Preterm Small For Gestational Age Infants Research Articles

Effect of Intra- and Extrauterine Growth on Long-Term Neurologic Outcomes of Very Preterm Infants

To determine whether extrauterine growth is associated with neurologic outcomes and if this association varies by prenatal growth profile. For 1493 preterms from the EPIPAGE (Étude Épidémiologique sur les Petits Âges Gestationnels [Epidemiological Study on Small Gestational Ages]) cohort, appropriate for gestational-age (AGA) was defined by birth weight >-2 SD and small for gestational-age (SGA) by birth weight ≤-2 SD. Extra-uterine growth was defined by weight gain or loss between birth and 6months by z-score change. Growth following-the-curve (FTC) was defined as weight change -1 to +1 SD, catch-down-growth (CD) as weight loss ≥1 SD, and catch-up-growth (CU) as weight gain ≥1 SD. At 5years, a complete medical examination (n=1305) and cognitive evaluation with the Kauffman Assessment Battery for Children (n=1130) were performed. Behavioral difficulties at 5years and school performance at 8years were assessed (n=1095). Overall, 42.5% of preterms were AGA-FTC, 20.2% AGA-CD, 17.1% AGA-CU, 5.6% SGA-FTC, and 14.5% SGA-CU. Outcomes did not differ between CU and FTC preterm AGA infants. Risk of cerebral palsy was greater for AGA-CD compared with AGA-FTC (aOR 2.26 [95% CI 1.37-3.72]). As compared with children with SGA-CU, SGA-FTC children showed no significant increased risk of cognitive deficiency (aOR 1.41[0.94-2.12]) or school difficulties (aOR 1.60 [0.84-3.03]). Compared with AGA-FTC, SGA showed increased risk of cognitive deficiency (SGA-FTC aOR 2.19 [1.25-3.84]) and inattention-hyperactivity (SGA-CU aOR 1.65 [1.05-2.60]). Deficient postnatal growth was associated with poor neurologic outcome for AGA and SGA preterm infants. CU growth does not add additional benefits. Regardless of type of postnatal growth, SGA infants showed behavioral problems and cognitive deficiency.

Analysis of correlation factors and pregnancy outcomes of hypertensive disorders of pregnancy – a secondary analysis of a random sampling in Beijing, China

Objective: We aimed to assess the prevalence and risk factors for hypertensive disorders and to study the main pregnancy outcomes in the Beijing area of China.Study design: This study randomly sampled 15 hospitals in Beijing from Jun 2013 to Nov 2013 and evaluated 15 194 deliveries. Logistic regression analysis was used to study the association between risk factors and hypertensive disorders. Pregnancy outcomes included preterm birth, cesarean delivery and small for gestational age (SGA).Results: The prevalence of hypertensive disorders, preeclampsia (PE) and severe PE was 4.4, 2.7 and 1.8%, respectively. The risk factors for hypertensive disorders and severe PE were maternal body mass index before pregnancy, gestational weight gain (GWG), gestational diabetes and pre-gestational diabetes, and third trimester cholesterol (CHOL) levels. First trimester high-density lipoprotein was a protective factor for severe PE. The incidence of hypertensive disorders increased with maternal age. Preterm delivery, cesarean delivery and small infant size for gestational age were more prevalent in the severe PE group compared with the non-hypertensive group.Conclusions: In the Beijing area of China, maternal body mass index before pregnancy, GWG, maternal complications of gestational diabetes and pre-gestational diabetes, and third trimester CHOL levels are risk factors for both hypertensive disorders of pregnancy and severe PE. First trimester high-density lipoprotein is a protective factor for severe PE. Severe preeclampsia leads to a higher incidence of preterm delivery, cesarean delivery and SGA infants.

Defining small-for-gestational-age: prescriptive versus descriptive birthweight standards.

