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Fetal growth restriction is worse than extreme prematurity for the developing lung

Sophie Soudée1, Lucie Vuillemin, Corinne Alberti

  • 1Neonatal Intensive Care Unit, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, Sorbonne Paris Cité, Paris France.

Neonatology
|August 30, 2014
PubMed

Insights

Very preterm infants with intrauterine growth restriction (IUGR) face higher risks of neonatal mortality and chronic lung disease (CLD). This risk is greater than for extremely low gestational age (ELGA) infants or those appropriate for gestational age (AGA).

Area of Science:

  • Neonatal Medicine
  • Perinatal Research
  • Pediatric Pulmonology

Background:

  • Perinatal lung development is sensitive to inflammation and intrauterine growth restriction (IUGR), key risk factors for chronic lung disease (CLD) in preterm infants.
  • The comparative impact of extremely low gestational age (ELGA) versus IUGR on CLD and co-morbidities in very preterm infants requires further investigation.

Purpose of the Study:

  • To compare neonatal morbidity, including CLD, and mortality among three groups of very preterm infants.
  • Groups included: ELGA infants with normal birth weight (ELGA-AGA), very preterm infants with IUGR (<3rd percentile) (VLGA-IUGR), and very preterm infants appropriate for gestational age (VLGA-AGA) matched with VLGA-IUGR.

Main Methods:

  • Retrospective comparison of perinatal and neonatal characteristics across the three infant groups.
  • Exclusion of infants with major congenital anomalies.
  • Chronic lung disease (CLD) diagnosis based on supplemental oxygen or non-invasive ventilation at 36 weeks postmenstrual age.

Main Results:

  • Neonatal mortality was 35% higher in very preterm infants with IUGR (VLGA-IUGR) compared to ELGA-AGA infants, despite a 3-week difference in gestational age.
  • Very preterm infants with IUGR (VLGA-IUGR) were five times more likely to develop CLD than ELGA-AGA infants.
  • These associations remained significant after adjusting for antenatal steroids, gender, and respiratory distress syndrome.

Conclusions:

  • Very preterm infants with IUGR (VLGA-IUGR) exhibit increased risks for neonatal mortality and CLD.
  • These risks are elevated compared to both extremely low gestational age infants appropriate for gestational age (ELGA-AGA) and very preterm infants appropriate for gestational age (VLGA-AGA).
Abstract

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