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

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• 作者：Lilia C. De Jesus ; MD¹ ; Athina Pappas ; MD¹ ; Seetha Shankaran ; MD¹ ; Lei Li ; PhD² ; Abhik Das ; PhD² ; Edward F. Bell ; MD³ ; Barbara J. Stoll ; MD⁴ ; Abbot R. Laptook ; MD⁵ ; Michele C. Walsh ; MD ; MS⁶ ; Ellen C. Hale ; RN ; BS⁴ ; Nancy S. Newman ; RN⁶ ; Rebecca Bara ; RN¹ ; Rosemary D. Higgins ; MD⁷ ; Eunice Kennedy Shriver National Institute of Health ; Human Development Neonatal Research Network &lowast
• 关键词：AGA ; Appropriate for gestational age ; BSID-III ; Bayley Scales of Infant and Toddler Development ; Third Edition ; BW ; Birth weight ; CA ; Corrected age ; CP ; Cerebral Palsy ; GA ; Gestational age ; ICH ; Intracranial hemorrhage ; NRN ; Neonatal Research Network ; PMA
• 刊名：The Journal of Pediatrics
• 出版年：2013
• 出版时间：July, 2013
• 年：2013
• 卷：163
• 期：1
• 页码：55-60.e3
• 全文大小：251 K

文摘

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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 ¡Ý10th 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.