Descriptive population-based birthweight standards possess low sensitivity in detecting infants with growth impairment. A prescriptive birthweight standard based on a 'healthy' subpopulation without risk factors for intrauterine growth restriction might be superior. We created two birthweight standards based on live born, singleton infants with gestational age 24-42weeks and born in The Netherlands between 2000 and 2007. Inclusion criteria for the prescriptive birthweight standard were restricted to infants without congenital malformations, born to healthy mothers after uncomplicated pregnancies. We defined small-for-gestational-age (SGA) as birthweight <10th percentile and assessed the ability of both standards to predict adverse neonatal outcomes. The prescriptive birthweight standard identified significantly more infants as SGA, up to 38.0% at 29weeks gestation. SGA infants classified according to both standards as well as those classified according to the prescriptive birthweight standard only, were at increased risk of both major and minor adverse neonatal outcomes. The prescriptive birthweight standard was both more sensitive and less specific, with a maximum increase in sensitivity predicting bronchopulmonary dysplasia (+42.6%) and a maximum decrease in specificity predicting intraventricular haemorrhage (-26.9%) in infants aged 28-31weeks. Prescriptive birthweight standards could improve identification of infants born SGA and at risk of adverse neonatal outcomes. • Descriptive birthweight standards possess low sensitivity in detecting growth restricted infants at risk of adverse neonatal outcomes. • Prescriptive standards could improve identification of very preterm small-for-gestational-age (SGA) infants at risk of intraventricular haemorrhage. What is New: • Prescriptive standards identify more preterm and term SGA infants at risk of major adverse neonatal outcomes. • Late preterm and term SGA infants classified according to the prescriptive standard are at increased risk of minor adverse neonatal outcomes with potentially harmful implications.

Cost-Effectiveness of Pre-Pregnancy Bariatric Surgery [9C

INTRODUCTION: We sought to determine if bariatric surgery is a cost-effective pre-pregnancy approach to reduce pregnancy complications in obese women. METHODS: We assessed the cost-effectiveness of bariatric surgery prior to becoming pregnant in a theoretical cohort of obese women age 20–39 in the United States. Outcomes included gestational diabetes (GDM), preeclampsia, preterm delivery, cesarean delivery, maternal mortality, and neurodevelopmental disability. All model inputs were derived from the literature. We calculated quality-adjusted life years (QALYs) to compare strategies, accounting for maternal and neonatal utilities. We ran our models with and without consideration of anovulation rates given its substantial impact on QALYs. RESULTS: Pre-pregnancy bariatric surgery led to lower rates of GDM, preeclampsia, and large-for-gestational-age infants, but more small-for-gestational-age (SGA) infants. Overall, no bariatric surgery was the preferred strategy with lower costs and better outcomes. However, when considering the impact on fecundity from improved ovulation rates after bariatric surgery, it would then become cost effective at $2,528 per QALY. Women who underwent pre-pregnancy bariatric surgery had higher rates of preterm delivery, SGA infants, cesarean delivery, maternal death and neonates with neurodevelopmental disabilities. Univariate sensitivity analyses showed that pre-pregnancy bariatric surgery became the preferred strategy when the probability of having an SGA baby became less than 0.121 from a baseline probability of 0.156. CONCLUSION: Bariatric surgery reduces the risk of GDM, preeclampsia and LGA infants, but it is not a cost-effective intervention in obese women of reproductive age. However, in women who are anovulatory, it may be a reasonable approach to improve overall pregnancy outcomes.

Effects of asphyxia as a"Second Hit"on renal function in small for gestational age infants

