Impact of being small for gestational age in neonates born below 600 g birth weight

There are controversial data regarding the impact of being small for gestational age (SGA) on outcome of infants born below 600 g. Comparing mortality, morbidities and neurodevelopmental outcome at 2-3 years in GA-matched very low birth weight neonates born SGA vs. appropriate for gestational age (AGA).

Retrospective single centre matched cohort study including infants born ≥22 weeks GA 2012-2022. Study group was defined as ≤600 g birthweight and SGA and matched with AGA controls for GA, sex, and year of birth.

A total of 103 SGA and 103 AGA infants were matched. SGA neonates had higher rates of surfactant administration, surgically treated persistent ductus arteriosus, bronchopulmonary dysplasia, and retinopathy of prematurity intervention. Survival until discharge was 56% in SGA and 85% in AGA neonates. Using Bayley Scales of Infant Development at 2-3 years 42% of SGA and 66% of AGA infants showed normal cognitive outcome, 45% SGA and 60% AGA infants had normal motor development. Severe neurodevelopmental impairment was present in 10 SGA (26%) and 12 AGA survivors (18%, p = 0.102).

SGA patients exhibited significantly higher mortality rates and increased incidences of short-term morbidities compared to AGA neonates. Significant difference regarding cognitive and motor development was observed.

There is a lack of studies examining the differences between SGA and AGA infants, particularly within the very low birth weight (VLBW) category. Despite this gap, SGA infants continue to face notable disadvantages. This paper contributes novel insights into the outcomes of VLBW SGA patients. Survival rate was 56% in SGA compared to 85% in AGA neonates. A total of 26% of SGA and 18% of AGA infants experienced severe neurodevelopmental impairment. The study's findings may pave the way for improved parental counselling, by providing valuable centre-based data to ensure informed decision-making and support families more effectively in the future.