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Differences in early postnatal morbidity risk by pattern of fetal growth in Argentina
L E Caulfield1, J D Haas, J M Belizán
1Department of International Health, Johns Hopkins University, Baltimore, Maryland 21205.
Insights
Small for gestational age (SGA) infants with low ponderal index (PI) face higher risks of asphyxia, hypoglycemia, and respiratory distress. SGA infants are not a uniform group regarding postnatal health outcomes.
Area of Science:
- Neonatal Medicine
- Perinatal Epidemiology
- Pediatric Health Outcomes
Background:
- Small for gestational age (SGA) is a common indicator of fetal growth restriction.
- Early postnatal morbidity significantly impacts infant health and survival.
- The ponderal index (PI) provides insights into infant body composition, differentiating SGA infants.
Purpose of the Study:
- To investigate the association between ponderal index (PI) and early postnatal morbidity in small for gestational age (SGA) infants.
- To determine if SGA infants with low PI (SGA-LPI) have different morbidity risks compared to SGA infants with adequate PI (SGA-API).
- To explore the homogeneity of health risks among SGA infants.
Main Methods:
- Retrospective cohort study of 5539 singleton births at term in Rosario, Argentina.
- Classification of SGA infants into low PI (SGA-LPI) and adequate PI (SGA-API) groups.
- Comparison of early postnatal morbidity rates (asphyxia, hypoglycemia, respiratory distress, hyperbilirubinemia) between SGA subgroups and non-SGA infants.
Main Results:
- SGA-LPI infants showed significantly higher odds of asphyxia (OR 4.35), hypoglycemia (OR 13.75), and respiratory distress (OR 2.32) compared to SGA-API infants.
- These increased risks for SGA-LPI infants persisted after adjusting for gender, birthweight, gestational age, and hospital.
- No significant difference in hyperbilirubinemia risk was observed between SGA-API and SGA-LPI infants; SGA-API infants had similar morbidity risks to non-SGA infants.
Conclusions:
- SGA infants are not a homogeneous group concerning early postnatal health and survival.
- Infants classified as SGA-LPI exhibit distinct and elevated risks for specific morbidities.
- Findings support the timing hypothesis regarding the etiology of PI variation in SGA infants.
Abstract:
Information on a cohort of 5539 singleton births delivered at term in two hospitals in Rosario, Argentina, was used to examine differences in early postnatal morbidity between small for gestational age (SGA) infants classified by their ponderal index (PI). SGA infants with low PI (SGA-LPI) were 4.35 (90% CI: 1.50, 12.61) times more likely to have asphyxia, 13.75 (2.48, 76.31) times more likely to have hypoglycaemia and 2.32 (1.03, 5.26) times more likely to have respiratory distress (RD) than SGA infants with adequate PI (SGA-API). The increased risks of asphyxia and hypoglycaemia observed for SGA-LPI infants diminished, but remained statistically significant after controlling for the infant's gender, birthweight, gestational age and hospital of birth. There was no difference in risk of hyperbilirubinaemia between SGA-API and SGA-LPI infants. With the exception of risk of hyperbilirubinaemia, SGA-API infants carried the same risks of morbidity as non-SGA infants. The results of the study show that SGA infants do not constitute a homogeneous group with respect to their prospects for early postnatal health and survival. Furthermore, the pattern of differences in morbidity risk between SGA-API and SGA-LPI infants observed in this study is consistent with the timing hypothesis for the aetiology of variation in PI among SGA infants.