Skip to main content

Advertisement

SpringerLink
Log in

Propensity-Matched Comparison of Very Preterm Small- and Appropriate-for-Gestational-Age Neonates

  • Original Article
  • Published:
Indian Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Objective

Comparison of mortality and major morbidities between very preterm (< 32 wk gestational age) small-for-gestational-age (SGA) and appropriate-for-gestational-age (AGA) neonates.

Methods

A retrospective observational study of neonates born between 26–31 wk gestational age from January 2015 to December 2019 was done in level-3 neonatal intensive care unit of a high-risk perinatal center in South India.

Results

Of the 1,178 very preterm neonates born in the study period, 909 were eligible for inclusion. After propensity score matching for gestational age, gender, and antenatal steroid use, 592 (444 AGA and 148 SGA) were included in the final analysis. SGA neonates had increased odds of necrotizing enterocolitis (NEC) ≥ stage 2A [adjusted odds ratio (aOR): 2.2; 95% CI: 1.15–4.21], abnormal composite outcome, i.e., any one of the mortality or major morbidities (aOR: 2.99; 95% CI: 1.96–4.57), hypoglycemia requiring intravenous fluids (aOR: 2.11; 95% CI: 1.05–4.23), and anemia requiring blood transfusions (aOR: 3.13; 95% CI: 1.98–4.93); and a trend towards increased odds of bronchopulmonary dysplasia (aOR: 1.9, 95% CI: 0.92–3.91). Mortality, intraventricular hemorrhage ≥ grade 2, periventricular leukomalacia ≥ grade 2, and retinopathy of prematurity requiring treatment were not different.

Conclusions

SGA neonates have higher odds of having NEC ≥ stage 2A, abnormal composite outcome, hypoglycemia, and anemia compared to appropriately grown neonates.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data Availability

On reasonable request.

References

  1. Lee ACC, Katz J, Blencowe H, et al. National and regional estimates of term and preterm babies born small for gestational age in 138 low-income and middle-income countries in 2010. Lancet Glob Health. 2013;1:e26-36.

    Article  Google Scholar 

  2. Malhotra A, Allison BJ, Castillo-Melendez M, Jenkin G, Polglase GR, Miller SL. Neonatal morbidities of fetal growth restriction: pathophysiology and impact. Front Endocrinol. 2019;10:55.

    Article  Google Scholar 

  3. Sacchi C, Marino C, Nosarti C, Vieno A, Visentin S, Simonelli A. Association of intrauterine growth restriction and small for gestational age status with childhood cognitive outcomes: a systematic review and meta–analysis. JAMA Pediatr. 2020;174:772–81.

    Article  Google Scholar 

  4. Priante E, Verlato G, Giordano G, et al. Intrauterine growth restriction: new insight from the metabolomic approach. Metabolites. 2019;9:267.

    Article  CAS  Google Scholar 

  5. Mendez-Figueroa H, Truong VTT, Pedroza C, Chauhan SP. Morbidity and mortality in small-for-gestational-age infants: a secondary analysis of nine MFMU network studies. Am J Perinatol. 2017;34:323–32.

    PubMed  Google Scholar 

  6. Boghossian NS, Geraci M, Edwards EM, Horbar JD. Morbidity and mortality in small for gestational age infants at 22 to 29 weeks’ gestation. Pediatrics. 2018;141:e20172533.

  7. Zeitlin J, El Ayoubi M, Jarreau PH, et al. Impact of fetal growth restriction on mortality and morbidity in a very preterm birth cohort. J Pediatr. 2010;157:733–9.

    Article  Google Scholar 

  8. Grisaru-Granovsky S, Reichman B, Lerner-GevaL,et al. Mortality and morbidity in preterm small-for-gestational-age infants: a population–based study. Am J Obstet Gynecol. 2012;206:150.

  9. Yamakawa T, Itabashi K, Kusuda S. Mortality and morbidity risks vary with birth weight standard deviation score in growth restricted extremely preterm infants. Early Hum Dev. 2016;92:7–11.

    Article  Google Scholar 

  10. Qiu X, Lodha A, Shah PS, et al. Neonatal outcomes of small for gestational age preterm infants in canada. Am J Perinatol. 2012;29:87–94.

    Article  Google Scholar 

  11. Tsai LY, Chen YL, Tsou KI, Mu SC. The Impact of small-for-gestational-age on neonatal outcome among very-low-birth-weight Infants. Pediatr Neonatol. 2015;56:101–7.

    Article  Google Scholar 

  12. Jensen EA, Foglia EE, Dysart KC, et al. Adverse effects of small for gestational age differ by gestational week among very preterm infants. Arch Dis Child Fetal Neonatal Ed. 2019;104:F192–8.

    Article  Google Scholar 

  13. de Costa IT, Leone CR. Intrauterine growth restriction influence on the nutritional evolution and growth of preterm newborns from birth until discharge. Rev Paul Pediatr. 2009;27:15–20.

