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Adverse effects of small for gestational age differ by gestational week among very preterm infants

Erik A Jensen1,2, Elizabeth E Foglia1,2, Kevin C Dysart1,2

  • 1Department of Pediatrics, Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.

Archives of Disease in Childhood. Fetal and Neonatal Edition
|May 7, 2018
PubMed

Insights

Small for gestational age (SGA) birth in very preterm infants is linked to increased risks of death and major morbidities like bronchopulmonary dysplasia (BPD). These risks vary significantly by gestational age at birth.

Area of Science:

  • Neonatal Perinatal Medicine
  • Pediatric Critical Care
  • Perinatal Epidemiology

Background:

  • Small for gestational age (SGA) is a common complication in preterm births.
  • The independent risks associated with SGA birth among very preterm infants require detailed characterization.
  • Understanding these risks stratified by gestational age is crucial for targeted interventions.

Purpose of the Study:

  • To quantify the excess risk of death, severe intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), and severe retinopathy of prematurity (ROP) associated with SGA birth.
  • To stratify these risks by completed weeks of gestation in very preterm infants.
  • To assess the independent contribution of SGA to adverse neonatal outcomes.

Main Methods:

  • Retrospective cohort study utilizing the Optum Neonatal Database.
  • Inclusion of infants born <32 weeks gestation without severe congenital anomalies.
  • Definition of SGA as birth weight <10th percentile; adjusted risk differences (aRDs) were calculated to assess excess outcome risk.

Main Results:

  • SGA infants (11.1% of 6708) exhibited higher unadjusted rates for most adverse outcomes compared to non-SGA infants.
  • The excess risk associated with SGA varied by outcome and gestational age; highest aRD for death was at 24 weeks gestation.
  • Peak risks for BPD and composite outcomes (death/BPD, death/major morbidity) occurred at 27 weeks gestation, with SGA infants showing risks similar to non-SGA infants born 2-3 weeks earlier.

Conclusions:

  • The independent risks of neonatal morbidity and mortality linked to SGA birth are significantly influenced by the specific adverse outcome and the infant's gestational age.
  • Gestational age is a critical factor modifying the impact of SGA on neonatal outcomes.
  • Findings highlight the need for gestational age-specific risk assessment and management strategies for SGA very preterm infants.
Abstract

Keywords:
bronchopulmonary dysplasiaintra-uterine growth restrictionintraventricular hemorrhagepremature Infantretinopathy of prematurity

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