Objective To investigate the effects of the asphyxia as aSecond Hiton renal function during early stage after birth in small for gestational age (SGA) infants. Methods The infants who were hospitalized within 24 hours after birth in Peking University Third Hospital between January 2013 and March 2015 were retrospectively enrolled, and divided into different groups depending on gestational age and asphyxia history. There were 40 preterm non-asphyxia SGA infants and 80 controls who were preterm non-asphyxia appropriate for gestational age (AGA) infants; 11 preterm asphyxia SGA infants and an equal number of preterm asphyxia AGA infants as controls; 33 term non-asphyxia SGA infants and 33 term non-asphyxia AGA infants as controls; and four term asphyxia SGA infants and 13 term asphyxia AGA infants as controls. Blood urea nitrogen (BUN), serum creatinine (SCr), and estimate glomerular filtration rate (eGFR) were tested within 48 h after admission and the incidence of abnormal indexes was compared between groups by t-test and Fisher exact test. Results (1) Compared with preterm non-asphyxia AGA group, BUN level significantly decreased in preterm non-asphyxia SGA group [(3.99±1.69) vs (5.11±2.08) mmol/L, t=2.948, P=0.004]. Compared with term non-asphyxia AGA group, term non-asphyxia SGA group had higher SCr level [(72.03±10.29) vs (62.58±12.27) μmol/L, t=3.390, P=0.001] and lower eGFR level [(25.19±4.07) vs (33.99±8.75) ml/(min·1.73 m2), t=5.238, P=0.000]. (2) Compared with preterm non-asphyxia AGA infants, preterm asphyxia AGA infants had higher BUN [(6.96±3.09) vs (5.11±2.08) mmol/L, t=2.602, P=0.011] and SCr [(76.45±10.11) vs (66.70±13.18) μmol/L, t=2.357, P=0.021] and lower eGFR level [(15.86±2.31) vs (19.54±5.08) ml/(min·1.73 m2), t=2.361, P=0.020]. Compared with preterm non-asphyxia SGA group, there was a significant increase in BUN level [(6.70±3.37) vs (3.99±1.69) mmol/L, t=2.581, P=0.025] and decrease in eGFR level [(14.80±4.67) vs (18.66±5.03) ml/(min·1.73 m2), t=2.285, P=0.027] in preterm asphyxia SGA group. Changes in term infants were similar to preterm infants. (3) Compared with asphyxia AGA group, asphyxia SGA group showed a higher frequency of abnormal eGFR in term infants (4/4 vs 4/13, Fisher exact test, P=0.029). Conclusions Asphyxia as a probableSecond Hitcan influence the renal function during early stage in both preterm and term infants, especially in SGA infants. Key words: Asphyxia neonatorum; Infant, small for gestational age; Glomerular filtration rate; Blood urea nitrogen; Creatinine

Impact of Gestational Weight Gain on Perinatal Outcomes in Obese Women.

Objective This study aims to evaluate perinatal outcomes, according to gestational weight gain (GWG) in obese women. Study Design A retrospective cohort of perinatal outcomes in obese women who gained below, within, or above the 2009 Institute of Medicine guidelines and delivered ≥ 36 weeks. Additionally, outcomes, according to the rate of GWG (kg/week; minimal [< 0.16], moderate [0.16-0.49], or excessive [> 0.49]) were compared among women delivering preterm. Results Overall, 5,651 obese women delivered ≥ 36 weeks. GWG above guidelines was associated with increased cesarean section (adjusted odds ratio [aOR]: 1.44, 95% confidence interval [CI]: 1.21-1.72), gestational hypertension (aOR: 1.58, 95% CI: 1.21-2.06), and macrosomia (birth weight ≥ 4,000 g) (aOR: 2.08, 95% CI: 1.62-2.67). GWG below recommendations was associated with less large for gestational age infants (aOR: 0.60, 95% CI: 0.47-0.75). A total of 6,663 women delivered ≥ 20 weeks. Minimal weekly GWG was associated with increased spontaneous preterm birth (aOR: 1.56, 95% CI: 1.23-1.98) and more small for gestational age (SGA) infants (aOR: 1.55, 95% CI: 1.19-2.01). Excessive weekly GWG was associated with increased indicated preterm birth (aOR: 1.61, 95% CI: 1.29-2.01), cesarean section (aOR: 1.39, 95% CI: 1.20-1.61), preeclampsia (aOR: 1.83, 95% CI: 1.49-2.26), neonatal intensive care unit admission (aOR: 1.33, 95% CI: 1.08-1.63), and macrosomia (aOR: 2.40, 95% CI: 1.94-2.96). Conclusions Obese women with excessive GWG had worse outcomes than women with GWG within recommendations. Limited GWG was associated with increased spontaneous preterm birth and SGA infants.

Intimate partner violence during pregnancy and the risk for adverse infant outcomes: a systematic review and meta-analysis.

