Lin Chia-Ying, Chang Hung-Yang, Chang Jui-Hsing, Hsu Chyong-Hsin, Jim Wai-Tim, Peng Chun-Chih, Chen Chia-Huei
Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan.
Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.
Front Pediatr. 2023 Jul 14;11:1209765. doi: 10.3389/fped.2023.1209765. eCollection 2023.
The impact of small-for-gestational-age (SGA) on very-low-birth-weight (VLBW) premature infants remains inconclusive. This study aimed to assess the effects of being born SGA status on the short-term and long-term outcomes in VLBW preterm infants.
We conducted a population-based, prospective cohort study on VLBW preterm infants born in Taiwan between 2012 and 2017. Sociodemographic, neonatal, growth and neurological data at 2 years of corrected age were collected. A total of 4243 VLBW infants born at 24 through 32 completed weeks' gestation participated in this study, of whom 1,005 had SGA status defined as a birth weight <10th percentile of gestation, and 3,238 did not (the non-SGA group).We compared the risks of short-term outcomes (neonatal mortality and morbidities), long-term outcomes (growth status, including weight, height, and head circumference <10th percentile, and neurodevelopmental impairments at 2 years of age). Subgroup analysis was performed by stratification of gestation age (GA): GA 24-26, 27-29 and 30-32 weeks.
In the analysis of short-term outcomes, the SGA group had an increased risk of neonatal mortality [adjusted odds ratio (OR) = 2.66, 2.99, and 2.19, respectively] in all GA subgroups in comparison with the non-SGA group ( < 0.05). The SGA group had a significantly increased risk of bronchopulmonary dysplasia in GA 27-29 and 30-32 weeks (adjusted OR = 2.11 and 1.86, respectively). We also found that there was an increased risk of severe retinopathy of prematurity in GA 24-26 and 27-29 weeks in the SGA group compared with the non-SGA group (adjusted OR = 1.68 and 1.59, respectively).In the analysis of long-term outcomes, the SGA group had a significantly increased risk of NDI throughout all GA subgroups (adjusted = 1.94, 1.33, and 1.35, respectively) in comparison with the non-SGA group. The SGA groups also had an increased risk of growth status <10th percentile at 2 years of age ( < 0.05).
SGA VLBW premature infants had higher risks of neonatal death, growth status <10th percentile, and NDI at 2 years of corrected age compared with the non- SGA premature infants. Prenatal surveillance, postnatal attention, and long- term follow-up are warranted to improve the outcomes of VLBW SGA premature infants.
小于胎龄儿（SGA）对极低出生体重（VLBW）早产儿的影响尚无定论。本研究旨在评估出生时SGA状态对VLBW早产儿短期和长期结局的影响。
我们对2012年至2017年在台湾出生的VLBW早产儿进行了一项基于人群的前瞻性队列研究。收集了矫正年龄2岁时的社会人口学、新生儿、生长和神经学数据。共有4243例孕24至32周整周出生的VLBW婴儿参与了本研究，其中1005例为SGA状态，定义为出生体重<妊娠第10百分位数，3238例不是（非SGA组）。我们比较了短期结局（新生儿死亡率和发病率）、长期结局（生长状况，包括体重、身高和头围<第10百分位数，以及2岁时的神经发育障碍）的风险。按胎龄（GA）分层进行亚组分析：GA 24 - 26周、27 - 29周和30 - 32周。
在短期结局分析中，与非SGA组相比，SGA组在所有GA亚组中的新生儿死亡风险均增加[调整后的优势比（OR）分别为2.66、2.99和2.19，P<0.05]。SGA组在GA 27 - 29周和30 - 32周时支气管肺发育不良的风险显著增加（调整后的OR分别为2.11和1.86）。我们还发现，与非SGA组相比，SGA组在GA 24 - 26周和27 - 29周时发生重度早产儿视网膜病变的风险增加（调整后的OR分别为1.68和1.59）。在长期结局分析中，与非SGA组相比，SGA组在所有GA亚组中的神经发育障碍风险均显著增加（调整后的OR分别为1.94、1.33和1.35）。SGA组在2岁时生长状况<第10百分位数的风险也增加（P<0.05）。
与非SGA早产儿相比，SGA VLBW早产儿在矫正年龄2岁时新生儿死亡、生长状况<第10百分位数和神经发育障碍的风险更高。产前监测、产后关注和长期随访对于改善VLBW SGA早产儿的结局是必要的。
