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Severity of small-for-gestational-age and morbidity and mortality among very preterm neonates

Journal of Perinatology volume 43, pages 437–444 (2023)Cite this article

Subjects

Abstract

Objective

Evaluate the association between small for gestational age (SGA) severity and morbidity and mortality in a contemporary, population of very preterm infants.

Study design

This secondary analysis of a California statewide database evaluated singleton infants born during 2008–2018 at 24–32 weeks’ gestation, with a birthweight <15th percentile. We analyzed neonatal outcomes in relation to weight for gestational age (WGA) and symmetry of growth restriction.

Results

An increase in WGA by one z-score was associated with decreased major morbidity or mortality risk (aRR 0.73, 95% CI 0.68–0.77) and other adverse outcomes. The association was maintained across gestational ages and did not differ by fetal growth restriction diagnosis. Symmetric growth restriction was not associated with neonatal outcomes after standardizing for gestational age at birth.

Conclusions

Increasing SGA severity had a significant impact on neonatal outcomes among very preterm infants.

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Fig. 1: Major neonatal morbidity or mortality as a function of weight for gestational age percentile.

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Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We appreciate the approval from the CPQCC to conduct this investigation.

Author information

Authors and Affiliations

  1. Division of Maternal-Fetal Medicine & Obstetrics, Department of Obstetrics and Gynecology, School of Medicine, Stanford University, Stanford, CA, US

    Kathleen C. Minor, Katherine Bianco, Maurice L. Druzin & Stephanie A. Leonard

  2. Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA, US

    Lillian Sie & Henry C. Lee

  3. California Perinatal Quality Care Collaborative, Stanford, CA, US

    Lillian Sie & Henry C. Lee

Authors
  1. Kathleen C. Minor
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Contributions

KM contributed to the concept of the work, drafting and revising the manuscript. SL substantially contributed to the design of the study, analysis and co-wrote the manuscript. LS contributed to design, data analysis and revising of the manuscript. KB, MD and HL substantially contributed to the conception of the work, drafting and revising the manuscript and gave approval of this version.

Corresponding author

Correspondence to Kathleen C. Minor.

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Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

This study was approved by the California Committee for the Protection of Human Subjects (IRB #12-06-0393) and the Stanford University Institutional Review Board (IRB #14746). The Study was performed in accordance with the Declaration of Helsinki.

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Minor, K.C., Bianco, K., Sie, L. et al. Severity of small-for-gestational-age and morbidity and mortality among very preterm neonates. J Perinatol 43, 437–444 (2023). https://doi.org/10.1038/s41372-022-01544-w

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