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Association between Infant Birth Size Classification and Development of Morbidities in the Neonatal Intensive Care
A Nicole Ferguson1, Marion Granger Howard1, Kevin B Gittner1,2
1School of Data Science and Analytics, Kennesaw State University, Kennesaw, Georgia, USA.
Insights
Birth size impacts prematurity morbidities differently. Small for gestational age (SGA) infants face higher risks for chronic lung disease (CLD) and severe retinopathy of prematurity (sROP), while large for gestational age (LGA) infants show varied associations. Severe intraventricular hemorrhage (sIVH) was rarely linked to birth size.
Area of Science:
- Neonatalogy
- Perinatal Medicine
- Pediatric Critical Care
Background:
- Morbidities of prematurity (CLD, sROP, sIVH, sNEC) are often studied together, potentially masking distinct risk factors.
- Gestational age (GA) and birth size are critical determinants of neonatal outcomes.
Purpose of the Study:
- To assess the association between birth size metrics (weight, length, head circumference) and specific morbidities in preterm infants.
- To stratify these associations by gestational age (GA) and relevant covariates.
Main Methods:
- Utilized data from the Pediatrix Clinical Data Warehouse (2013-2018) for GAs with >=1% morbidity.
- Classified birth size as small (SGA), appropriate (AGA), or large (LGA) for GA using Olsen curves.
- Employed logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for specific covariates.
Main Results:
- Small for gestational age (SGA) weight increased odds of CLD (OR: 1.6-2.9) and sROP (OR: 1.7-3.6) across most GAs, and sNEC (OR: 1.6-1.8) in at least half.
- Large for gestational age (LGA) weight decreased CLD odds in some GAs and increased sIVH odds only at 27 weeks GA.
- Birth length and head circumference showed similar trends to birth weight.
Conclusions:
- Chronic lung disease (CLD) and severe retinopathy of prematurity (sROP) show consistent associations with GA and birth size.
- Severe necrotizing enterocolitis (sNEC) association with birth size varied across GAs.
- Severe intraventricular hemorrhage (sIVH) demonstrated minimal association with birth size in this cohort.
Introduction:
Morbidities of prematurity are often analyzed as if their epidemiology is shared, but this assumption may mask key differences in morbidity risk. This study assesses the association between three birth size metrics and development of chronic lung disease (CLD), severe retinopathy of prematurity (sROP), severe intraventricular hemorrhage (sIVH), and severe necrotizing enterocolitis (sNEC) when stratified by gestational age (GA) with morbidity-specific GA ranges and covariates.
Methods:
For each morbidity, data from the Pediatrix Clinical Data Warehouse (2013-2018) were included for GAs with at least 1% morbidity. Birth weight, length, and head circumference were classified as small (SGA), appropriate (AGA), or large for GA (LGA) using the Olsen curves. Odds ratios and 95% confidence intervals (AGA as referent) for each morbidity by GA were calculated using logistic regression, adjusting for morbidity-specific adjustors.
Results:
SGA weight increased the odds of CLD (OR: 1.6-2.9) and sROP (OR: 1.7-3.6) for most GAs and sNEC (OR: 1.6-1.8) in at least half of the GAs but not sIVH at any GA. LGA weight decreased the odds of CLD in some GAs and increased the odds of sIVH only at 27 weeks GA, but was not associated with sROP or sNEC at any GA. Results were similar for length and head circumference.
Conclusion:
CLD, sROP, sNEC, and sIVH are associated with GA, birth size, and covariates differently. CLD and sROP were consistently associated with size classification and GA, while sNEC demonstrated variability in its association. However, sIVH was rarely associated with birth size in this sample.
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