Intimate partner violence (IPV) is of particular concern during pregnancy when not one, but two lives are at risk. Previous meta-analyses have suggested an association between IPV and adverse birth outcomes; however, many large studies have since been published, illustrating the need for updated pooled effect estimates. To evaluate the relationship between IPV during pregnancy and the risk of preterm birth (PTB), low-birthweight (LBW), and small-for-gestational-age (SGA) infants. We searched PubMed and SCOPUS (from inception until May2015), and the reference lists of the relevant studies. Observational studies comparing the rates of at least one adverse birth outcome (SGA, LBW, or PTB) in women who experienced IPV during pregnancy and those who did not. Data extracted from 50 studies were pooled and pooled odds ratios were calculated using random-effects models. Intimate partner violence (IPV) was significantly associated with PTB (OR1.91, 95%CI 1.60-2.29) and LBW (OR2.11, 95%CI 1.68-2.65), although a large level of heterogeneity was present for both (I(2) =84 and 91%, respectively). The association with SGA was less pronouncedandmarginally significant (OR1.37, 95%CI 1.02-1.84), althoughfewer studies were available for meta-analysis (n=7). Our meta-analysis indicates that women who experienced IPV during pregnancy are at increased risk ofhaving a PTB, and an LBW or an SGA infant. More studiesexamining the association between IPV and SGA are needed. Meta-analysis of IPV during pregnancy finds increased risk for preterm birth, LBW and SGA infants.

Effect of Bifidobacterium breve M-16V supplementation on faecal bifidobacteria in growth restricted very preterm infants – analysis from a randomised trial

Background: Gut development, function and colonisation are impaired in animal models of prematurity with intrauterine growth restriction (IUGR). The effect of Bifidobacterium breve (B. breve) supplementation on faecal bifidobacteria in small for gestational age (SGA: birth weight <10th centile due to IUGR) preterm infants is not known.Objective: We compared B. breve M-16V supplementation effect on faecal bifidobacteria in preterm (<33 weeks) SGA versus non-SGA infants in the two arms of our randomised controlled trial.Results: There were no baseline differences in the proportion of detectable B. breve counts between SGA versus non-SGA infants [probiotic: 7 (33%) versus 22 (42%), p = 0.603; placebo: 1 (6%) versus 1 (2%), p = 0.429]. B. breve counts did not differ between SGA and non-SGA infants in response to treatment (p = 0.589), after adjusting for baseline count (p < 0.001) and treatment allocation (p < 0.001). An interaction term between growth status and treatment showed negligible change (p = 0.938). Probiotic treated SGA infants reached full feeds earlier than SGA controls (HR 2.00, 95% CI 1.05–3.82, p = 0.035): Median (IQR): 16 (12–26) versus 19 (11–25) days, after adjustment for age at starting feeds and gestation <28 weeks.Conclusion: Response to B. breve M-16V supplementation was not significantly different in preterm (<33 weeks) SGA versus non-SGA infants.

Iron Stores in Term and Late Preterm Small for Gestational Age and Appropriate for Gestational Age Neonates at Birth and in Early Infancy.

To compare body iron stores in late preterm and term small for gestational age (SGA) infants with gestation matched appropriate-for-gestational age (AGA) infants at birth and at 2 mo of age. In this prospective observational study, live births of 34-42 wk gestation and SGA (<10th centile for GA) were enrolled along with gestation matched AGA (10th-90th centile for GA) infants. Infants' blood samples were taken within 2h of delivery, and repeated at 60±7 d of life. Primary outcome was serum ferritin at birth and 60 d of age. Secondary outcomes were hematocrit at birth and 60 d and need for transfusion until 60 d of life. A total of 37 SGA (gestation 37.2±1.9 wk, birth weight 1861±401g) and 30 AGA infants (gestation 37.3±1.9 wk, birth weight 2607±405g) were enrolled in the study. There was no difference in the serum ferritin between AGA and SGA infants at birth {median [IQR]: 254.0 [214.3-293.8] vs. 259.7 [217.8-301.5] μg/L; p=0.85} or 60d of life {147.2 [101.4-193.0] vs. 155.0 [106.6-203.6] μg/L; p=0.81}. Mean hematocrit was 55.5±9.6 vs. 52.4±5.0 at birth (p=0.10) and 32.1±4.9 vs. 31.6±3.8 at 60 d (p=0.77) in SGA and AGA infants respectively. No infant required blood transfusion during the study period. Iron stores of late preterm and term SGA infants are comparable to term AGA infants at birth and 2 mo of age. Recommendations on iron supplementation to these infants need to be formulated through appropriately designed randomized trials.

