Association of small-for-gestational-age status with mortality and morbidity in very preterm Chinese infants

Chunhua Liu; Kaiyan Wang; Gaozhan Huang; Zishan Huang; Yunchong Guo; Zhexi Xie; Zhisheng Wu; Ziqi Guo; Jizhong Guo

doi:10.1080/14767058.2023.2258257

Association of small-for-gestational-age status with mortality and morbidity in very preterm Chinese infants

J Matern Fetal Neonatal Med. 2023 Dec;36(2):2258257. doi: 10.1080/14767058.2023.2258257. Epub 2023 Sep 18.

Authors

Chunhua Liu¹, Kaiyan Wang², Gaozhan Huang¹, Zishan Huang¹, Yunchong Guo³, Zhexi Xie¹, Zhisheng Wu¹, Ziqi Guo¹, Jizhong Guo¹

Affiliations

¹ Neonatal Intensive Care Unit, Department of Pediatrics, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, P.R. China.
² Medical Informatics Research Center, Shantou University Medical College, Shantou, Guangdong, P.R. China.
³ Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China.

PMID: 37722705
DOI: 10.1080/14767058.2023.2258257

Abstract

Background: Very preterm infants born small for gestational age (SGA) are at risk for short- and long-term excess mortality and morbidity resulting from immaturity and deficient intrauterine growth. However, previous findings are inconclusive, and there is a paucity of contemporary data in Chinese population.

Objectives: To evaluate the excess risks of mortality and morbidity independently associated with SGA birth in very preterm (before 32 weeks of gestation) Chinese infants.

Materials and methods: The study population included all very preterm infants admitted to the neonatal intensive care units (NICUs) in our hospital and our medical treatment partner hospitals during a 6-year period. The SGA group consisted of 615 SGA infants, and 1230 appropriate-for-gestation-age (AGA) infants were matched with GA and sex as controls at a ratio of 2:1. The associations between SGA birth and outcomes (in-hospital mortality and morbidity) were evaluated by using multivariate logistic regression analysis after adjustment for potential confounders. The CRIBII score was used to indicate admission illness severity, acting as a covariate in the multivariate analysis.

Results: The SGA group was associated with increased risks of mortality [odds ratio (OR) 2.12; 95% CI: 1.27-3.54] and BPD [OR 1.95; 95% CI: 1.58-2.41] compared to the AGA group. No significant incidences of respiratory distress syndrome (RDS), severe retinopathy of prematurity (sROP), severe intraventricular hemorrhage (sIVH), and necrotizing enterocolitis (NEC) were observed in the SGA group. Further GA-stratified subgroup analysis showed SGA status exhibited certain patterns of effects on mortality and morbidity in different GA ranges.

Conclusions: SGA status is associated with excess risks of neonatal mortality and BPD in very preterm infants, but the increased risks of mortality and morbidity are not homogeneous in different GA ranges. The contemporary data can help inform perinatal care decision-making and family counseling, particularly for very preterm SGA neonates.

Keywords: CRIBII; Small for gestational age; infant; morbidity; mortality; very preterm.

MeSH terms

East Asian People
Female
Humans
Infant
Infant, Extremely Premature*
Infant, Newborn
Infant, Newborn, Diseases* / mortality
Infant, Premature, Diseases* / epidemiology
Infant, Premature, Diseases* / mortality
Infant, Small for Gestational Age*
Infant, Very Low Birth Weight*
Morbidity
Pregnancy