NEONATAL OUTCOME IN GROWTH-RESTRICTED VERSUS APPROPRIATELY GROWN PRETERM INFANTS

 

 Buy Article Permissions and Reprints

ABSTRACT

The objective of this paper is to examine whether growth-restricted preterm infants have a different neonatal outcome than appropriately grown preterm infants. All consecutive, singleton preterm deliveries between 27-35 weeks' gestation were included over a 4-year period. Infants with congenital anomalies and infants of diabetic mothers were excluded. Infants were categorized as small-for-gestational-age (SGA) when birth weight was at or below the 10th percentile, and appropriate-for-gestational-age (AGA) when between the 11th and 90th percentiles. Outcome variables included: neonatal death, respiratory distress syndrome (RDS), sepsis, intraventricular hemorrhage (IVH), and necrotizing enterocolitis (NEC). Neonatal morbidity and mortality were examined by univariate and stepwise multivariate logistic regression analyses. Factors controlled for during the analysis included: maternal age; gestational age; mode of delivery; presence of preeclampsia, HELLP syndrome, prolonged premature rupture of membranes (PROM), placental abruption, placenta previa, prenatal steroid exposure, infant gender, and low Apgar score. Seventy-six infants were included in the SGA group and 209 in the AGA group. SGA infants had a higher mortality rate (p = 0.003). They also had more culture-proven sepsis episodes (p = 0.001). No differences were found with respect to the other outcomes. The results were similar when analyzed separately for the group of infants born at or below 32 weeks' gestation. Growth-restricted preterm infants were found to have both higher mortality and infection rates compared with AGA preterm infants. Growth restriction in the preterm neonate was not found to protect against other neonatal outcomes associated with prematurity. When considering elective preterm delivery for this high-risk group of pregnancies, the increased risks in the neonatal period should be taken into account.

REFERENCES

• 1 Fetal growth restriction. In: Cunningham FG, MacDonald PC, Gant NF, et al, eds. Williams Obstetrics, 20th ed. Stamford, CT: Appleton & Lange 1997: 839-853
  Google Scholar
• 2 Tyson J E, Kennedy K, Broyles S, Rosenfeld C R. The small for gestational age infant: accelerated or delayed pulmonary maturation? Increased or decreased survival?.  Pediatrics. 1995;  95 534-538
  PubMedGoogle Scholar
• 3 Piper J M, Xenakis E MJ, McFarland M, Elliott B D, Berkus M D, Langer O. Do growth-retarded premature infants have different rates of perinatal morbidity and mortality than appropriately grown premature infants?.  Obstet Gynecol . 1996;  87 169-174
  CrossrefPubMedGoogle Scholar
• 4 Procianoy R S, Garcia-Prats J A, Adams J M. Hyaline membrane disease and intraventricular hemorrhage in small for gestational age infants.  Arch Dis Child . 1980;  55 502-505
  PubMedGoogle Scholar
• 5 Laatikainen T J, Raisanen I J, Salminen K R. Corticotropin-releasing hormone in amniotic fluid during gestation and labor and in relation to fetal lung maturation.  Am J Obstet Gynecol . 1988;  59 891-895
  PubMedGoogle Scholar
• 6 Owen J, Baker S L, Hauth J C, Goldenberg R L, Davis R O, Copper R L. Is indicated or spontaneous preterm delivery more advantageous for the fetus?.  Am J Obstet Gynecol . 1990;  163 868-872
  PubMedGoogle Scholar
• 7 Friedman S A, Schiff E, Kao L, Sibai B M. Neonatal outcome after preterm delivery for preeclampsia.  Am J Obstet Gynecol . 1995;  172 1785-1788
  CrossrefPubMedGoogle Scholar
• 8 Schiff E, Friedman S A, Mercer B M, Sibai B M. Fetal lung maturity is not accelerated in preeclamptic pregnancies.  Am J Obstet Gynecol . 1993;  169 1096-1101
  PubMedGoogle Scholar
• 9 Usher R, McLean F. Intrauterine growth of live-born caucasian infants at sea level: standards obtained from measurements in 7 dimensions of infants born between 25 and 44 weeks of gestation.  J Pediatr . 1969;  74 901-910
  PubMedGoogle Scholar
• 10 Lieberman J R, Frased D, Weitzman S, Glezerman M. Birthweight curves in southern Israel populations.  Isr J Med Sci . 1993;  29 198-203
  PubMedGoogle Scholar
• 11 Usher R. Clinical and therapeutic aspects of fetal malnutrition.  Pediatr Clin North Am . 1970;  17 178
  PubMedGoogle Scholar
• 12 Gluck L, Kulovich M. Lecitin/sphingomyelin ratios in amniotic fluid in normal and abnormal pregnancy.  Am J Obstet Gynecol . 1975;  115 539-546
  PubMedGoogle Scholar
• 13 Stahlman M T. Acute respiratory disorders in the newborn. In: Avery G, ed. Neonatology, Pathophysiology and Management of the Newborn Philadelphia: Lippincott 1981: 376-377
  Google Scholar
• 14 Yoon J J, Kohl S, Harper R G. The relationship between maternal hypertensive disease of pregnancy and the incidence of idiopathic RDS.  Pediatrics . 1980;  65 735-739
  PubMedGoogle Scholar
• 15 Koenig J M, Christensen R D. Incidence, neutrophil kinetics, and natural history of neonatal neutropenia associated with maternal hypertension.  N Engl J Med . 1989;  321 557-562
  PubMedGoogle Scholar
• 16 Pena I C, Teberg A J, Finello K M. The premature small-for-gestational-age infant during the first year of life: comparison by birth weight and gestational age.  J Pediatr . 1988;  113 1066-1073
  PubMedGoogle Scholar
• 17 Dahms B B, Krauss A N, Auld P AM. Pulmunary function in dysmature infants.  J Pediatr . 1974;  84 434-437
  PubMedGoogle Scholar
• 18 Rigo J, Beke A, Papp Z, Paulin F. Neonatal outcome after preterm delivery for preeclampsia.  Am J Obstet Gynecol . 1996;  174 1080-1081
  PubMedGoogle Scholar
• 19 Bernstein I M, Horbar J D, Badger G J, Golan A, Ohisson A. Intrauterine growth restriction in very low birth weight newborns: neonatal outcome [abstract].  Am J Obstet Gynecol . 1997;  176 s31
  PubMedGoogle Scholar