Differential Morbidity in Preterm Small versus Appropriate for Gestational Age: Perhaps Unverifiable

The objective of this study was to determine the morbidity of preterm small for gestational age (SGA) infants compared with appropriate for GA (AGA). This is a secondary analysis of the randomized trial evaluating magnesium sulfate for the prevention of cerebral palsy (CP). We compared outcomes of preterm (< 37 weeks) nonanomalous infants who were SGA (birth weight < 10% for GA) versus AGA (birth weight 10-89% for GA). We compared (1) the parent trial primary outcome, a composite of stillbirth, infant death by 1 year of age, or moderate to severe CP at 2 years of age and (2) composite neonatal morbidity (CNM). Of the 1,948 infants who met inclusion criteria, 95% were AGA and 5% were SGA. The primary outcome was similar (10 and 15%, p = 0.08), as was the CNM (24 and 25%, p = 0.89). Sample size calculations indicate that detection of a one-third higher rate of CNM among SGA compared with AGA infants requires more than 93,900 preterm births; for a one-third difference in moderate to severe CP, more than 1.4 million infants. Owing to the prohibitive sample size required, ascertaining a difference in sequela between preterm SGA and AGA infants is possibly unverifiable.

Prepregnancy Body Mass Index is an Independent Risk Factor for Pregnancy Complications and Poor Birth Outcomes

Pregnancy complications and poor birth outcomes represent public health burden with serious consequences to both mothers and infants. Public health burdens can be reduced by achieving gestational weight gain (GWG) guidelines, which are dependent on prepregnant weight status (ppg‐BMI). We examined if ppg‐BMI alone is a risk factor for gestational hypertension, gestational diabetes, preterm labor, and birth of small‐for‐gestational‐age (SGA) and large‐for‐gestational‐age (LGA) infants. Included in this study are the data of 219,868 women from 2004‐2011 PRAMS which were from the state birth certificate file plus self‐administered questionnaires. Multivariate logistic regression analyses were performed to examine if ppg‐BMI was associated with pregnancy complications and poor birth outcomes after controlling for gestational weight gain, maternal age, race/ethnicity, education level, marital status, gestational age at birth, participation in WIC, and smoking during pregnancy.The IOM's GWG guidelines were achieved inadequate, adequate and excessive by 23%, 29% and 48%, respectively. Even after GWG was controlled, compared to normal ppg‐BMI (18.5–24.9 kg/m2) group, women with obese ppg‐BMI (蠅30 kg/m2) had increased adjusted odds ratio (AOR; 95% CI) of gestational hypertension (2.91; 2.76–3.07), gestational diabetes (2.78; 2.60–2.96), and LGA infants (1.87; 1.76–1.99), whereas underweight ppg‐BMI group (&lt;18.5 kg/m2) had increased odds of preterm labor (1.25; 1.16–1.36) and SGA infants (1.36; 1.25–1.49), but decreased odds of LGA infants (0.72; 0.61–0.85).Preconception care of reproductive aged women is as important as prenatal care during pregnancy to lower the risk of pregnancy complications and adverse birth outcomes.

