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Sánchez-Rosado M, Reis JD, Jaleel MA, Clipp K, Mangona KLM, Brown LS, Nelson DB, Wyckoff MH, Verma D, Kiefaber I, Lair CS, Nayak SP, Burchfield PJ, Thomas A, Brion LP. Impact of Size for Gestational Age on Multivariate Analysis of Factors Associated with Necrotizing Enterocolitis in Preterm Infants: Retrospective Cohort Study. Am J Perinatol 2023. [PMID: 37769697 DOI: 10.1055/a-2183-5155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
OBJECTIVE Necrotizing enterocolitis (NEC) primarily affects preterm, especially small for gestational age (SGA), infants. This study was designed to (1) describe frequency and timing of NEC in SGA versus non-SGA infants and (2) assess whether NEC is independently associated with the severity of intrauterine growth failure. STUDY DESIGN Retrospective cohort study of infants without severe congenital malformations born <33 weeks' gestational age (GA) carried out from 2009 to 2021. The frequency and time of NEC were compared between SGA and non-SGA infants. Multivariate logistic regression was used to assess whether NEC was independently associated with intrauterine growth restriction. Severe growth restriction was defined as birth weight Z-score < -2. RESULTS Among 2,940 infants, the frequency of NEC was higher in SGA than in non-SGA infants (25/268 [9.3%] vs. 110/2,672 [4.1%], respectively, p < 0.001). NEC developed 2 weeks later in SGA than non-SGA infants. In multivariate analysis, the adjusted odds of NEC increased with extreme prematurity (<28 weeks' GA) and with severe but not moderate growth restriction. The adjusted odds of NEC increased with urinary tract infection or sepsis within a week prior to NEC, were lower in infants fed their mother's own milk until discharge, and did not change over five epochs. NEC was independently associated with antenatal steroid (ANS) exposure in infants with birth weight (BW) Z-score < 0. CONCLUSION NEC was more frequent in SGA than in non-SGA infants and developed 2 weeks later in SGA infants. NEC was independently associated with severe intrauterine growth failure and with ANS exposure in infants with BW Z-score < 0. KEY POINTS · We studied 2,940 infants <33 weeks' GA.. · We assessed NEC.. · NEC was more frequent in SGA infants.. · NEC occurred 2 weeks later in SGA infants.. · NEC was associated with severe growth restriction..
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Affiliation(s)
- Mariela Sánchez-Rosado
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
- Division of Neonatology, Joe DiMaggio Children's Hospital, Hollywood, Florida
| | - Jordan D Reis
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Pediatrics, Baylor Scott and White, Dallas, Texas
| | - Mambarambath A Jaleel
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kimberly Clipp
- Department of Pediatrics, Parkland Health and Hospital System, Dallas, Texas
| | - Kate L M Mangona
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - L Steven Brown
- Department of Pediatrics, Parkland Health and Hospital System, Dallas, Texas
| | - David B Nelson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, and Parkland Health, Dallas, Texas
| | - Myra H Wyckoff
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Diksha Verma
- University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Cheryl S Lair
- Department of Pediatrics, Parkland Health and Hospital System, Dallas, Texas
| | - Sujir P Nayak
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Patti J Burchfield
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Anita Thomas
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Luc P Brion
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
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Yildiz D, Ceran B, Çakir U, Tuğcu AU, Tayman C. Effects of being small for gestational age on morbidities of prematurity. Anadolu Klin 2022; 27:287-292. [DOI: 10.21673/anadoluklin.1096789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Amaç: Gebelik yaşına göre düşük doğum ağırlığı (small for gestational age: SGA) olan prematüre bebeklerin prematüreliğe ek olarak hangi morbiditeler açısından daha riskli olduğu konusundaki kanıtlar yetersizdir. Çalışmamızda gebelik haftası <32 hafta olan SGA prematüre bebeklerin morbidite ve mortalite açısından risklerinin değerlendirilmesi amaçlanmıştır.Yöntemler: Gebelik haftası <32 hafta olup SGA olan bebeklerin morbiditeleri ve mortalite verileri, <32 gebelik haftasında doğan gebelik haftasına uygun doğum ağırlığı ile doğan (appropriate for gestational age: AGA) bebekler ile karşılaştırıldı.Bulgular: Çalışmaya 122 (%24,6) SGA ve 372 (%75,4) AGA bebek olmak üzere toplam 494 prematüre bebek dâhil edildi. Doğumda SGA olan bebeklerde AGA olanlara göre annede preeklampsi, nekrotizan enterokolit (NEK), prematüre retinopatisi (ROP), intraventiküler kanama (İVK) oranı daha yüksekti. Ayrıca SGA olanlarda AGA olanlara göre tam enteral beslenmeye geçiş zamanı, yoğun bakımda yatış süresi anlamlı olarak daha yüksekti (p<0,05).Sonuç: Gebelik haftaları benzer olsa da SGA ve prematüre olan bebeklerde, AGA olan bebeklere göre İVK, ROP ve NEK gibi prematüre morbiditeleri daha yüksekti.
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超早产儿/超低出生体重儿临床结局的性别差异:一项倾向性评分匹配研究. Zhongguo Dang Dai Er Ke Za Zhi 2022; 24. [PMID: 35644191 DOI: 10.7499/j.issn.1008-8830.2201049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To study the effect of sex on the clinical outcome of extremely preterm infants (EPIs)/extremely low birth weight infants (ELBWIs) by propensity score matching. METHODS A retrospective analysis was performed for the medical data of 731 EPIs or ELBWIs who were admitted from January 1, 2011 to December 31, 2020. These infants were divided into two groups: male and female. A propensity score matching analysis was performed at a ratio of 1:1. The matching variables included gestational age, birth weight, percentage of withdrawal from active treatment, percentage of small-for-gestational-age infant, percentage of use of pulmonary surfactant, percentage of 1-minute Apgar score ≤3, percentage of mechanical ventilation, duration of mechanical ventilation, percentage of antenatal use of inadequate glucocorticoids, and percentage of hypertensive disorders in pregnancy. The two groups were compared in the incidence rate of main complications during hospitalization and the rate of survival at discharge. RESULTS Before matching, compared with the female group, the male group had significantly higher incidence rates of neonatal respiratory distress syndrome, bronchopulmonary dysplasia (BPD), severe intraventricular hemorrhage, periventricular leukomalacia, necrotizing enterocolitis, and patent ductus arteriosus (P<0.05), while after matching, the male group only had a significantly higher incidence rate of BPD than the female group (P<0.05). There was no significant difference in the rate of survival at discharge between the two groups before and after matching (P>0.05). CONCLUSIONS Male EPIs/ELBWIs have a higher risk of BPD than female EPIs/ELBWIs, but male and female EPIs/ELBWIs tend to have similar outcomes.
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