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Does the antenatal detection of small-for-gestational-age babies influence their two-year outcomes?
E M Ogundipe1, C D Wolfe, P Seed
1Department of Public Health Sciences, Guy's King's & St Thomas's School of Medicine and Dentistry, London, United Kingdom.
Insights
Antenatal detection of small-for-gestational-age (SGA) babies using ultrasound reduces perinatal mortality. While detected SGA infants showed some developmental differences at two years, overall severe morbidity was not increased, indicating improved survival outcomes.
Area of Science:
- Perinatal Medicine
- Neonatal Outcomes
- Pediatric Development
Background:
- Small-for-gestational-age (SGA) infants are at increased risk for adverse outcomes.
- Antenatal detection methods, including ultrasound, aim to identify growth-restricted fetuses.
- Understanding the impact of antenatal detection on long-term infant outcomes is crucial for clinical practice.
Purpose of the Study:
- To evaluate whether antenatal detection of small-for-gestational-age (SGA) babies influences 2-year outcomes.
- To compare perinatal mortality and 2-year developmental assessments between detected and undetected SGA infants.
Main Methods:
- A cohort study identified low-birth-weight infants in the South-Thames region (1992-1993).
- Antenatal detection of SGA was confirmed via ultrasound.
- Infants were assessed postnatally and at 2 years for growth, development, and clinical outcomes.
Main Results:
- Of 3,456 low-birth-weight infants, 1,451 (42.5%) were SGA, with 611 (42%) detected antenatally.
- Undetected SGA infants had higher perinatal mortality (12.6% vs. 6.4%) compared to detected SGA infants.
- At 2 years, detected SGA infants had smaller head circumferences, higher febrile convulsions, and lower locomotor scores, but no increased severe neuro-developmental morbidity.
Conclusions:
- Antenatal detection of SGA is associated with significantly lower perinatal mortality.
- Despite some minor developmental differences, antenatal detection does not lead to a parallel increase in severe 2-year morbidity.
- Ultrasound detection of SGA improves survival without substantially increasing long-term adverse developmental outcomes.
Abstract:
The aim of this paper is to determine whether antenatal detection of small-for-gestational-age (SGA) babies influences 2-year outcomes. All low-birth-weight (<2,500g) infants born in South-EastThames region, England from September 1, 1992 to August 31, 1993 were identified at birth. Antenatal "suspicion" and ultrasound assessment confirming growth restriction was categorized as "detection" of SGA. Postnatally, infants were classified as SGA if they had a birth weight for given gestation below the 10th centile. At 2 years, those below 32 weeks' gestation and a random 25% sample of infants of 32 weeks' gestation or more underwent pediatric assessments. Of 49,787 births, 3,456 (6.9%) were of low birth weight. One thousand four hundred and fifty one (42.5%) were SGA, of whom 611 (42%) were detected antenatally by ultrasound scan. At 2 years, 1,008 (75.8%) of 1,358 expected infants were assessed, 379 (37.6%) were SGA at birth, and 188 (49.6%) were confirmed antenatally. Although undetected infants had higher mean birth weights and gestational ages, they had a higher proportion of perinatal deaths (12.6 vs. 6.4%, RR 1.96: CI 1.32-2.86) than detected infants. At 2 years, detected SGA infants had smaller head circumferences (p = 0.026), a higher prevalence of febrile convulsions (8.0 vs. 3.1 %: p = 0.040) and lower scores on the locomotor (DQA) scale of Griffith's developmental test (p = 0.021) compared with undetected SGA infants. Despite detected SGA fetuses having lower weights and gestation at birth than undetected fetuses, they had significantly lower mortality without a parallel increase in severe 2-year neuro-developmental, clinical, or growth morbidity.