Being Small for Gestational Age does not Change Short-Term Outcomes for Extremely Low Birth Weight Babies at Townsville University Hospital

Natalee Williamson; Gary Alcock; Yoga Kandasamy

doi:10.1055/s-0042-1757612

Journal of Child Science, Table of Contents

CC BY 4.0 · Journal of Child Science 2022; 12(01): e200-e206
DOI: 10.1055/s-0042-1757612

Original Article

Being Small for Gestational Age does not Change Short-Term Outcomes for Extremely Low Birth Weight Babies at Townsville University Hospital

Authors

Natalee Williamson

¹Townsville University Hospital Neonatal Unit, Douglas, Queensland, Australia
Gary Alcock

¹Townsville University Hospital Neonatal Unit, Douglas, Queensland, Australia
Yoga Kandasamy

¹Townsville University Hospital Neonatal Unit, Douglas, Queensland, Australia

Abstract

Aim To determine whether being small for gestational age (SGA) is associated with increased mortality and short-term morbidity for extremely low birth weight (ELBW) babies at Townsville University Hospital (TUH).

Methods All babies with a birth weight of <1,000 g born at TUH between January 1, 2010 and January 1, 2021 were included. Data from the neonatal unit's NeoDATA database were used to compare mortality and short-term morbidity outcomes for babies categorized as SGA (birth weight <10th centile) or not. Statistical analyses were used to determine associations between being SGA and survival to discharge, intubation for mechanical ventilation, duration of respiratory support, chronic neonatal lung disease (CNLD), home oxygen, intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC), sepsis, time to full enteral feeds, and duration of admission.

Results Of 461 ELBW babies, 62 (13.4%) were SGA. The SGA babies were significantly smaller at 714 (580–850) versus 810 (700–885) g (p < 0.001) and of advanced gestational age at 28.6 (26.6–30.2) versus 25.4 (24.4–26.6) weeks (p < 0.001). No significant difference in mortality existed, with 85% of SGA babies and 84% of others surviving. On univariate analysis, being SGA was associated with significant reductions in intubation for mechanical ventilation (p < 0.001), duration of respiratory support (p < 0.001), intraventricular hemorrhage (p = 0.002), NEC (p = 0.037), and admission duration (p = 0.038). After controlling for confounding factors, no outcomes were independently associated with being SGA. Logistic regression found survival was associated with birth weight (p = 0.030), gestational age (p = 0.007), and antenatal corticosteroids (p = 0.008).

Conclusions Being SGA is not an independent predictor of mortality nor adverse short-term morbidity for ELBW babies.

Keywords

Small for gestational age - growth restricted - extremely low birth weight - premature - mortality - morbidity

