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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Population based study on the outcome of small for gestational age newborns
D B Bartels1, L Kreienbrock, O Dammann
1Perinatal Epidemiology Infectious Diseases Unit, Department of Pediatrics, Hannover Medical School, Germany.
Insights
Small for gestational age (SGA) very low birthweight (VLBW) infants face higher mortality risks. While they have decreased respiratory distress syndrome (RDS) risk, they do not show increased severe intraventricular haemorrhage (IVH) or periventricular leucomalacia (PVL) risks.
Area of Science:
- Neonatalogy
- Perinatal Medicine
- Public Health
Background:
- Population-based data can inform hypotheses regarding infant health outcomes.
- Regional quality control programs offer valuable datasets for research.
- Understanding risks for small for gestational age (SGA) very low birthweight (VLBW) infants is crucial.
Purpose of the Study:
- To investigate the hypothesis that SGA VLBW infants have increased risks of death, severe intraventricular haemorrhage (IVH), and periventricular leucomalacia (PVL).
- To explore whether SGA VLBW infants have a decreased risk of respiratory distress syndrome (RDS).
- To assess the utility of population-based data from a quality control program for these investigations.
Main Methods:
- Analysis of population-based perinatal/neonatal data (1991-1996) from Lower Saxony, Germany.
- Exclusion criteria included high birth weight, malformations, multiple births, and specific gestational age ranges.
- Multivariable Cox proportional hazard and logistic regression models were used to analyze outcomes.
Main Results:
- An increase in the proportion of VLBW and SGA infants was observed between 1991 and 1996.
- SGA VLBW infants had a significantly increased risk of death (adjusted hazard ratio 2.54).
- SGA VLBW infants had a decreased risk of RDS (adjusted odds ratio 0.57) but similar risks for severe IVH and PVL.
Conclusions:
- SGA VLBW infants are at a higher risk of mortality.
- SGA VLBW infants are not at increased risk for severe IVH or PVL.
- SGA VLBW infants exhibit a decreased risk of RDS, warranting further investigation into hospital-level mortality differences.
Objective:
To explore whether and how population based data from a regional quality control programme can be used to investigate the hypothesis that small for gestational age (SGA) very low birthweight infants (VLBW, <1500 g) are at increased risk of death, severe intraventricular haemorrhage (IVH), and periventricular leucomalacia (PVL), but at decreased risk of respiratory distress syndrome (RDS).
Methods:
Analyses of population based perinatal/neonatal data (1991-96) from a quality control programme in Lower Saxony, Germany. After assessment of data validity and representativeness, exclusion criteria were defined: birth weight >90th centile, severe malformations, siblings of multiple births, and gestational age (GA) <25 or >29 weeks. Outcomes of interest were death, severe IVH, PVL, and RDS. Multivariable analyses were performed by Cox proportional hazard and logistic regression models.
Results:
Within the data validation procedure, an increase in proportions of both VLBW (from 0.95% in 1991 to 1.11% in 1996; +17%) and SGA (from 22.7% to 27.4%; +21%) infants became apparent (p<0.05). The study population consisted of 1623 infants (173 SGA). Mortality was 12.1% (n = 196), with an adjusted hazard ratio for SGA infants of 2.54, 95% confidence interval (CI) 1.70 to 3.79. Both groups were at similar risk of severe IVH (adjusted odds ratio 0.93, 95% CI 0.5 to 1.65) and PVL (1.54, 95% CI 0.78 to 2.87), but SGA infants had less RDS (0.57, 95% CI 0.35 to 0.93). Male sex, multiple birth, hypothermia (<35.5 degrees C), and sepsis were associated with IVH and RDS. Infants admitted to hospitals with <36 VLBW admissions/year had increased mortality (adjusted hazard ratio 1.56, 95% CI 1.12 to 2.18).
Conclusions:
SGA VLBW infants are at increased risk of death, but not of IVH and PVL, and at decreased risk of RDS. That mortality is higher in smaller hospitals needs further investigation.
