Abstract
Background: In our region, the contribution of very low birth weight infants (VLBW, < 1500 g) to overall neonatal mortality reaches 50-70%. Among these infants, the outcome is worse for those who are small for gestational age (SGA).
Aims: 1) to evaluate the severity and proportionality of SGA neonates among VLBW infants of the Neocosur Collaborative Group according to gestational age; 2) to estimate the risk of neonatal mortality associated with being SGA and its severity and proportionality. Population: the prospective continuous registry of Neocosur (18 Neonatal Units of Chile, Argentina, Peru, Paraguay, Uruguay, and Brazil), including all VLBW infants (25- 36 gestational weeks; n = 1518). Exclusion criteria: lethal congenital anomalies.
Methods. Design: observational. Anthropometric indexes: a) BW < 3rd and 10th centile; b) Severity of IUGR (FGR, fetal growth ratio = observed weight/mean BW for GA); not growth retarded: FGR 0.90 – 1.10; mildly: retarded: FGR 0.80 - 0.89, moderately retarded: FGR 0.75 – 0.79 and severely retarded: FGR < 0.75; c)Proportionality: coefficient of bimodality (values >0.55 indicate substantial body asymmetry) and Z Score of the Ponderal Index (PI = g/cm3+100; < -1 SD suggest asymmetric IUGR); d) neonatal mortality until discharge.
Results: < 3rd centile: 13.5% (p< 0.001); < 10th centile: 31% (95% CI 28.6-33.2;p<0.001); FGR: 0.90 + 0.21 (p<0.001); mildly retarded FGR: 20.8%, moderately retarded FGR: 8.7% and severely retarded FGR: 32.6%. Coefficient of bimodality: 0.53; Ponderal Index: 2.27 + 0.51; Z Score PI: 0.007 + 1.0; Z Score PI<-1: 7.9% (Chi>2 for trend by increasing GA: p = 0.178 and for decreasing FGR p< 0.001). Maternal hypertensive disease was systematically associated with an adjusted odds ratios of being SGA (aOR 1.86, 95% CI 1.38-2.5), FGR < 0.89 [adjusted Odds Ratio (aOR) 2.89, 95% CI 2.18-3.83) and Z Score PI < -1 (aOR 1.81, 95% CI 1.18-2.76). aOR for neonatal mortality were 2.64 (95% CI 1.71-3.92) for SGA; 3.04 (95% CI 2.12-4.36) for FGR <0.89, and 1.37 (95% CI 0.80-2.32) for Z Score PI < -1.
Conclusions: SGA, mostly symmetric and severe, is a frequent condition in infants with VLBW, and it is associated with higher mortality rates.
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Grandi, C., Tapia, J., Marshall, G. et al. 8 Severity, Proportionality and Risk of Neonatal Mortality of Very Low Birth Weight Infants with Fetal Growth Restriction. A Multicentric South American Analysis. Pediatr Res 57, 921 (2005). https://doi.org/10.1203/00006450-200506000-00036
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DOI: https://doi.org/10.1203/00006450-200506000-00036