Neonatal morbidities in small for gestational age preterm neonates: Is it Really Double Trouble?
CPS ePoster Library. Bhattacharya S. 06/25/15; 99120; 57
Dr. Soume Bhattacharya
Dr. Soume Bhattacharya
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Abstract
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Introduction
Small for gestational age premature neonates are an important subset among the preterm population. Small for gestational age preterm infants may suffer from complications of both prematurity and intrauterine growth retardation. Different studies have shown varying results. Some studies report an increase in neonatal mortality and morbidity in small for gestational age premature neonates. While there are other studies that report that rates of RDS, NEC IVH, etc are similar among the AGA and SGA preterm population. The varying results could have been because use of different growth standards , or inclusion based on liberal birth weight criteria. Hence we designed a study, in a well defined sample, with sex specific ,valid, population based growth standards, to study neonatal morbidity affecting small for gestational age neonates born at less than 31 weeks of gestation .
Methods:
This was a hospital based cohort study of infants admitted or transferred in to the neonatal intensive care unit at a tertiary care center. The neonates were classified as Appropriate for gestational age(10th-90th) or Small for gestational age(<10th) as per their birth percentile based on Kramer et al .Infants with major congenital anomalies were excluded. Maternal & neonatal demographic data and data regarding neonatal morbidities such as RDS, BPD, Mechanical Ventilation, PDA, PDA treatment, NEC, IVH, PVL , Blood Transfusion, Sepsis, ROP, treatment for ROP were collected from the Neonatal Perinatal Database.
Results:
A total of 923 neonates met the inclusion criteria of which 9.5 % were SGA and 87.6 % were AGA. Maternal PIH was significantly high in the SGA group (51.1%) compared to the AGA group(14.0%) with a P value of less than 0.00. A significantly higher proportion of SGA babies were delivered via Cesarean section. Neonatal morbidity like RDS, BPD, sepsis, NEC, Sepsis, ROP , IVH and PVL were found to be comparable with no significant difference in the two groups. Hemodynamically significant PDA was significantly lower in SGA infants(39.8%) than AGA infants( 53.8%) , p=.013. The need for mechanical ventilation was also found to be lower in SGA infants (68.2%) vs AGA infants ( 78.6 %) , p=0.03. Days on oxygen and number of days to full feed were comparable in the two groups.
Conclusion: Small for gestational age preterm infants born at less than 31 weeks of gestation were found to have similar rates of neonatal morbidity such as RDS, BPD, NEC, ROP as their AGA peers. SGA infants had lower rates of mechanical ventilation and hemo-dynamically significant PDA.
Introduction
Small for gestational age premature neonates are an important subset among the preterm population. Small for gestational age preterm infants may suffer from complications of both prematurity and intrauterine growth retardation. Different studies have shown varying results. Some studies report an increase in neonatal mortality and morbidity in small for gestational age premature neonates. While there are other studies that report that rates of RDS, NEC IVH, etc are similar among the AGA and SGA preterm population. The varying results could have been because use of different growth standards , or inclusion based on liberal birth weight criteria. Hence we designed a study, in a well defined sample, with sex specific ,valid, population based growth standards, to study neonatal morbidity affecting small for gestational age neonates born at less than 31 weeks of gestation .
Methods:
This was a hospital based cohort study of infants admitted or transferred in to the neonatal intensive care unit at a tertiary care center. The neonates were classified as Appropriate for gestational age(10th-90th) or Small for gestational age(<10th) as per their birth percentile based on Kramer et al .Infants with major congenital anomalies were excluded. Maternal & neonatal demographic data and data regarding neonatal morbidities such as RDS, BPD, Mechanical Ventilation, PDA, PDA treatment, NEC, IVH, PVL , Blood Transfusion, Sepsis, ROP, treatment for ROP were collected from the Neonatal Perinatal Database.
Results:
A total of 923 neonates met the inclusion criteria of which 9.5 % were SGA and 87.6 % were AGA. Maternal PIH was significantly high in the SGA group (51.1%) compared to the AGA group(14.0%) with a P value of less than 0.00. A significantly higher proportion of SGA babies were delivered via Cesarean section. Neonatal morbidity like RDS, BPD, sepsis, NEC, Sepsis, ROP , IVH and PVL were found to be comparable with no significant difference in the two groups. Hemodynamically significant PDA was significantly lower in SGA infants(39.8%) than AGA infants( 53.8%) , p=.013. The need for mechanical ventilation was also found to be lower in SGA infants (68.2%) vs AGA infants ( 78.6 %) , p=0.03. Days on oxygen and number of days to full feed were comparable in the two groups.
Conclusion: Small for gestational age preterm infants born at less than 31 weeks of gestation were found to have similar rates of neonatal morbidity such as RDS, BPD, NEC, ROP as their AGA peers. SGA infants had lower rates of mechanical ventilation and hemo-dynamically significant PDA.
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