeks.