Bhurawala Habib, Lee Stephanie, Trompert-Thompson Kaitlyn, Toh Shen Yung, Poulton Alison
Department of Paediatrics, Nepean Hospital, Penrith, NSW, Australia.
Sydney Medical School Nepean, Discipline of Paediatrics, The University of Sydney, Sydney, NSW, Australia.
Transl Pediatr. 2024 Sep 30;13(9):1540-1550. doi: 10.21037/tp-24-83. Epub 2024 Sep 24.
Infants with small for gestational age (SGA) have an increased risk of short and long-term health outcomes, with potentially modifiable risk factors. This study aims to determine the prenatal risk factors associated SGA and evaluate the clinical management of affected infants.
An observational retrospective study of medical records of infants born at Nepean Hospital and discharged with a diagnosis of SGA over 5 years (1 January 2015 to 31 December 2019). Data included demographic details, antenatal care, maternal risk factors and clinical management of the infants.
Six hundred and seven infants had a discharge diagnosis of SGA, from 20,392 infants born. Of the 607 infants identified, 487 (80%) had SGA, 97 (16%) had asymmetrical SGA, 175 (29%) had symmetrical SGA, and 50 (8%) were incorrectly diagnosed with SGA based on growth measurements taken at birth. The most prevalent maternal risk factors were the presence of chronic disease (n=402, 66.23%), current smoking (n=159, 26.19%), social work input (n=108, 17.79%), gestational diabetes mellitus (n=96, 15.82%) and Aboriginal background (n=73, 12.03%). Prenatal genetic testing was conducted in 89.62% (n=544); 58.81% (n=357) had placental abnormalities; 36.57% (n=222) were recommended follow-up with a general practitioner (GP) and paediatrician, and 21.09% (n=128) were recommended a combination of midwifery in the home (MITH), GP, and paediatric follow-up. Two infants were recorded with no follow-up.
Diagnostic inaccuracies were found in infants with SGA. More intensive antenatal care for women with risk factors for SGA might improve the health of those with chronic disease; support for smoking cessation could also be offered.
小于胎龄儿（SGA）患短期和长期健康问题的风险增加，且存在一些可能可改变的风险因素。本研究旨在确定与SGA相关的产前风险因素，并评估受影响婴儿的临床管理情况。
对在尼平医院出生并在5年期间（2015年1月1日至2019年12月31日）出院诊断为SGA的婴儿的病历进行观察性回顾研究。数据包括人口统计学细节、产前护理、母亲风险因素以及婴儿的临床管理情况。
在出生的20392名婴儿中，有607名婴儿出院诊断为SGA。在这607名确诊婴儿中，487名（80%）为SGA，97名（16%）为不对称性SGA，175名（29%）为对称性SGA，50名（8%）根据出生时的生长测量结果被错误诊断为SGA。最常见的母亲风险因素是患有慢性病（n = 402，66.23%）、当前吸烟（n = 159，26.19%）、社会工作介入（n = 108，17.79%）、妊娠期糖尿病（n = 96，15.82%）以及原住民背景（n = 73，12.03%）。89.62%（n = 544）的婴儿进行了产前基因检测；58.81%（n = 357）有胎盘异常；36.57%（n = 222）被建议由全科医生（GP）和儿科医生进行随访，21.09%（n = 128）被建议采用家庭助产服务（MITH）、全科医生和儿科随访相结合的方式。记录显示有两名婴儿未进行随访。
发现SGA婴儿存在诊断不准确的情况。对有SGA风险因素的女性加强产前护理可能会改善患有慢性病者的健康状况；也可以提供戒烟支持。
