Small for gestational age: towards 2004

The impact of small-for-gestational-age Status on the outcomes in very-Low-birth-weight (VLBW) premature infants: a prospective cohort study in Taiwan

Background

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.

Methods

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.

Results

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 (p < 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 (p < 0.05).

Conclusions

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.

Parenting and cognitive and psychomotor delay due to small-for-gestational-age birth

BACKGROUND

To examine whether different dimensions of parenting at different ages help small-for-gestational-age (SGA) children 'catch-up' the normal children in cognition and psychomotor.

METHODS

We analyzed data of 800 children born SGA and 3,000 children born appropriate-for-gestational-age (AGA) from the Early Childhood Longitudinal Study-Birth cohort. The Two Bag Task was used to measure 2-year or 4-year parenting dimensions. Children's reading, math, gross motor, and fine motor scores were assessed at 5 years. Multivariable linear regression models were fitted to test the interactions between SGA and 2-year or 4-year parenting dimensions on 5-year cognitive and psychomotor outcomes (dependent variables).

RESULTS

There were significant interactions between SGA and early parenting on 5-year reading, math, and fine motor scores. The gap between SGA and AGA children in 5-year fine motor score was attenuated to null [-0.25 (95% confidence interval, -0.41, -0.09) vs. 0.03 (-0.13, 0.20)] when 2-year parental sensitivity score increased from 1 standard deviation (SD) below mean (Mean - SD) to 1 SD above mean (Mean + SD). The gap between SGA and AGA children in 5-year fine motor [-0.28 (-0.44, -0.13) vs. 0.06 (-0.09, 0.22)] and math [-1.32 (-2.27, -0.37) vs. 0.20 (-0.77, 1.17)] scores was also attenuated to null when 4-year parental emotional support score increased from Mean - SD to Mean + SD. In contrast, the gap between SGA and AGA children in 5-year reading score increased from 0.49 (-0.90, 1.88) to -1.31 (-2.55, -0.07) when 4-year parental intrusiveness score increased from Mean - SD to Mean + SD. Similarly, the gap between SGA and AGA children in fine motor score increased with 4-year parental negative regard from 0.02 (-0.14, 0.18) to -0.23 (-0.38, -0.08).

CONCLUSIONS

Early high-quality parenting may buffer some adversity in long-term reading, math, and fine motor skills related to SGA birth, whereas low-quality parenting can amplify the adversity.

Neurological outcome in preterm small for gestational age infants compared to appropriate for gestational age preterm at the age of 18 months: a prospective study

The aim of this study was to investigate the neurological outcome of premature small for gestational age infants at the corrected age of 18 months by the Hammersmith Infant Neurological Examination. A prospective trial was conducted comparing 41 preterm infants being small for gestational age with 41 appropriate for gestational age infants. Birth weight was significantly lower in small for gestational age infants compared with appropriate for gestational age infants (1724.6 +/- 433 versus 1221 +/- 328 g). There were no significant differences regarding the median gestational age and Apgar scores. Median global scores differ significantly between both groups: 75 (47-78) versus 76 (72-78) for the small for gestational age and appropriate for gestational age infants, respectively. Both groups had optimal scores. In conclusion, although the small for gestational age group scored lower in the Hammersmith Infant Neurological Examination, median global score in both groups was within optimal range.

The effect of intrauterine development and nutritional status on perinatal mortality

OBJECTIVE

To study the influence of bodily development and nutritional status on perinatal mortality.

METHODS

The authors developed a new method, the MDN system (MDN: Maturity, Development, Nutritional Status), to determine the development and nutritional status of newborns based on their weight and length standard positions. Using data of 680,947 neonates born in the 7 years from 1997 to 2003 in Hungary, they computed the perinatal mortality (PM) rate of each developmental groups of neonates.

RESULTS

PM in the group of neonates of absolute average development was 7 per thousand, 30 per thousand in the proportionally retarded group and it was 90 per thousand in the extremely overnourished group. The PM rate was the highest (191 per thousand) in the extremely undernourished group.

CONCLUSIONS

Both bodily development and nourishment have a major impact on PM. The MDN system is a suitable method to differentiate the most endangered groups of neonates based on their development and nutritional status.

Neonatal state organization, neuromaturation, mother-infant interaction, and cognitive development in small-for-gestational-age premature infants

OBJECTIVE

The purpose of this work was to examine the relations among neuromaturation, mother-infant relationship, and cognitive development in small-for-gestational-age premature infants and to assess the interactive effects of birth weight and intrauterine growth restriction on developmental outcomes.

METHODS

We studied 120 singleton premature infants (birth weight: 530-1790 g; gestational age: 25-35 weeks). In group 1, 40 small-for-gestational-age infants (22 girls) were case-matched with group 2 (n = 40) for birth weight (appropriate for gestational age matched for birth weight) and group 3 (n = 40) matched for gestational age (appropriate for gestational age matched for gestational age). Exclusion criteria included intraventricular hemorrhage grade 4, perinatal asphyxia, central nervous system infections, and genetic conditions. Infants were further divided into those born below and above 1000-g subgroups. Neonatal state organization was observed for 4 consecutive hours. Neuromaturation was assessed with the Neonatal Behavioral Assessment Scale. At 3 and 24 months' corrected age, mother-infant interaction was evaluated. At 1 and 2 years' corrected age, the infants' cognitive development was tested with the Bayley Scale of Infant Development, 2nd edition.

RESULTS

Small-for-gestational-age infants showed less organized state and less mature neurobehavioral profiles, particularly in the orientation and motor domains. Mother-infant interactions were characterized by maternal intrusiveness and miscoordination and negative infant engagement. Cognitive outcomes at 1 and 2 years were lower for the small-for-gestational-age group. Small-for-gestational-age infants born < 1000 g showed the poorest neurodevelopmental, social, and cognitive development of all of the groups. Cognitive outcomes at 2 years were predicted by small-for-gestational-age status, the interaction of actual birth weight and small-for-gestational-age status, neonatal state organization, and maternal intrusive behavior.

CONCLUSION

Small-for-gestational-age premature infants are at higher risk for developmental and cognitive delays, as well as difficulties in the mother-infant relationship across infancy. Those born at extremely low birth weight are at a double risk. This group should receive special clinical attention and care.