Proactive Enteral Nutrition in Moderately Preterm Small for Gestational Age Infants: A Randomized Clinical Trial

To investigate the efficacy of a proactive feeding regimen (PFR) in reducing hospital length of stay in a population of moderately preterm small for gestational age (SGA) infants. SGA infants (z-score <-1.28) of gestational age (GA) 32-36 weeks and birth weight (BW) >1499 g were allocated at random to receive either a PFR, starting with 100 mL/kg/day and gradually increasing to 200 mL/kg/day by day 4, or a standard feeding regimen, starting with 60 mL/kg/day and gradually increasing to 170 mL/kg/day by day 9. All infants received human milk. A total of 72 infants were randomized to the 2 groups, 36 to the PFR group (mean GA, 35.1 ± 0.7 weeks; mean BW, 1761 ± 177 g) and 36 to the standard feeding regimen group (mean GA, 35.5 ± 1.2 weeks; mean BW, 1754 ± 212 g). Infants in the PFR group were discharged significantly earlier (mean, 9.8 ± 3.1 days vs 11.9 ± 4.7 days; P = .029). The need for intravenous fluids (2.8% vs 33.3%; P = .0013) and the incidence of hypoglycemia (0 vs 33.3%; P = .00016) were significantly lower in the PFR group. Feeding intolerance and fecal calprotectin levels did not differ between the 2 groups. A PFR in moderately preterm SGA infants is well tolerated and significantly reduces both the length of stay and the risk of neonatal hypoglycemia.

Prepregnancy body mass index is an independent risk factor for gestational hypertension, gestational diabetes, preterm labor, and small- and large-for-gestational-age infants

Objective: We examined if prepregnancy body mass index (BMI) is a risk factor for gestational hypertension, gestational diabetes, preterm labor, and small-for-gestational-age (SGA) and large-for-gestational-age (LGA) infants with consideration of gestational weight gain, to document the importance of preconception versus prenatal stage.Methods: We used the data of 219 868 women from 2004 to 2011 Pregnancy Risk Assessment Monitoring System (PRAMS). Multivariate logistic regression analyses were performed to examine the effect of prepregnancy BMI for gestational hypertension, gestational diabetes, preterm labor, and SGA and LGA infants with consideration of gestational weight gain.Results: Regardless of gestational weight gain, women with obese prepregnancy BMI (≥30 kg/m2) had increased odds of gestational hypertension (adjusted odds ratios (AOR) = 2.91; 95% CI = 2.76–3.07), gestational diabetes (2.78; 2.60–2.96), and LGA (1.87; 1.76–1.99) compared to women with normal prepregnancy BMI (18.5–24.9 kg/m2). Women with underweight prepregnancy BMI (<18.5 kg/m2) had increased odds of preterm labor (1.25; 1.16–1.36) and SGA infants (1.36; 1.25–1.49), but decreased odds of LGA infants (0.72; 0.61–0.85) in reference to women with normal prepregnancy BMI (18.5–24.9 kg/m2).Conclusions: Regardless of adequacy of gestational weight gain, the risk of gestational hypertension, gestational diabetes, and LGA infants increases with obese prepregnancy BMI, whereas that of preterm labor and SGA infants increases with underweight prepregnancy BMI. Preconception care of reproductive aged women is as important as prenatal care to lower the risk of gestational hypertension, gestational diabetes, preterm labor, and SGA and LGA infants.

Incidence of short stature at 3 years of age in late preterm infants: a population-based study

ObjectivesThis study aimed to investigate the incidence of short stature at 3 years of age in a Japanese cohort of late preterm infants who were born at 34–36 weeks’ gestational...

Lean mass and fat mass accretion between term age and 6 months post-term in growth-restricted preterm infants.

Early growth restriction followed by nutritional intakes that permit accelerated growth may result in adiposity and metabolic disease in later life. This study compared growth, body composition and nutritional intake between term age and 6 months post-term in 83 appropriate-for-gestational-age preterm infants with growth restriction at term age (AGA GR+), 15 AGA without growth restriction at term age (AGA GR-) and 33 small-for-gestational-age (SGA) preterm infants. AGA GR+ and SGA preterm infants had higher protein intake, higher energy intake and higher gain in weight SDS between term age and 6 months post-term, with similar lean mass (LM) and lower fat mass (FM) at 6 months post-term compared with AGA GR- preterm infants. In conclusion, despite higher energy and protein intake compared with AGA GR- preterm infants during the first 6 months post-term, AGA GR+ and SGA preterm infants restore their LM without excessive FM.

Risk factors and adverse perinatal outcomes among term and preterm infants born small-for-gestational-age: secondary analyses of the WHO Multi-Country Survey on Maternal and Newborn Health.

