Original Article
Outcomes of Small for Gestational Age Infants Born at <27 Weeks' Gestation

https://doi.org/10.1016/j.jpeds.2012.12.097Get rights and content

Objective

To determine whether small for gestational age (SGA) infants born at <27 weeks gestational age (GA) are at increased risk for mortality, morbidity, and growth and neurodevelopmental impairment at 18-22 months corrected age.

Study design

This was a retrospective cohort study from National Institute of Child Health and Human Development Neonatal Research Network's Generic Database and Follow-Up Studies. Infants born at <27 weeks GA between January 2006 and July 2008 were included. SGA was defined as birth weight <10th percentile for GA based on Olsen growth curves. Infants with birth weight ≥10th percentile for GA were classified as non-SGA. Maternal and infant characteristics, neonatal outcomes, and neurodevelopmental data were compared in SGA and non-SGA infants. Neurodevelopmental impairment was defined as any of the following: cognitive score <70 on the Bayley Scales of Infant Development III, moderate or severe cerebral palsy, bilateral hearing loss (with and without amplification), or blindness (bilateral vision <20/200). Logistic regression analysis was applied to evaluate the associations between SGA status and death or neurodevelopmental impairment.

Results

The SGA group comprised 385 infants; the non-SGA group, 2586 infants. Compared with mothers of non-SGA infants, mothers of SGA infants were more likely to have a high school education, prenatal care, cesarean delivery, pregnancy-induced hypertension, and antenatal corticosteroid exposure. Compared with non-SGA infants, SGA infants had higher mortality and were more likely to have postnatal growth failure, prolonged mechanical ventilation, and postnatal steroid use. SGA status was associated with increased risk of death or neurodevelopmental impairment (OR, 3.91; 95% CI, 2.91-5.25; P < .001).

Conclusion

SGA status in infants born at <27 weeks GA is associated with an increased likelihood of postnatal steroid use, mortality, growth failure, and neurodevelopmental impairment at 18-22 months corrected age.

Section snippets

Methods

This study was a retrospective cohort analysis of data collected prospectively from the National Institute of Child Health and Human Development's Neonatal Research Network (NRN) Generic Database and Follow-Up Studies. Infants born in one of the participating NRN sites between January 2006 and July 2008 were included if they were born between 23 and 26 6/7 weeks GA. Infants with major congenital anomalies or syndromes and those who declined neurodevelopmental follow-up were excluded from the

Results

The study population comprised 2971 infants born between 23 0/7 and 26 6/7 weeks GA, including 385 SGA infants and 2586 non-SGA infants (Figure; available at www.jpeds.com). Compared with the non-SGA group, mothers of infants in the SGA group were more likely to have received prenatal care and antenatal corticosteroids, to have experienced pregnancy-induced hypertension, and to have a high school education. SGA infants were more likely to be delivered by cesarean delivery and to have a 5-minute

Discussion

In our study cohort, there was a significantly higher rate of maternal pregnancy-induced hypertension in the SGA group compared with the non-SGA group. Non-SGA infants had higher rates of neonatal morbidities, including RDS, surgically treated patent ductus arteriosus and grade III-IV ICH, whereas SGA infants had a higher rate of antenatal corticosteroid use and longer durations of mechanical ventilation and hospitalization. Despite their lower rate of prematurity-associated morbidities, the

References (30)

  • M.J. Simchen et al.

    Neonatal outcome in growth-restricted versus appropriately grown preterm infants

    Am J Perinatol

    (2000)
  • N. Evans et al.

    Prenatal predictors of mortality in very preterm infants cared for in the Australian and New Zealand Neonatal Network

    Arch Dis Child Fetal Neonatal Ed

    (2007)
  • A. Spinillo et al.

    Infant neurodevelopmental outcome in pregnancies complicated by gestational hypertension and intra-uterine growth retardation

    J Perinat Med

    (1993)
  • A. Spinillo et al.

    Rates of neonatal death and cerebral palsy associated with fetal growth restriction among very low birthweight infants: a temporal analysis

    Br J Obstet Gynecol

    (2006)
  • E. Morsing et al.

    Cognitive function after intrauterine growth restriction and very preterm birth

    Pediatrics

    (2011)

    • Cited by (92)

    • Postneonatal mortality of severely small for gestational age extremely low birth weight infants

      2024, Pediatrics and Neonatology

    • Physical examination

      2022, Goldsmith's Assisted Ventilation of the Neonate: An Evidence-Based Approach to Newborn Respiratory Care, Seventh Edition

    • Use of E-Cigarettes and Cigarettes during Late Pregnancy among Adolescents

      2023, JAMA Network Open

    • ASQ-3 and BSID-III’s concurrent validity and predictive ability of cognitive outcome at 5 years

      2023, Pediatric Research

    • The Prevalence of Small for Gestational Age and Extrauterine Growth Restriction among Extremely and Very Preterm Neonates, Using Different Growth Curves, and Its Association with Clinical and Nutritional Factors

      2023, Nutrients

    • Fetal growth and its trajectory

      2023, In Utero Pediatrics: Research &amp; Practice
    View all citing articles on Scopus

    The National Institutes of Health, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Center for Research Resources, and the National Center for Advancing Translational Sciences provided grant support for the Neonatal Research Network's Generic Database and Follow-up Studies. Data collected at participating sites of the NICHD Neonatal Research Network were transmitted to RTI International, the data coordinating center for the network; which stored, managed and analyzed the data for this study. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors declare no conflicts of interest.

    ∗

    A list of members of the Eunice Kennedy Shriver National Institute of Health and Human Development Neonatal Research Network are available at www.jpeds.com (Appendix).

    View full text
    Copyright © 2013 Published by Mosby, Inc.