Clinical outcomes in premature infants born small and low-weight for gestational age

• Anton D. Yuditskiy
• Dmitry N. Degtyarev
• Tatiana V. Kovalenko
• Irina N. Petrova

Abstract

In recent years, the morbidity characteristics of premature infants born small and low for gestational age (SGA) have been the subject of debate. Low birth weight is considered a risk factor for pathological conditions of the neonatal period, neonatal and infant mortality.

Objective: study of the morbidity of premature infants born with SGA in modern clinical practice.

Material and methods. The study included 533 premature babies: the observation group – 82 children born SGA, the comparison group – 451 children, appropriate for gestational age. There are 2 subgroups: premature, born before 32 weeks and at 32–36 weeks. The frequency and risk of developing the main pathological conditions of the neonatal period were assessed. The reliability of data differences was assessed using nonparametric methods. The relative risk (RR) was calculated.

Results. Premature infants born with SGA had a higher incidence of severe birth asphyxia (RR=5.5, p<0.05), pneumothorax and pneumomediastinum (RR=5.5, p<0.05), intracranial hemorrhage (RR=5.0, p<0.001), neonatal seizures (RR=4.7, p<0.05), retinopathy of prematurity (RR=3.9, p<0.05) and bronchopulmonary dysplasia (RR=5.2, p<0.001). At the gestational age of 24–31 weeks, severe birth asphyxia was recorded more often – 20.8 per 100 examined (in the comparison group – 5.9 per 100 examined, p<0.05), intracranial hemorrhage – 37.5 per 100 examined (in the comparison group – 11.8 per 100 examined, p<0.01), neonatal convulsions – 20.8 per 100 examined (in the comparison group – 4.4 per 100 examined, p<0.05), air leak syndrome – 20.8 per 100 examined (in the comparison group – 4.4 per 100 examined), bronchopulmonary dysplasia – 62.5 per 100 examined (in the comparison group – 20.6 per 100 examined, p<0.001).

Conсlusion. Pathological conditions that determine the severity of the neonatal period and possible adverse outcomes have the highest risk of development in premature infants born SGA. The most significant adverse effects are observed with a combination of prematurity (gestational age at birth less than 32 weeks) and small size of the newborn for gestational age.

Keywords: prematurity; small for gestational age newborns; morbidity; short-term consequences

References

1. Volodin N.N., Degtyarev D.N. (eds). Neonatology: national leadership. Moscow: GEOTAR-Media, 2023: 752 p. (in Russian)

2. Hokken-Koelega A.C.S., van der Steen M., Boguszewski M.C.S., et al. International Consensus Guideline on small for gestational age: etiology and management from infancy to early adulthood. Endocr Rev. 2023; 44 (3): 539–65. DOI: https://doi.org/10.1210/endrev/bnad002

3. Alda M.G., Holberton J., MacDonald T.M., et al. Small for gestational age at preterm birth identifies adverse neonatal outcomes more reliably than antenatal suspicion of fetal growth restriction. J Matern Fetal Neonatal Med. 2023; 36 (2): 2279017. DOI: https://doi.org/10.1080/14767058.2023.2279017

4. Finken M.J.J., van der Steen M., Smeets C.C.J., et al. Children born small for gestational age: differential diagnosis, molecular genetic evaluation, and implications. Endocr Rev. 2018; 39 (6): 851–94. DOI: https://doi.org/10.1210/er.2018-00083

5. Savel’eva G.M., Sukhikh G.T., Serov V.N., Radzinsky V.E. (eds). Midwifery: national leadership. Moscow: GEOTAR-Media, 2022: 1080 p. (in Russian)

6. Kesavan K., Devaskar S.U. Intrauterine growth restriction: postnatal monitoring and outcomes. Pediatr Clin North Am. 2019; 66 (2): 403–23. DOI: https://doi.org/10.1016/j.pcl.2018.12.009

7. Costa L.P., Costa G.A.M., Valete C.O.S., et al. In-hospital outcomes in preterm and small-for-gestational-age newborns: a cohort study. Einstein (Sao Paulo). 2022; 20: eAO6781. DOI: https://doi.org/10.31744/einstein_journal/2022AO6781

