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Significance of low birthweight for gestational age among very preterm infants
A Spinillo1, E Capuzzo, G Piazzi
1Department of Obstetrics and Gynaecology, IRCCS Policlinico San Matteo, Pavia, Italy.
Insights
Lower birth weight in very preterm infants increases the risk of adverse neonatal outcomes, including death and intraventricular hemorrhage. However, gestational age remains a stronger predictor of these outcomes than birth weight.
Area of Science:
- Neonatalogy
- Perinatal Medicine
- Pediatric Research
Background:
- Preterm birth (24-31 weeks gestation) is a major risk factor for neonatal morbidity and mortality.
- The impact of birth weight, independent of gestational age, on neonatal outcomes is not fully understood.
Purpose of the Study:
- To assess the combined effects of prematurity and low birth weight on specific adverse neonatal events.
- To determine the independent contribution of suboptimal birth weight to neonatal outcomes in very preterm infants.
Main Methods:
- A cohort study was conducted on 230 singleton infants born between 24 and 31 weeks of gestation.
- Birth weight standard deviation scores (SDS) were calculated to assess deviations from expected weight for gestational age.
- Statistical analysis adjusted for gestational age and other potential confounders.
Main Results:
- Decreasing birth weight SDS was significantly associated with increased odds of neonatal death, grade III-IV intraventricular hemorrhage, and neonatal acidosis.
- Infants with birth weight SDS < -1 had substantially higher odds for these adverse events compared to those with SDS ≥ 0.
- Gestational age was a more significant predictor of neonatal outcome than birth weight SDS.
Conclusions:
- Suboptimal birth weight is an independent risk factor for several adverse neonatal outcomes in very preterm infants.
- While low birth weight contributes to adverse outcomes, prematurity (gestational age) remains the primary determinant of neonatal prognosis.
Objective:
To estimate the risk of specific adverse neonatal events resulting from the combined effects of prematurity and low birthweight in very preterm infants (delivered at 24-31 weeks of gestation).
Design:
A cohort study of specific adverse neonatal events in preterm infants born at between 24 and 31 weeks of gestation.
Setting:
Pavia, Italy.
Population:
Two hundred and thirty singleton infants with sonographically confirmed gestational age, delivered at 24 to 31 weeks of gestation.
Methods:
To evaluate the impact of a lower than expected birthweight on selected neonatal events independently of gestational age, we calculated birthweight standard deviation scores (differences between actual birthweight and fitted birthweight divided by fitted standard deviation) for each week of gestation.
Results:
After adjustment for gestational age and other confounders, there was a significant linear trend relating a decreasing birthweight SDS to an increased likelihood of neonatal death, intraventricular haemorrhage, severe respiratory distress syndrome, and acidosis. Compared with infants with SDS > or = 0 (> or = 50th centile of birthweight), infants with birthweight SDS < -1 (< 16th centile) had increased odds for neonatal death [odds ratio (OR) 3.7, 95% confidence interval (CI) 1.42-9.6], grade III-IV intraventricular haemorrhage (OR 17.5, 95% CI 4.04-75.9), and neonatal acidosis (OR 3.22, 95% CI 1.41-7.4). The significance of birthweight SDS as a predictor of neonatal outcome, however, was lower than that of gestational age.
Conclusions:
A lower than expected birthweight affects the likelihood of several adverse neonatal events in very preterm infants. However, a decreasing birthweight SDS affects neonatal outcome less than decreasing gestation does.