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

• Published in: The Journal of pediatrics Vol. 163; no. 1; pp. 55 - 60.e3
• Main Authors: De Jesus, Lilia C., MD, Pappas, Athina, MD, Shankaran, Seetha, MD, Li, Lei, PhD, Das, Abhik, PhD, Bell, Edward F., MD, Stoll, Barbara J., MD, Laptook, Abbot R., MD, Walsh, Michele C., MD, MS, Hale, Ellen C., RN, BS, Newman, Nancy S., RN, Bara, Rebecca, RN, Higgins, Rosemary D., MD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01-07-2013
• Subjects: birth weight; blindness; cerebral palsy; children; cognition; Cohort Studies; death; Female; Gestational Age; Growth Disorders - epidemiology; hearing; Humans; hypertension; Incidence; Infant; infant development; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases - epidemiology; Infant, Small for Gestational Age; infants; Male; morbidity; mortality; mothers; neonatal development; Nervous System Diseases - epidemiology; Pediatrics; pregnancy; prenatal care; regression analysis; Retrospective Studies; risk; Risk Assessment; Risk Factors; secondary education; small for gestational age; steroid hormones; vision; RDS; Bayley Scales of Infant and Toddler Development, Third Edition; PMA; Corrected age; Intracranial hemorrhage; NRN; SGA; CP; Gestational age; ICH; BSID-III; Neonatal Research Network; Postmenstrual age; Respiratory distress syndrome; Appropriate for gestational age; BW; Birth weight; GA; AGA; Small for gestational age; Cerebral Palsy; CA
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2012.12.097

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.