8. Liu C., Wang K., Huang G. Association of small-for-gestational-age status with mortality and morbidity in very preterm Chinese infants. J Matern Fetal Neonatal Med. 2023; 36 (2): 2258257. DOI: https://doi.org/10.1080/14767058.2023.2258257

9. Molony C.L., Hiscock R., Kaufman J. Growth trajectory of preterm small-for-gestational-age neonates. J Matern Fetal Neonatal Med. 2022; 35 (25): 8400–6. DOI: https://doi.org/10.1080/14767058.2021.1974835

10. Ryumina I.I., Baybarina E.N., Narogan M.V., Markelova M.M., Orlovskaya I.V., Zubkov V.V., et al. The usage of the international growth standards to assess the physical development of newborn and premature children. Neonatologiya: novosti, mneniya, obuchenie [Neonatology: News, Opinions, Training]. 2023; 11 (2): 48–52. DOI: https://doi.org/10.33029/2308-2402-2023-11-2-48-52 (in Russian)

11. Giapros V., Drougia A., Krallis N., et al. Morbidity and mortality patterns in small-for-gestational age infants born preterm. J Matern Fetal Neonatal Med. 2012; 25 (2): 153–7. DOI: https://doi.org/10.3109/14767058.2011.565837

12. Padilla-Gomes N.F., Enrıquez G., Acosta-Rojas R., et al. Prevalence of neonatal ultrasound brain lesions in premature infants with and without intrauterine growth restriction. Acta Paediatr. 2007; 96 (11): 1582–7. DOI: https://doi.org/10.1111/j.1651-2227.2007.00496.x

13. McElrath T.F., Allred E.N., Boggess K.A., et al. Maternal antenatal complications and the risk of neonatal cerebral white matter damage and later cerebral palsy in children born at an extremely low gestational age. Am J Epidemiol. 2009; 170 (7): 819–28. DOI: https://doi.org/10.1093/aje/kwp206

14. Ballabh P., de Vries L.S. White matter injury in infants with intraventricular haemorrhage: mechanisms and therapies. Nat Rev Neurol. 2021; 17 (4): 199–214. DOI: https://doi.org/10.1038/s41582-020-00447-8

15. Maritz G.S., Cock M.L., Louey S., et al. Fetal growth restriction has long-term effects on postnatal lung structure in sheep. Pediatr Res. 2004; 55: 287–95.

16. Hitti J., Krohn M.A., Patton D.L., et al. Amniotic fluid tumor necrosis factor-a and the risk of respiratory distress syndrome among preterm infants. Am J Obstet Gynecol. 1997; 177: 50–6.

17. Amarilyo G., Oren A., Mimouni F.B. Increased cord serum inflammatory markers in small for-gestational-age neonates. J Perinatol. 2011; 31: 30–2.

18. Ovsyannikov D.Yu., Geppe N.A., Malakhov A.B., Degtyarev D.N. (eds). Bronchopulmonary dysplasia. Moscow: RUDN, 2020: 176 p. (in Russian)

19. Gidi N.W., Goldenberg R.L., Nigussie A.K., 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 (1): e000740. DOI: https://doi.org/10.1136/bmjpo-2020-000740

20. Blankenship S.A., Brown K.E., Simon L.E., et al. Antenatal corticosteroids in preterm small-for-gestational age infants: a systematic review and meta-analysis. Am J Obstet Gynecol MFM. 2020; 2 (4): 100215. DOI: https://doi.org/10.1016/j.ajogmf.2020.100215

21. Sharma D., Shastri S., Sharma P. Intrauterine growth restriction: antenatal and postnatal aspects. Clin Med Insights Pediatr. 2016; 14 (10): 67–83. DOI: https://doi.org/10.4137/CMPed.S40070

22. Neroev V.V., Katargina L.A. (eds). Retinopathy of prematurity. Moscow: Ikar, 2020: 222 p. (in Russian)

23. Razak A., Faden M. Association of small for gestational age with retinopathy of prematurity: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed. 2020; 105 (3): 270–8. DOI: https://doi.org/10.1136/archdischild-2019-316976

All articles in our journal are distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0 license)