Association of small-for-gestational-age status with mortality and morbidity in very preterm Chinese infants
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Published on: January 7, 2018
Chunhua Liu1, Kaiyan Wang2, Gaozhan Huang1
1Neonatal Intensive Care Unit, Department of Pediatrics, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, P.R. China.
Insights
Small for gestational age (SGA) very preterm infants face higher mortality and bronchopulmonary dysplasia (BPD) risks. These risks vary by gestational age, informing crucial perinatal care decisions for these vulnerable neonates.
Area of Science:
- Neonatal Medicine
- Perinatal Epidemiology
- Pediatric Critical Care
Background:
- Very preterm infants born small for gestational age (SGA) face elevated risks of mortality and morbidity due to immaturity and poor intrauterine growth.
- Existing research on SGA risks in preterm infants is inconclusive, with limited contemporary data from Chinese populations.
Purpose of the Study:
- To quantify the independent risks of mortality and morbidity associated with SGA birth in very preterm infants (before 32 weeks gestation) in China.
- To provide contemporary data to guide clinical decision-making and family counseling for very preterm SGA neonates.
Main Methods:
- A retrospective cohort study involving 615 SGA infants and 1230 appropriate-for-gestation-age (AGA) controls (2:1 ratio) admitted to NICUs over 6 years.
- Multivariate logistic regression analysis was used to assess the association between SGA status and outcomes, adjusting for confounders. The CRIBII score was included as a covariate.
Main Results:
- SGA infants showed significantly increased risks of mortality (OR 2.12) and bronchopulmonary dysplasia (BPD) (OR 1.95) compared to AGA infants.
- No significant differences were found in the incidence of respiratory distress syndrome (RDS), severe retinopathy of prematurity (sROP), severe intraventricular hemorrhage (sIVH), or necrotizing enterocolitis (NEC).
- Gestational age-stratified analysis revealed that SGA's impact on mortality and morbidity varied across different gestational age ranges.
Conclusions:
- SGA status is linked to increased neonatal mortality and BPD risks in very preterm infants.
- The magnitude of these risks is not uniform across all gestational ages, highlighting the need for tailored management.
- This study provides crucial contemporary data for improving perinatal care and counseling for very preterm SGA neonates in the Chinese population.
Background:
Very preterm infants born small for gestational age (SGA) are at risk for short- and long-term excess mortality and morbidity resulting from immaturity and deficient intrauterine growth. However, previous findings are inconclusive, and there is a paucity of contemporary data in Chinese population.
Objectives:
To evaluate the excess risks of mortality and morbidity independently associated with SGA birth in very preterm (before 32 weeks of gestation) Chinese infants.
Materials And Methods:
The study population included all very preterm infants admitted to the neonatal intensive care units (NICUs) in our hospital and our medical treatment partner hospitals during a 6-year period. The SGA group consisted of 615 SGA infants, and 1230 appropriate-for-gestation-age (AGA) infants were matched with GA and sex as controls at a ratio of 2:1. The associations between SGA birth and outcomes (in-hospital mortality and morbidity) were evaluated by using multivariate logistic regression analysis after adjustment for potential confounders. The CRIBII score was used to indicate admission illness severity, acting as a covariate in the multivariate analysis.
Results:
The SGA group was associated with increased risks of mortality [odds ratio (OR) 2.12; 95% CI: 1.27-3.54] and BPD [OR 1.95; 95% CI: 1.58-2.41] compared to the AGA group. No significant incidences of respiratory distress syndrome (RDS), severe retinopathy of prematurity (sROP), severe intraventricular hemorrhage (sIVH), and necrotizing enterocolitis (NEC) were observed in the SGA group. Further GA-stratified subgroup analysis showed SGA status exhibited certain patterns of effects on mortality and morbidity in different GA ranges.
Conclusions:
SGA status is associated with excess risks of neonatal mortality and BPD in very preterm infants, but the increased risks of mortality and morbidity are not homogeneous in different GA ranges. The contemporary data can help inform perinatal care decision-making and family counseling, particularly for very preterm SGA neonates.
