ORIGINAL ARTICLES

Neonatal mortality and morbidity in extremely preterm small for gestational age infants: a population based study

S H Westby Wold¹, K Sommerfelt^1,2, H Reigstad², A Rønnestad³, S Medbø⁴, T Farstad⁵, P I Kaaresen⁶, R Støen⁷, K T Leversen^1,2, L M Irgens⁸, T Markestad^1,2

¹ Department of Clinical Medicine, University of Bergen, Bergen, Norway
² Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
³ Department of Pediatrics, Rikshospitalet University Hospital, Oslo, Norway
⁴ Department of Pediatrics, Ullevål University Hospital, Oslo, Norway
⁵ Department of Pediatrics, Akershus University Hospital, Lørenskog, Norway
⁶ Department of Pediatrics, University Hospital of Northern Norway, Tromsø, Norway
⁷ Department of Pediatrics, St. Olav University Hospital, Trondheim, Norway
⁸ Medical Birth Registry of Norway, Locus of Registry-Based Epidemiology, Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway

^{Correspondence to} S H Westby Wold, Department of Pediatrics, Barneklinikken, 5021 Haukeland University Hospital, Bergen, Norway; helenwold{at}broadpark.no

Aim: To assess if growth restricted (small for gestational age, SGA) extremely preterm infants have excess neonatal mortality and morbidity.

Methods: This was a cohort study of all infants born alive at 22–27 weeks’ post menstrual age in Norway during 1999–2000. Outcomes were compared between those who were SGA, defined as a birth weight less than the fifth percentile for post menstrual age, and those who had weights at or above the fifth percentile.

Results: Of 365 infants with a post menstrual age of <28 weeks, 31 (8%) were SGA. Among infants with a post menstrual age of <28 weeks, only chronic lung disease was associated with SGA status (OR 2.7, 95% CI 1.0 to 7.2). SGA infants with a post menstrual age of 26–27 weeks had excess neonatal mortality (OR 3.8, 95% CI 1.3 to 11), chronic lung disease and a significantly higher mean number of days (age) before tolerating full enteral nutrition. SGA infants with a post menstrual age of 22–25 weeks had an excess risk of necrotising enterocolitis.

Conclusion: Extremely preterm SGA infants had excess neonatal mortality and morbidity in terms of necrotising enterocolitis and chronic lung disease.

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