BackgroundSmall for gestational age (SGA) is not only a major indicator of perinatal mortality and morbidity, but also the morbidity risks in later in life. We aim to estimate the association between the birth of SGA infants and the risk factors and adverse perinatal outcomes among twenty-nine countries in Africa, Latin America, the Middle East and Asia in 359 health facilities in 2010–11.MethodsWe analysed facility-based, cross-sectional data from the WHO Multi-country Survey on Maternal and Newborn Health. We constructed multilevel logistic regression models with random effects for facilities and countries to estimate the risk factors for SGA infants using country-specific birthweight reference standards in preterm and term delivery, and SGA’s association with adverse perinatal outcomes. We compared the risks and adverse perinatal outcomes with appropriate for gestational age (AGA) infants categorized by preterm and term delivery.ResultsA total of 295,829 singleton infants delivered were analysed. The overall prevalence of SGA was highest in Cambodia (18.8%), Nepal (17.9%), the Occupied Palestinian Territory (16.1%), and Japan (16.0%), while the lowest was observed in Afghanistan (4.8%), Uganda (6.6%) and Thailand (9.7%). The risk of preterm SGA infants was significantly higher among nulliparous mothers and mothers with chronic hypertension and preeclampsia/eclampsia (aOR: 2.89; 95% CI: 2.55–3.28) compared with AGA infants. Higher risks of term SGA were observed among sociodemographic factors and women with preeclampsia/eclampsia, anaemia and other medical conditions. Multiparity (> = 3) (AOR: 0.88; 95% CI: 0.83–0.92) was a protective factor for term SGA. The risk of perinatal mortality was significantly higher in preterm SGA deliveries in low to high HDI countries.ConclusionPreterm SGA is associated with medical conditions related to preeclampsia, but not with sociodemographic status. Term SGA is associated with sociodemographic status and various medical conditions.

Outcome of singleton preterm small for gestational age infants born to mothers with pregnancy-induced hypertension. A population-based study

Background: Pregnancy-induced hypertension (PIH) has been associated with a decreased risk of infant mortality in small for gestational age (SGA) preterm infants.Objective: To evaluate the influence of PIH on mortality and major neonatal morbidities in singleton preterm SGA infants, in the presence and absence of acute pregnancy complications.Methods: Population-based observational study of singleton SGA infants, born at 24 to 32 weeks gestation in the period 1995–2010 (n = 2139). Multivariable logistic regression analyses were used to assess the independent effect of PIH on mortality and neonatal morbidities. Acute pregnancy complications comprised premature labor, premature rupture of membranes >6 h, antepartum hemorrhage and clinical chorioamnionitis.Results: In the absence of pregnancy complications, the odds ratio (95% confidence interval) for mortality (0.77; 0.50–1.16), survival without severe neurological morbidity (1.14; 0.79–1.65) and survival without bronchopulmonary dysplasia (BPD) (0.85; 0.59–1.21) were similar in the PIH versus no-PIH groups. In the presence of pregnancy complications, mortality (0.76; 0.40–1.44), survival without severe neurological morbidity (1.16; 0.64–2.12) and survival without BPD (1.04; 0.58–1.86) were also similar in the PIH versus no-PIH groups.Conclusions: PIH was not associated with improved outcome in preterm SGA infants, both in the presence and absence of acute pregnancy complications.

Ultrasonographic Study of Initial Size and Postnatal Growth of Kidneys in Preterm Infants

