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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
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Small for gestational age subgroups have differential morbidity, growth, and neurodevelopment at age 2: the

Aris T Papageorghiou1, María C Restrepo-Méndez1, Rose McGready2

  • 1Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK; Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK.

American Journal of Obstetrics and Gynecology
|May 25, 2025
PubMed

Insights

Small for gestational age (SGA) is not a single condition but comprises distinct subgroups. Identifying these subgroups is crucial for understanding varied neonatal and childhood health trajectories in SGA infants.

Area of Science:

  • Perinatal Medicine
  • Developmental Pediatrics
  • Reproductive Health

Background:

  • Small for gestational age (SGA) is a complex perinatal syndrome linked to significant neonatal risks and impaired long-term growth and neurodevelopment.
  • Current birthweight-based classifications of SGA fail to capture its heterogeneity and predict future health outcomes accurately.

Purpose of the Study:

  • To identify and characterize distinct subgroups of small for gestational age (SGA) newborns.
  • To evaluate the associations between these SGA subgroups and neonatal morbidity, growth, and neurodevelopmental outcomes up to age 2.

Main Methods:

  • A prospective cohort study involving 5153 non-SGA and 1549 SGA newborns across six countries (2012-2018).
  • Utilized 2-step cluster analysis to identify SGA subgroups based on maternal, fetal, and environmental factors.
  • Logistic regression was employed to assess health and developmental outcomes in SGA subgroups compared to non-SGA newborns, adjusting for confounders.

Main Results:

  • Nine distinct SGA subgroups were identified, including those related to severe maternal disease, previous low birthweight/preterm birth, and smoking.
  • Severe SGA newborns in specific subgroups faced increased risks of neonatal morbidity, long-term health issues, and poor growth.
  • Moderate SGA newborns exposed to hypertensive disorders showed higher risks of neonatal morbidity and neurodevelopmental deficits in language and behavior.

Conclusions:

  • Small for gestational age (SGA) is a heterogeneous condition with distinct subgroups.
  • These subgroups exhibit unique patterns of neonatal morbidity, postnatal growth, and neurodevelopmental outcomes.
  • Refined classification of SGA based on identified subgroups can improve understanding and management of associated health trajectories.
Abstract

Keywords:
developmentfetal growth restrictionmorbiditymortalityneurodevelopmentnutritionsyndrome

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