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Outcomes of small for gestational age micropremies depending on how young or how small they are
Hee Joon Yu1, Eun Sun Kim, Jin Kyu Kim
1Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Insights
Extremely small for gestational age (SGA) infants born very preterm have higher mortality. This risk is significant in the lowest gestational age groups, offering insights for prenatal counseling regarding extremely low birth weight infants (ELBWIs).
Area of Science:
- Neonatalogy
- Perinatology
- Pediatric Outcomes Research
Background:
- Outcomes for small for gestational age (SGA) infants, particularly extremely low birth weight infants (ELBWIs), remain a subject of debate.
- ELBWIs represent a vulnerable population where birth size relative to gestational age may influence survival and morbidity.
Purpose of the Study:
- To evaluate the mortality and morbidity of ELBWIs.
- To specifically assess the impact of being small for gestational age (SGA) on ELBWI outcomes.
Main Methods:
- Retrospective review of 415 inborn ELBWIs (birth weight <1,000 g) admitted to a neonatal intensive care unit from 2000-2008.
- Comparison of mortality and morbidity across body size groups: very SGA (VSGA, ≤3rd percentile), SGA (3rd-10th percentile), and appropriate for gestational age (AGA, >10th percentile).
- Gestational age subgroups analyzed: ≤24(+6) weeks, 25-26(+6) weeks, and ≥27(+0) weeks.
Main Results:
- Maternal factors like cesarean section and pregnancy-induced hypertension were more frequent in VSGA and SGA pregnancies.
- Mortality was significantly higher in VSGA infants within the lowest gestational age subgroups (≤24(+6) weeks and ≤26(+6) weeks).
- While VSGA and SGA infants initially showed lower incidences of conditions like respiratory distress syndrome, these differences were not statistically significant after logistic regression analysis within gestational subgroups.
Conclusions:
- Extremely small for gestational age (SGA) status in ELBWIs, especially in lower gestational age subgroups, is associated with increased mortality.
- Findings provide valuable data for prenatal counseling concerning the risks for ELBWIs who are also SGA.
Purpose:
The outcomes of small for gestational age (SGA) infants especially in extremely low birth weight infants (ELBWIs) are controversial. This study evaluated the mortality and morbidity of ELBWIs, focusing on whether or not they were also SGA.
Methods:
The medical records of 415 ELBWIs (birth weight <1,000 g), who were inborn and admitted to the Samsung Medical Center neonatal intensive care unit from January 2000 to December 2008, were reviewed retrospectively. Mortality and morbidities were compared by body size groups: very SGA (VSGA), birth weight ≤3rd percentile; SGA, 3rd to 10th percentile; and appropriate for gestational age (AGA) infants, >10th percentile for gestational age. For gestational subgroup analysis, groups were divided into infants with gestational age ≤24(+6) weeks (subgroup I), 25(+0) to 26(+6) weeks (subgroup II), and ≥27(+0) weeks (subgroup III).
Results:
Gestational age was 29(+2)±2(+6) weeks in the VSGA infants (n=49), 27(+5)±2(+2) weeks in the SGA infants (n=45), and 25(+4)±1(+4) weeks in AGA infants (n=321). Birth weight was 692±186.6 g, 768±132.9 g, and 780±142.5 g in the VSGA, SGA, and AGA groups, respectively. Cesarean section rate and maternal pregnancy-induced hypertension were more common in the VSGA and SGA than in AGA pregnancies. However, chorioamnionitis was more common in the AGA group. The mortalities of the lowest gestational group (subgroup I), and also of the lower gestational group (subgroup I+II) were significantly higher in the VSGA group than the SGA or AGA groups (P=0.020 and P=0.012, respectively). VSGA and SGA infants showed lower incidence in respiratory distress syndrome, ductal ligation, bronchopulmonary dysplasia, intraventricular hemorrhage than AGA group did. However, by multiple logistic regression analysis of each gestational subgroup, the differences were not significant.
Conclusion:
Of ELBWIs, extremely SGA in the lower gestational subgroups, had an impact on mortality, which may provide information useful for prenatal counseling.
