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Published on: December 31, 2015
Screening investigations in small-for-gestational-age near-term and term infants
Mohan B Krishnamurthy1, Abigail Popiel2, Atul Malhotra3,4,5
1Monash Newborn, Monash Children's Hospital, Melbourne, Australia.
Insights
Screening investigations for small-for-gestational-age (SGA) infants yield few positive results without additional risk factors. Consider maternal or neonatal characteristics before initiating neonatal screening for SGA babies.
Area of Science:
- Neonatal Medicine
- Pediatric Research
- Clinical Practice Guidelines
Background:
- Small-for-gestational-age (SGA) infants face higher risks for complications.
- Neonatal screening is often performed for SGA infants, including TORCH screening and cranial ultrasounds.
- The yield and necessity of these investigations in near-term and term SGA populations require further examination.
Purpose of the Study:
- To assess the frequency of investigations in near-term and term SGA infants.
- To determine if birth weight below the third percentile impacts positive investigation rates.
- To identify characteristics associated with positive screening outcomes in SGA infants.
Main Methods:
- Retrospective cohort study of 30,461 infants over 4 years.
- Identified SGA infants (gestational age ≥35 weeks), categorized by <10th and <3rd percentiles.
- Analyzed screening investigation rates and positive results, including karyotypes, cranial ultrasounds, and urine CMV tests.
Main Results:
- 11.3% of infants were SGA (3437/30,461).
- 12.1% of SGA infants (415/3437) underwent screening, with 11.8% (49/415) yielding positive results.
- Birth weight <3rd percentile did not increase positive investigation yield; most positive cases had additional risk factors.
Conclusions:
- Neonatal screening investigations show a low yield in SGA infants lacking additional maternal or neonatal characteristics.
- The presence of specific maternal or neonatal risk factors should guide decisions regarding SGA infant screening.
- Current screening practices may benefit from refinement based on the presence of additional risk factors.
Abstract:
The aims of this study are to examine how frequently near-term and term small-for-gestational-age (SGA) infants were investigated in our clinical practice, whether being born less than the third centile for weight increased the yield of positive investigations, and whether there were additional characteristics in infants with positive investigations. This retrospective cohort study was compiled using a database of a large maternity network, using the search near term and term gestational age (greater than or equal to 35 weeks) over a span of 4 years. SGA babies were further filtered into less than the tenth centile and third centile. Out of a population of 30,461 infants in the study period, 3437 (11.3%) SGA infants were identified. Four hundred fifteen SGA infants (12.1%) underwent screening investigations, of which 49 infants (11.8%) yielded a positive investigation. 27.2% of karyotypes, 12.8% of cranial ultrasounds and 0.4% of urine CMV tests showed positive results in < 10th centile group. Being born less than the third centile for weight did not increase the yield of positive investigations. Most infants with positive investigations had an additional maternal or neonatal characteristic or risk factor present.
Conclusion:
SGA babies without additional maternal or neonatal characteristics have a poor yield on neonatal screening investigations. Additional characteristics may be considered while deciding whether a SGA infant needs screening investigation. What is Known: • Small-for-gestational-age (SGA) infants have an increased risk of short- and long-term complications. • Whilst the causes for SGA are multifactorial, there has been a tendency to undertake screening investigations like Toxoplasma, Others, Rubella, Cytomegalovirus, Herpes group of viruses (TORCH) screening and cranial ultrasounds in the neonatal period. What is New: • Comprehensive study investigating the rates of screening in near-term and term SGA population. • The yield of screening tests for near-term and term SGA infants without additional antenatal and postnatal characteristics is low.