Full Text

References

References:
1 Mactier H, Bates SE, Johnston T. et al; BAPM Working Group. Perinatal management of extreme preterm birth before 27 weeks of gestation: a framework for practice. Arch Dis Child Fetal Neonatal Ed 2020; 105 (03) 232-239
2 Patel RM, Rysavy MA, Bell EF, Tyson JE. Survival of infants born at periviable gestational ages. Clin Perinatol 2017; 44 (02) 287-303
3 Myrhaug HT, Brurberg KG, Hov L, Markestad T. Survival and impairment of extremely premature infants: a meta-analysis. Pediatrics 2019; 143 (02) e20180933
4 Ogawa M, Matsuda Y, Kanda E. et al. Survival rate of extremely low birth weight infants and its risk factors: case-control study in Japan. ISRN Obstet Gynecol 2013; 2013: 873563-873566
5 Lui K, Lee SK, Kusuda S. et al; International Network for Evaluation of Outcomes (iNeo) of neonates Investigators. Trends in outcomes for neonates born very preterm and very low birth weight in 11 high-income countries. J Pediatr 2019; 215: 32-40.e14
6 Moore T, Hennessy EM, Myles J. et al. Neurological and developmental outcome in extremely preterm children born in England in 1995 and 2006: the EPICure studies. BMJ 2012; 345 (7886): e7961
7 Colella M, Frérot A, Novais ARB, Baud O. Neonatal and long-term consequences of fetal growth restriction. Curr Pediatr Rev 2018; 14 (04) 212-218
8 Piper JM, Xenakis EM, McFarland M, Elliott BD, Berkus MD, Langer O. Do growth-retarded premature infants have different rates of perinatal morbidity and mortality than appropriately grown premature infants?. Obstet Gynecol 1996; 87 (02) 169-174
9 Garite TJ, Clark R, Thorp JA. Intrauterine growth restriction increases morbidity and mortality among premature neonates. Am J Obstet Gynecol 2004; 191 (02) 481-487
10 Bernstein IM, Horbar JD, Badger GJ, Ohlsson A, Golan A.. The Vermont Oxford Network. Morbidity and mortality among very-low-birth-weight neonates with intrauterine growth restriction. Am J Obstet Gynecol 2000; 182 (1 Pt 1): 198-206
11 Zeitlin J, El Ayoubi M, Jarreau PH. et al; MOSAIC Research Group. Impact of fetal growth restriction on mortality and morbidity in a very preterm birth cohort. J Pediatr 2010; 157 (05) 733-9.e1
12 Hasthi UR, Ashwani N, Kumar CS, Chejeti SR. Morbidity and mortality patterns in small for gestational age versus appropriate for gestational age preterm neonates admitted in level ii neonatal intensive care unit: a observational study. Int J Sci Stud 2017; 4 (10) 133-136
13 Sharma P, McKay K, Rosenkrantz TS, Hussain N. Comparisons of mortality and pre-discharge respiratory outcomes in small-for-gestational-age and appropriate-for-gestational-age premature infants. BMC Pediatr 2004; 4: 9
14 Soudée S, Vuillemin L, Alberti C. et al. Fetal growth restriction is worse than extreme prematurity for the developing lung. Neonatology 2014; 106 (04) 304-310
15 Bartels DB, Kreienbrock L, Dammann O, Wenzlaff P, Poets CF. Population based study on the outcome of small for gestational age newborns. Arch Dis Child Fetal Neonatal Ed 2005; 90 (01) F53-F59
16 Tsai LY, Chen YL, Tsou KI, Mu SC.. Taiwan Premature Infant Developmental Collaborative Study Group. The impact of small-for-gestational-age on neonatal outcome among very-low-birth-weight infants. Pediatr Neonatol 2015; 56 (02) 101-107
17 Kok JH, den Ouden AL, Verloove-Vanhorick SP, Brand R. Outcome of very preterm small for gestational age infants: the first nine years of life. Br J Obstet Gynaecol 1998; 105 (02) 162-168
18 Yamakawa T, Itabashi K, Kusuda S.. Neonatal Research Network of Japan. Mortality and morbidity risks vary with birth weight standard deviation score in growth restricted extremely preterm infants. Early Hum Dev 2016; 92: 7-11
19 Griffin IJ, Lee HC, Profit J, Tancedi DJ. The smallest of the small: short-term outcomes of profoundly growth restricted and profoundly low birth weight preterm infants. J Perinatol 2015; 35 (07) 503-510
20 Nobile S, Marchionni P, Carnielli VP. Neonatal outcome of small for gestational age preterm infants. Eur J Pediatr 2017; 176 (08) 1083-1088
21 Rani RRK, Antony BFC, Kuzhiyil AP. Neurodevelopmental outcomes of preterm small for gestational age and appropriate for gestational age babies at one year of age. clinical report. J Evol Med Dent Sci 2020; 9: 3231
22 Gidi NW, Goldenberg RL, Nigussie AK. et al. Comparison of neonatal outcomes of small for gestational age and appropriate for gestational age preterm infants born at 28-36 weeks of gestation: a multicentre study in Ethiopia. BMJ Paediatr Open 2020; 4 (01) e000740
23 Bose C, Van Marter LJ, Laughon M. et al; Extremely Low Gestational Age Newborn Study Investigators. Fetal growth restriction and chronic lung disease among infants born before the 28th week of gestation. Pediatrics 2009; 124 (03) e450-e458
24 Kurata H, Ochiai M, Inoue H. et al. Inflammation in the neonatal period and intrauterine growth restriction aggravate bronchopulmonary dysplasia. Pediatr Neonatol 2019; 60 (05) 496-503
25 Eriksson L, Haglund B, Odlind V, Altman M, Ewald U, Kieler H. Perinatal conditions related to growth restriction and inflammation are associated with an increased risk of bronchopulmonary dysplasia. Acta Paediatr 2015; 104 (03) 259-263
26 Ireland S, Larkins S, Ray R, Woodward L, Devine K. Adequacy of antenatal steroids, rather than place of birth, determines survival to discharge in extreme prematurity in North Queensland. J Paediatr Child Health 2019; 55 (02) 205-212
27 Hoftiezer L, Hukkelhoven CWPM, Hogeveen M, Straatman HMPM, van Lingen RA. Defining small-for-gestational-age: prescriptive versus descriptive birthweight standards. Eur J Pediatr 2016; 175 (08) 1047-1057
28 Fenton TR. A new growth chart for preterm babies: Babson and Benda's chart updated with recent data and a new format. BMC Pediatr 2003; 3: 13
29 Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr 2013; 13 (01) 59
30 Chow S, Creighton P, Chambers G, Lui K. Report of the Australian and New Zealand Neonatal Network 2019. Green Print Centre UNSW; 2021. :112.
31 Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978; 92 (04) 529-534
32 Bell MJ, Ternberg JL, Feigin RD. et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978; 187 (01) 1-7
33 Briana DD, Malamitsi-Puchner A. Small for gestational age birth weight: impact on lung structure and function. Paediatr Respir Rev 2013; 14 (04) 256-262
34 Zaw W, Gagnon R, da Silva O. The risks of adverse neonatal outcome among preterm small for gestational age infants according to neonatal versus fetal growth standards. Pediatrics 2003; 111 (6 Pt 1): 1273-1277