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Excess mortality and morbidity among small-for-gestational-age premature infants: a population-based study
Rivka H Regev1, Ayala Lusky, Tzipora Dolfin
1Neonatal Department Meir Hospital, Kfar Saba, Israel. regevdr@netvision.net.il
Insights
Small for gestational age (SGA) premature infants face significantly higher risks of death and major health issues. This study highlights the critical impact of intrauterine growth restriction on infant outcomes.
Area of Science:
- Neonatal research
- Perinatal medicine
- Developmental pediatrics
Background:
- Intrauterine growth restriction (IUGR) is a significant concern in high-risk pregnancies.
- Premature infants, especially those born very low birth weight (VLBW), are particularly vulnerable.
- Understanding the impact of IUGR on VLBW infants is crucial for improving neonatal care.
Purpose of the Study:
- To investigate the association between small for gestational age (SGA) status and adverse outcomes in VLBW premature infants.
- To quantify the increased risks of mortality and major morbidities in SGA VLBW infants.
Main Methods:
- Retrospective cohort study of 2764 VLBW infants (24-31 weeks gestation) born between 1995-1999 in Israel.
- Identified 406 (15%) infants as SGA.
- Utilized multiple logistic regression to analyze the effect of SGA on death, bronchopulmonary dysplasia, and retinopathy of prematurity, adjusting for perinatal risk factors.
Main Results:
- SGA infants demonstrated a 4.52-fold increased risk of death (95% CI, 3.24-6.33).
- Bronchopulmonary dysplasia risk was 3.42-fold higher in SGA infants (95% CI, 2.29-5.13).
- Grade 3 to 4 retinopathy of prematurity risk was 2.06-fold higher for SGA infants (95% CI, 1.15-3.66).
Conclusions:
- Small for gestational age (SGA) status significantly increases mortality risk in premature VLBW infants.
- Survivors born SGA experience a higher incidence of major morbidities, including bronchopulmonary dysplasia and severe retinopathy of prematurity.
- Intrauterine growth restriction is a critical determinant of poor outcomes in premature infants.
Objective:
We examined the effect of intrauterine growth restriction on mortality and morbidity in the Israel cohort of very low birth weight premature infants.
Methods:
The study population included 2764 singleton very low birth weight infants without congenital malformations born from 24 to 31 weeks of gestation during 1995 to 1999. Four hundred six (15%) were born small for gestational age (SGA). The effect of SGA on death, bronchopulmonary dysplasia, and retinopathy of prematurity was assessed using multiple logistic regression analysis.
Results:
After adjustment for perinatal risk factors, SGA infants had a 4.52-fold risk for death (95% CI, 3.24-6.33), a 3.42-fold risk for bronchopulmonary dysplasia (95% CI, 2.29-5.13), and a 2.06-fold risk for grade 3 to 4 retinopathy of prematurity (95% CI, 1.15-3.66).
Conclusions:
SGA premature infants had an increased risk for death, and major morbidity among survivors was increased.