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[Retardation problems within the scope of prematurity]
Insights
Small for gestational age (SGA) infants experienced higher rates of fetal distress and C-sections but showed better postnatal adaptation and lower mortality than premature infants. Despite higher acidosis, SGA infants adapted better post-birth.
Area of Science:
- Perinatology
- Neonatology
- Obstetrics
Context:
- Study of 804 infants with low birth weight (<2500g) born between 1978-1981.
- One-third of low birth weight infants were small for gestational age (SGA).
- Comparison between SGA infants and premature infants appropriate for gestational age.
Purpose:
- To compare prenatal, intranatal, and postnatal outcomes of SGA infants versus premature infants.
- To investigate the impact of fetal distress and placental insufficiency on delivery methods.
- To analyze neonatal adaptation and mortality rates in relation to gestational age and birth weight.
Summary:
- SGA infants exhibited higher rates of severe fetal distress and obstetrical interventions, including C-sections (24.7% vs 15.2%).
- Premature SGA infants had the highest C-section incidence (30.3%).
- Postnatally, SGA infants showed significantly better adaptation, with lower rates of asphyxia (APGAR ≤7) and reduced neonatal/late mortality, despite higher acidosis.
Impact:
- Findings highlight the complex clinical behavior of SGA infants, necessitating specialized diagnostic and therapeutic approaches.
- Suggests potential benefits of longer gestation in SGA infants, contributing to better outcomes.
- Emphasizes the need for tailored management strategies for infants based on gestational age and growth parameters.
Abstract:
Among 804 short-weight infants (birth weight less than 2500 g) born at the Department of Obstetrics and Gynaecology, Medical School, Friedrich-Schiller University, Jena, from 1. 1. 1978 to 31. 12. 1981, one-third were small for gestational age babies. These hypotrophic infants showed, in relation to premature infants (appropriate for gestational age) a higher prenatal and intranatal mortality (statistically not significant). A frequent severe foetal distress mainly on the background of chronic or subacute placental insufficiency implied a higher rate of obstetrical operations by the hypotrophic infants. This was particularly evident by the incidence of caesarean sections (24.7% : 15.2% respectively). The premature hypotrophic infants had the highest caesarean section incidence, amounting to 30.3%. Postnatal adaptation proved more favourable with the small for gestational age babies than with the premature group. There was in fact a statistically significantly lower rate of asphyxiated infants detectable by means of APGAR-score less than or equal to 7 five minutes after labour and a lower neonatal and late mortality in spite of "acidotic morbidity", which was statistically significantly higher in the group of small for date infants (p less than 0.05). We consider as possible cause a higher average duration of gestation with approximately average birth weights. The difference in the clinical behaviour between the premature-hypotrophic and hypotrophic infants were smaller than between the premature-eutrophic and hypotrophic infants. This contradictory behaviour before, during and after labour requires the specialist to be capable of meeting the diagnostic and therapeutical requirements in every respect.