Small-for-Gestational-Age Status and Adverse Clinical Outcomes in Preterm and Very Preterm Infants: A Propensity...

Area of Science:

• Neonatalogy
• Perinatal Medicine
• Pediatric Critical Care

Background:

• Preterm infants (<37 weeks) and very preterm infants (<32 weeks) have higher mortality and morbidity rates than full-term infants.
• Small-for-gestational-age (SGA) infants, defined by birth weight below a specific gestational age threshold, represent a vulnerable subgroup within the preterm population.
• Understanding the specific clinical outcomes associated with SGA status in preterm infants is crucial for targeted interventions and improved care.

Purpose of the Study:

• To compare clinical outcomes between small-for-gestational-age (SGA) and appropriate-for-gestational-age (AGA) preterm infants.
• To identify specific risks and morbidities associated with SGA status in preterm and very preterm populations.
• To inform management strategies, particularly in resource-limited settings, to improve outcomes for SGA preterm infants.

Main Methods:

• Retrospective cohort study utilizing a prospectively collected database (2014-2025).
• Propensity score matching (PSM) was employed to create comparable groups of SGA and AGA preterm infants.
• Multivariate regression and subgroup analyses of very preterm infants were conducted to minimize confounding and assess specific outcomes.

Main Results:

• After PSM, SGA preterm infants (n=298) showed significantly higher risks of mortality or major morbidity (aRR, 1.89), mortality (aRR, 3.53), and mortality or moderate-to-severe bronchopulmonary dysplasia (aRR, 2.13) compared to AGA infants (n=298).
• In very preterm infants (n=190), SGA status was similarly associated with increased risks of mortality or major morbidity (aRR, 1.81), mortality (aRR, 3.23), mortality or moderate-to-severe bronchopulmonary dysplasia (aRR, 2.03), and mortality or treated retinopathy of prematurity (aRR, 2.62).

Conclusions:

• Small-for-gestational-age (SGA) status is an independent risk factor for increased mortality and major morbidity in both preterm and very preterm infants.
• These findings underscore the critical need for focused management strategies for SGA preterm infants to mitigate adverse short- and long-term outcomes.
• Implementing targeted interventions for SGA infants is particularly vital in resource-limited settings to improve survival and reduce long-term complications.