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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Assessing fetal growth impairments based on family data as a tool for identifying high-risk babies. An example with
Carsten B Pedersen1, Yuelian Sun, Mogens Vestergaard
1National Centre for Register-based Research, University of Aarhus, Aarhus, Denmark. cbp@ncrr.dk
Insights
A baby's failure to reach its expected birth weight, even if within the normal range, increases neonatal death risk. This finding highlights the importance of considering familial growth patterns for identifying at-risk infants.
Area of Science:
- Perinatal epidemiology
- Neonatal health
- Growth and development
Background:
- Low birth weight is a known risk factor for neonatal mortality and morbidity.
- Failure to achieve biologically intended size can increase adverse outcomes, even for non-small-for-gestational-age infants.
Purpose of the Study:
- To quantify the risk of neonatal death based on a baby's failure to achieve its predicted birth weight.
- To analyze this risk across the entire birth weight distribution.
Main Methods:
- Utilized data from 411,957 second-born infants in Denmark (1979-2002).
- Predicted each baby's birth weight based on the older sibling's birth weight.
- Assessed the ratio of achieved to predicted birth weight in relation to neonatal mortality risk.
Main Results:
- Neonatal death risk increased as the birth weight ratio (achieved/predicted) decreased.
- Even among infants achieving their predicted birth weight, lower birth weights were associated with higher neonatal mortality.
- The risk of neonatal death rose with decreasing birth weight across all categories.
Conclusions:
- While low achieved birth weight is a strong mortality predictor, failing to reach predicted birth weight increases mortality risk across nearly all birth weights.
- Family data can help identify infants at risk for adverse outcomes, particularly those with seemingly normal growth.
- This approach may improve early identification of vulnerable neonates.
Background:
Low birth weight is associated with an increased risk of neonatal and infant mortality and morbidity, as well as with other adverse conditions later in life. Since the birth weight-specific mortality of a second child depends on the birth weight of an older sibling, a failure to achieve the biologically intended size appears to increase the risk of adverse outcome even in babies who are not classified as small for gestation. In this study, we aimed at quantifying the risk of neonatal death as a function of a baby's failure to fulfil its biologic growth potential across the whole distribution of birth weight.
Methods:
We predicted the birth weight of 411,957 second babies born in Denmark (1979-2002), given the birth weight of the first, and examined how the ratio of achieved birth weight to predicted birth weight performed in predicting neonatal mortality.
Results:
For any achieved birth weight category, the risk of neonatal death increased with decreasing birth weight ratio. However, the risk of neonatal death increased with decreasing birth weight, even among babies who achieved their predicted birth weight.
Conclusion:
While a low achieved birth weight was a stronger predictor of mortality, a failure to achieve the predicted birth weight was associated with increased mortality at virtually all birth weights. Use of family data may allow identification of children at risk of adverse health outcomes, especially among babies with apparently "normal" growth.
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