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Mortality and morbidity risks vary with birth weight standard deviation score in growth restricted extremely preterm

Takuji Yamakawa1, Kazuo Itabashi1, Satoshi Kusuda2

  • 1Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan.

Early Human Development
|November 30, 2015
PubMed

Insights

Growth restriction in extremely preterm infants increases mortality and morbidity risks, with outcomes varying by birth weight standard deviation score (BWSDS). Lower BWSDS indicates higher risks for conditions like chronic lung disease and sepsis.

Area of Science:

  • Neonatalogy
  • Perinatal Medicine
  • Pediatric Research

Background:

  • Extremely preterm infants (<28 weeks gestation) often experience growth restriction.
  • Birth weight standard deviation score (BWSDS) quantifies deviation from expected fetal growth.
  • Understanding risks associated with varying degrees of growth restriction is crucial for neonatal care.

Purpose of the Study:

  • To investigate the association between birth weight standard deviation score (BWSDS) and mortality and morbidity in growth-restricted extremely preterm infants.
  • To determine if the risks of adverse outcomes differ across various categories of BWSDS.

Main Methods:

  • Multicenter retrospective cohort study involving 9149 infants born between 2003-2010 at <28 weeks gestation.
  • Infants categorized into groups based on BWSDS: <-2.0, -2.0 to -1.5, -1.5 to -1.0, -1.0 to -0.5, and ≥-0.5 (non-growth restricted).
  • Statistical analysis adjusted for covariates to assess risks of mortality and morbidities.

Main Results:

  • Adjusted analyses revealed significant differences in mortality and morbidity risks across BWSDS groups.
  • Infants with BWSDS -1.5 to <-1.0 showed increased adjusted odds ratios (aOR) for mortality (1.69) and chronic lung disease (CLD) (1.28).
  • Higher risks for severe retinopathy of prematurity (ROP) (aOR, 1.36) and sepsis (aOR, 1.72) were observed in infants with BWSDS -2.0 to <-1.5.
  • A BWSDS <-2.0 was associated with a significantly increased aOR for necrotizing enterocolitis (NEC) (2.41).

Conclusions:

  • Growth restriction in extremely preterm infants is linked to elevated risks of mortality and specific morbidities, including CLD, ROP, sepsis, and NEC.
  • The magnitude of these risks appears to be dependent on the degree of growth restriction, as indicated by BWSDS.
  • These findings highlight the importance of considering BWSDS when assessing and managing risks in this vulnerable population.
Abstract

Keywords:
Extremely preterm infantsFetal growth restrictionMorbidityMortalitySmall for gestational age

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