Neonatal Intensive Care Unit, Department of Pediatrics, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, P.R. China.
Medical Informatics Research Center, Shantou University Medical College, Shantou, Guangdong, P.R. China.
J Matern Fetal Neonatal Med. 2023 Dec;36(2):2258257. doi: 10.1080/14767058.2023.2258257. Epub 2023 Sep 18.
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.
To evaluate the excess risks of mortality and morbidity independently associated with SGA birth in very preterm (before 32 weeks of gestation) Chinese infants.
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.
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.
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.
出生体重小于胎龄（SGA）的极早产儿存在因不成熟和宫内生长受限导致的短期和长期超额死亡率和发病率的风险。然而，之前的研究结果并不一致，且中国人群的当代数据非常有限。
评估 SGA 出生与中国极早产儿（妊娠 32 周前）死亡率和发病率过高的独立相关性。
研究人群包括我院和医疗合作医院新生儿重症监护病房（NICU）在 6 年内收治的所有极早产儿。SGA 组包括 615 例 SGA 婴儿，1230 例胎龄和性别相匹配的适于胎龄（AGA）婴儿作为对照组，比例为 2:1。通过多变量 logistic 回归分析调整潜在混杂因素后，评估 SGA 出生与结局（院内死亡率和发病率）之间的关系。CRIBII 评分用于表示入院时疾病严重程度，作为多变量分析中的协变量。
与 AGA 组相比，SGA 组的死亡率（优势比[OR] 2.12；95%可信区间[CI]：1.27-3.54）和支气管肺发育不良（BPD）[OR 1.95；95% CI：1.58-2.41]的风险增加。SGA 组未观察到呼吸窘迫综合征（RDS）、严重早产儿视网膜病变（sROP）、严重脑室内出血（sIVH）和坏死性小肠结肠炎（NEC）的发生率显著增加。进一步的 GA 分层亚组分析显示，SGA 状态在不同 GA 范围内对死亡率和发病率的影响存在一定模式。
SGA 状态与极早产儿的新生儿死亡率和 BPD 风险增加相关，但不同 GA 范围内的死亡率和发病率增加的风险并不一致。当代数据有助于为围产期护理决策和家庭咨询提供信息，特别是对于极早产儿 SGA 新生儿。