    Article  Google Scholar 

  14. Giapros V, Drougia A, Krallis N, Theocharis P, Andronikou S. Morbidity and mortality patterns in small-for-gestational age infants born preterm. J Matern Fetal Neonatal Med. 2012;25:153–7.

    Article  Google Scholar 

  15. Marchant T, Willey B, Katz J, et al. Neonatal mortality risk associated with preterm birth in East Africa, adjusted by weight for gestational age: individual participant level meta-analysis. Bhutta ZA, editor. PLoS Med. 2012;9:e1001292.

  16. Ortigosa Rocha C, Bittar RE, Zugaib M. Neonatal outcomes of late-preterm birth associated or not with intrauterine growth restriction. Obstet Gynecol Int. 2010;2010:231842.

  17. Tannirwar S, Kadam S, Pandit A, Vaidya U, Parikh T, Ankit S. Comparisons of mortality and pre-discharge respiratory morbidities in small for gestational age and appropriate-for gestational age premature infants - an Indian Experience. Iran J Neonatol IJN. 2016;7:1–6.

    Google Scholar 

  18. 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 Study. 2017;4:133–6.

    Google Scholar 

  19. Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr. 2013;13:59.

    Article  Google Scholar 

  20. Tita ATN, Andrews WW. Diagnosis and management of clinical chorioamnionitis. Clin Perinatol. 2010;37:339–54.

    Article  Google Scholar 

  21. Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med. 2001;163:1723–9.

    Article  CAS  Google Scholar 

  22. Sehgal A, McNamara PJ. Does echocardiography facilitate determination of hemodynamic significance attributable to the ductus arteriosus? Eur J Pediatr. 2009;168:907–14.

    Article  Google Scholar 

  23. Walsh MC, Kliegman RM. Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am. 1986;33:179–201.

    Article  CAS  Google Scholar 

  24. de Vries LS, Eken P, Dubowitz LM. The spectrum of leukomalacia using cranial ultrasound. Behav Brain Res. 1992;49:1–6.

    Article  Google Scholar 

  25. Inder TE, Perlman JM, Volpe JJ. Intraventricularhemorrhage and post hemorrhagic hydrocephalus. In: Joseph J Volpe, Editor. Volpe Neurology of Newborn. Philadelphia, PA: Elsevier; 2018. pp. 425–57

  26. Early Treatment For Retinopathy Of Prematurity Cooperative Group. Revised indications for the treatment of retinopathy of prematurity: results of the early treatment for retinopathy of prematurity randomized trial. Arch Ophthalmol Chic Ill. 1960;2003:1684–94.

    Google Scholar 

  27. Committee on Fetus and Newborn, Adamkin DH. Postnatal glucose homeostasis in late–preterm and term infants. Pediatrics. 2011;127:575–9.

  28. New HV, Berryman J, Bolton-Maggs PH, et al. Guidelines on transfusion for fetuses, neonates and older children. Br J Haematol. 2016;175:784–828.

    Article  Google Scholar 

  29. RStudio Team. RStudio: Integrated Development for R. In:RStudio PBC Boston MA. 2020. Available at: http://www.rstudio.com/. Accessed on 25 June 2020.

Download references

Author information

Authors and Affiliations

  1. Newborn Unit, Fernandez Hospitals, Hyderabad, Telangana, 500029, India

    Rajendra Prasad Anne, Venkateshwarulu Vardhelli, Tejo Pratap Oleti, Saikiran Deshabhotla & Pravin Rao Vadije

  2. Newborn Unit, Paramita Children’s Hospital, Kothapet, L B Nagar, Hyderabad, Telangana, India

    Srinivas Murki & Venkat Reddy Kallem

  3. Evidencian Research Associates, Bengaluru, Karnataka, India

    Gopireddy Murali Mohan Reddy

Authors
  1. Rajendra Prasad Anne
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Venkateshwarulu Vardhelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tejo Pratap Oleti
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Srinivas Murki
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gopireddy Murali Mohan Reddy
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Saikiran Deshabhotla
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Venkat Reddy Kallem
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Pravin Rao Vadije
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

RPA conceptualized the study, supervised data collection, and prepared manuscript. VV, VRK, and PRV collected the data, helped in manuscript preparation, and reviewed the final manuscript. TPO, SM, and SD supervised the data collection, analysis, and gave important inputs to the final manuscript. GMMR checked authenticity of data, did propensity score match, and reviewed the final manuscript. RPA will act as the guarantor for this paper.

Corresponding author

Correspondence to Rajendra Prasad Anne.

Ethics declarations

Ethics Approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Ethics Committee of Fernandez hospitals approved this study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Anne, R.P., Vardhelli, V., Oleti, T.P. et al. Propensity-Matched Comparison of Very Preterm Small- and Appropriate-for-Gestational-Age Neonates. Indian J Pediatr 89, 59–66 (2022). https://doi.org/10.1007/s12098-021-03878-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12098-021-03878-3

Keywords

Search

Navigation