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Neonatal outcome of small for gestational age preterm infants

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Abstract

Small for gestational age (SGA) preterm neonates (birth weight < −2 SDS) are considered to have increased risk of bronchopulmonary dysplasia (BPD) compared to appropriate for GA (AGA) neonates. It is unclear if SGA infants have increased risk for respiratory distress syndrome (RDS) and mortality. We analyzed data from 515 neonates born <30 weeks GA, 98(19%) were SGA. SGA were compared to AGA by univariate analysis and logistic regression analysis (LRA). Significant variables at univariate analysis were IUGR (67 vs 7%, p = 0.000), chorioamnionitis (1 vs 13%, p = 0.017), pre-eclampsia (62 vs 18%, p = 0.000), surfactant retreatment (47 vs 25%, p = 0.000), BPD (32 vs 20%, p = 0.015), death (30 vs 12%, p = 0.000), SatO2/FiO2 on day 3 (376 vs 433, p = 0.013), and SatO2/FiO2 ratio on day 28 (400 vs 448, p = 0.000). LRA found the following associations: regarding mortality, a decreased Sat/FiO2 ratio on day 3 (OR 1.99, 95% CI 1.26–3.16, p = 0.003); regarding BPD, surfactant retreatment (3.70, 2.11–6.49, p = 0.000), being SGA (2.69, 1.36–5.36, p = 0.005), decreasing GA (1.05, 1.03–1.08, p = 0.000), decreasing SatO2/FiO2 ratio on day 3 (1.25, 1.11–1.40, p = 0.000); and regarding severe RDS, pre-eclampsia (2.68, 1.58–4.55, p = 0.000) and decreasing GA (1.06, 1.04–1.08, p = 0.000).

Conclusions: In our cohort of preterm infants, being SGA was significantly associated with BPD, but not with increased risk of mortality or RDS due to multiple pathophysiologic mechanisms.

What is Known:

• Small for gestational age preterm neonates are considered to have increased risk of bronchopulmonary dysplasia (BPD) compared to appropriate for GA neonates.

• It is still unclear if SGA infants have increased risk for respiratory distress syndrome (RDS) and mortality.

What is New:

• In our cohort of 515 preterm infants (19% SGA), being SGA was significantly associated with BPD, but not with increased risk of mortality or RDS.

• These results may be explained by the heterogeneity of mechanisms leading to SGA condition and by multiple mechanisms involving lung growth impairment and other factors.

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Abbreviations

AGA:

appropriate for gestational age

BPD:

bronchopulmonary dysplasia

IUGR:

intrauterine growth restriction

LGA:

large for gestational age

PDA:

patent ductus arteriosus

RDS:

respiratory distress syndrome

SDS:

standard deviation scores

SGA:

small for gestational age

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Authors and Affiliations

  1. Department of Maternal and Child Health, Salesi Children’s Hospital, Ancona, Italy

    Stefano Nobile, Paolo Marchionni & Virgilio P Carnielli

  2. Department of Industrial Engineering and Mathematical Sciences, Università Politecnica delle Marche, Ancona, Italy

    Paolo Marchionni

Authors
  1. Stefano Nobile
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  2. Paolo Marchionni
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  3. Virgilio P Carnielli
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Contributions

Dr. Nobile conceptualized the study, analyzed the data, wrote and approved the manuscript.

Dr. Marchionni collected and analyzed the data and approved the manuscript.

Dr. Carnielli wrote and approved the manuscript.

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Correspondence to Stefano Nobile.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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For this type of study formal consent is not required.

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Communicated by Patrick Van Reempts

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Nobile, S., Marchionni, P. & Carnielli, V.P. Neonatal outcome of small for gestational age preterm infants. Eur J Pediatr 176, 1083–1088 (2017). https://doi.org/10.1007/s00431-017-2957-1

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  • DOI: https://doi.org/10.1007/s00431-017-2957-1

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