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Respiratory distress syndrome in infants with impaired intrauterine growth
D Ley1, D Wide-Swensson, M Lindroth
1Department of Pediatrics, Lund University Hospital, Sweden.
Insights
Birthweight deviation in preterm infants impacts mortality and respiratory distress syndrome (RDS) risk differently based on gestational age. Small for gestational age infants face higher RDS risks early on, but lower risks later, with antenatal corticosteroids showing limited benefits.
Area of Science:
- Neonatalogy
- Perinatology
- Fetal Medicine
Background:
- Intrauterine growth curves are crucial for assessing fetal development.
- Birthweight deviation from expected norms affects preterm infant outcomes.
- Understanding these deviations is vital for optimizing neonatal care.
Purpose of the Study:
- To evaluate the association between birthweight deviation and outcomes in preterm infants.
- To analyze the incidence of respiratory distress syndrome (RDS) based on birthweight for gestational age (AGA).
- To investigate the impact of maternal pre-eclampsia and antenatal corticosteroid use on these outcomes.
Main Methods:
- Retrospective application of an intrauterine growth curve to 883 infants born before 33 weeks gestational age.
- Classification of infants into appropriate for gestational age (AGA), small for gestational age (SGA), and large for gestational age (LGA) groups.
- Statistical analysis using odds ratios (OR) adjusted for gestational age and other confounding variables.
Main Results:
- Birthweight deviation was significantly associated with increased mortality (OR 1.29 per SD).
- SGA infants at 25-28 weeks had higher RDS incidence (OR 1.98) compared to AGA infants.
- SGA infants at 29-32 weeks had lower RDS incidence (OR 0.52) compared to AGA infants.
- Maternal pre-eclampsia increased RDS risk in early preterm infants; negative birthweight deviation showed a protective effect against RDS in later preterm infants.
- Antenatal corticosteroids had limited benefits for SGA infants regarding mortality, RDS, and cerebral hemorrhage.
Conclusions:
- Birthweight for gestational age is a significant predictor of mortality and morbidity in preterm infants.
- The impact of SGA on RDS risk varies with gestational age, showing a complex relationship.
- Interventions like antenatal corticosteroids may require tailored approaches for SGA preterm infants.
Abstract:
The recently introduced intrauterine growth curve, based on ultrasonically estimated foetal weights, was retrospectively applied to an inborn population of 883 infants born before 33 gestational weeks at the University Hospital of Lund, during 1985-94. The estimation of birthweight deviation resulted in 630 (71.3%) infants with a birthweight appropriate for gestational age (AGA), 244 (27.6%) infants with a birthweight small for gestational age (SGA) and 9 (1.1%) infants with a birthweight large for gestational age. Birthweight deviation was associated with an increased mortality [odds ratio (OR) adjusted for gestational age 1.29 per SD (12%) change in birthweight for gestational age, 95% CI: 1.10-1.50; p = 0.002]. At gestational age 25-28 weeks, SGA-infants had an increased incidence of respiratory distress syndrome (RDS) as compared to AGA-infants (OR adjusted for gestational age: 1.98, 95% CI: 1.12-3.52; p = 0.019). At gestational age 29-32 weeks, SGA-infants had a lower incidence of RDS as compared to AGA-infants (OR adjusted for gestational age: OR 0.52, 95% CI: 0.34-0.80; p = 0.003). After adjustment for confounding variables, infants born at gestational age 25-28 weeks from mothers with pre-eclampsia, appeared to be a high-risk group for RDS, whereas at the age of 29-32 gestational weeks, negative birthweight deviation had a protective effect against RDS. Antenatal corticosteroid administration appeared to have a less beneficial effect on mortality, RDS and cerebral haemorrhage in infants born SGA vs in those born AGA.