Background: Preterm birth is known to be associated with risks of impaired nephrogenesis. Objectives: To determine the normal range of renal sizes at birth in preterm infants as well as their short-term postnatal renal growth, to assess the correlation between initial renal size and growth parameters at birth and to compare the initial and serial renal sizes between appropriate-for-gestational-age (AGA) and small-for-gestational-age (SGA) preterm infants. Methods: Initial ultrasonography (US) was prospectively performed in 125 preterm infants within the first 72 h of life and every 2 weeks thereafter until a postmenstrual age (PMA) of 37 weeks was reached. Correlation between renal size and growth parameters was investigated. Renal lengths of AGA and SGA preterm infants were compared with those of age-matched fetuses described in the literature. Results: The renal sizes at birth in preterm infants are presented. Multiple regression analysis showed the strongest correlation between initial renal size and birth weight (p < 0.0001). Initial renal lengths of AGA infants were not significantly different from those of age-matched fetuses at ≥30 weeks' gestational age (GA), whereas those of SGA infants were significantly smaller at ≥28 weeks' GA. Serial renal lengths of SGA infants were significantly smaller than fetal renal lengths at ≥30 weeks' GA. Conclusion: With US, the normal range of initial renal sizes of AGA preterm infants was defined according to GA. In contrast to AGA infants, SGA infants showed smaller initial renal sizes and no significant catch-up growth until a PMA of 37 weeks.

Procollagen type I N‐terminal peptide in preterm infants is associated with growth during the first six months post‐term

To identify growth-related collagen and bone parameters in small-for-gestational-age (SGA) and appropriate-for-gestational-age (AGA) preterm infants during the first six months post-term. In SGA preterm infants, increased growth and decreased bone acquisition, which we demonstrated previously, may be reflected by these markers. Observational study within a randomized controlled trial. Thirty-three SGA (weight, length or both at birth <-2 SDS) and 98 AGA preterm infants (gestational age [median (IQR)]: 31·1 (1·6) vs 30·3 (2·0) weeks; 72·7% vs 42·9% boys). Weight (g), length (cm), procollagen type I N-terminal peptide (PINP; μg/l), urinary helical peptide (UHP; μg/mmol creatinine) and alkaline phosphatase (ALP; U/l) expressed as standard deviation scores (SDS) at term age, three and six months post-term. Weight and length gain during the first six months post-term and PINP SDS at term age, three months and six months post-term were higher in SGA compared with AGA infants. UHP SDS and ALP SDS were similar in SGA and AGA infants. PINP SDS and UHP SDS at term age and PINP SDS at three months were associated with subsequent weight and length gain until six months post-term. Increased growth in SGA compared with AGA preterm infants is reflected by increased collagen type I synthesis during the first six months post-term, suggesting that PINP and UHP correspond with growth in preterm infants. An explanation for decreased bone acquisition of SGA preterm infants may be that increased collagen type I synthesis is not directly followed by increased bone mineralization.

The contribution of preterm birth and intrauterine growth restriction to childhood undernutrition in Tanzania

Objectives were to examine the growth patterns of preterm and growth-restricted infants and to evaluate the associations of prematurity and intrauterine growth restriction (IUGR) with risk of stunting, wasting and underweight. Data from a cohort of HIV-negative pregnant women-infant pairs were collected prospectively in Tanzania. Small for gestational age [SGA, birthweight (BW) <10th percentile] was used as proxy for IUGR. Anthropometry was measured monthly until 18 months. Length-for-age (LAZ), weight-for-length (WLZ), and weight-for-age (WAZ) z-scores were calculated using the 2006 World Health Organization (WHO) Child Growth Standards. Stunting, wasting and underweight were defined as binary outcomes using a cut-off of <-2 SD of the respective z-scores. Multivariate Cox proportional hazard models were used to assess the associations between preterm and SGA to time to stunting, wasting and underweight. The study included 6664 singletons. Preterm and appropriate for gestational age (AGA) infants had slightly better nutritional status than term-SGA infants and despite some catch-up growth, preterm-SGA infants had the poorest nutritional status. The gap in LAZ and WAZ z-scores among the groups remained similar throughout the follow-up. Compared with term-AGA babies, relative risk (RR) of stunting among preterm-AGA babies was 2.13 (95% confidence interval (CI) 1.93-2.36), RR among term-SGA was 2.21 (95% CI 2.02-2.41) and the highest risk was among the babies who were both preterm and SGA (RR = 7.58, 95% CI 5.41-10.64). Similar magnitude of RR of underweight was observed among the three groups. Preterm and SGA infants should be closely monitored for growth failure. Intervention to reduce preterm and SGA birth may lower risk of undernutrition in resource-limited settings.