This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Web of Science (25) Citing Articles via Google Scholar Google Scholar Articles by Zaw, W. Articles by da Silva, O. Search for Related Content PubMed PubMed Citation Articles by Zaw, W. Articles by da Silva, O. Related Collections Premature & Newborn Related AAP Red Book topics: Yersinia enterocolitica and... Social Bookmarking                         What's this?

PEDIATRICS Vol. 111 No. 6 June 2003, pp. 1273-1277

The Risks of Adverse Neonatal Outcome Among Preterm Small for Gestational Age Infants According to Neonatal Versus Fetal Growth Standards

Win Zaw, MBBS^*, Robert Gagnon, MD and Orlando da Silva, MD

^* Department of Child Health, University of Aberdeen, Aberdeen, United Kingdom
Departments of Obstetrics and Gynecology
Paediatrics, St Joseph’s Health Care London, the University of Western Ontario, London, Ontario, Canada

Objective. To evaluate neonatal and fetal growth standards in determining the impact of small for gestational age (SGA) on neonatal mortality and morbidity.

Design. A hospital-based cohort study of infants born in a regional tertiary care center and admitted to the neonatal intensive care unit.

Setting and Participants. A total of 1267 singleton neonates of <34 weeks gestational age, without any congenital anomalies, born between January 1, 1993 and December 31, 2001.

Outcome Measures. Each outcome variable including mortality, respiratory distress syndrome, bronchopulmonary dysplasia, intraventricular hemorrhage (IVH), periventricular leukomalacia, and necrotizing enterocolitis was related to growth status as defined by fetal and neonatal growth standards after adjustment for potential confounders.

Results. The number of SGA infants was 11.6% (n = 147) of the study population according to neonatal growth standards, but it was increased to 23.3% (n = 295) when fetal growth standards were used. According to fetal growth standards, when SGA was compared with appropriate for gestational age infants, it was associated with an increased risk of respiratory distress syndrome (odds ratio [OR] 1.40; 95% confidence interval [CI] 1.00–1.95), bronchopulmonary dysplasia (OR 2.18; 95% CI 1.33–3.59), IVH (OR 1.67; 95% CI 1.13–2.45), and retinopathy of prematurity (OR 3.88; 95% CI 2.33–6.48). However, only neonatal mortality (OR 3.64; 95% CI 1.64–8.09), retinopathy of prematurity (OR 5.38; 95% CI 2.87–10.90), and necrotizing enterocolitis (OR 2.47; 95% CI 1.21–5.07) were positively associated with SGA when using neonatal growth standards.

Conclusions. Compared with the neonatal growth standards, the fetal growth standards are better in identifying increased risk of respiratory morbidity and IVH among preterm SGA infants.

Key Words: neonatal outcome • small for gestational age

Abbreviations: SGA, small for gestational age • RDS, respiratory distress syndrome • AGA, appropriate for gestational age • AC, abdominal circumference • FL, femur length • IVH, intraventricular hemorrhage • BPD, bronchopulmonary dysplasia • NEC, necrotizing enterocolitis • ROP, retinopathy of prematurity • PVL, periventricular leukomalacia • OR, odds ratio • CI, confidence interval

---

Received for publication Nov 20, 2002; Accepted Jan 14, 2003.

CiteULike    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				C. Ferdynus, C. Quantin, M. Abrahamowicz, R. Platt, A. Burguet, P. Sagot, C. Binquet, and J.-B. Gouyon Can Birth Weight Standards Based on Healthy Populations Improve the Identification of Small-for-Gestational-Age Newborns at Risk of Adverse Neonatal Outcomes? Pediatrics, February 1, 2009; 123(2): 723 - 730. [Abstract] [Full Text] [PDF]

				J. A. Hutcheon and R. W. Platt The Missing Data Problem in Birth Weight Percentiles and Thresholds for "Small-for-Gestational-Age" Am. J. Epidemiol., April 1, 2008; 167(7): 786 - 792. [Abstract] [Full Text] [PDF]

				J. A. Hutcheon and R. W. Platt Hutcheon and Platt Respond to "The Hidden Population in Perinatal Epidemiology" Am. J. Epidemiol., April 1, 2008; 167(7): 797 - 798. [Full Text] [PDF]

				M. H Malloy Size for gestational age at birth: impact on risk for sudden infant death and other causes of death, USA 2002 Arch. Dis. Child. Fetal Neonatal Ed., November 1, 2007; 92(6): F473 - F478. [Abstract] [Full Text] [PDF]

				D. B Bartels, F. Schwab, C. Geffers, C. F Poets, and P. Gastmeier Nosocomial infection in small for gestational age newborns with birth weight <1500 g: a multicentre analysis Arch. Dis. Child. Fetal Neonatal Ed., November 1, 2007; 92(6): F449 - F453. [Abstract] [Full Text] [PDF]

				E. A. O'Brien, V. Barnes, L. Zhao, R. A. McKnight, X. Yu, C. W. Callaway, L. Wang, J. C. Sun, M. J. Dahl, A. Wint, et al. Uteroplacental insufficiency decreases p53 serine-15 phosphorylation in term IUGR rat lungs Am J Physiol Regulatory Integrative Comp Physiol, July 1, 2007; 293(1): R314 - R322. [Abstract] [Full Text] [PDF]

				R. A Ehrenkranz Estimated fetal weights versus birth weights: should the reference intrauterine growth curves based on birth weights be retired? Arch. Dis. Child. Fetal Neonatal Ed., May 1, 2007; 92(3): F161 - F162. [Full Text] [PDF]

				R. W I Cooke Conventional birth weight standards obscure fetal growth restriction in preterm infants Arch. Dis. Child. Fetal Neonatal Ed., May 1, 2007; 92(3): F189 - F192. [Abstract] [Full Text] [PDF]

				E Bertino, S Milani, C Fabris, and M De Curtis Neonatal anthropometric charts: what they are, what they are not Arch. Dis. Child. Fetal Neonatal Ed., January 1, 2007; 92(1): F7 - F10. [Full Text] [PDF]

				N Evans, J Hutchinson, J M Simpson, D Donoghue, B Darlow, D Henderson-Smart, and on behalf of the Australian and New Zealand Neonat Prenatal predictors of mortality in very preterm infants cared for in the Australian and New Zealand Neonatal Network Arch. Dis. Child. Fetal Neonatal Ed., January 1, 2007; 92(1): F34 - F40. [Abstract] [Full Text] [PDF]

				R. Feldman and A. I. Eidelman Neonatal State Organization, Neuromaturation, Mother-Infant Interaction, and Cognitive Development in Small-for-Gestational-Age Premature Infants Pediatrics, September 1, 2006; 118(3): e869 - e878. [Abstract] [Full Text] [PDF]

				R. Gagnon An Obstetric Point of View on Fetal Adaptation and Reprogramming NeoReviews, April 1, 2006; 7(4): e189 - e194. [Full Text] [PDF]

				B. A. Darlow, J. L. Hutchinson, D. J. Henderson-Smart, D. A. Donoghue, J. M. Simpson, N. J. Evans, and on behalf of the Australian and New Zealand Neonat Prenatal Risk Factors for Severe Retinopathy of Prematurity Among Very Preterm Infants of the Australian and New Zealand Neonatal Network Pediatrics, April 1, 2005; 115(4): 990 - 996. [Abstract] [Full Text] [PDF]

				D B Bartels, L Kreienbrock, O Dammann, P Wenzlaff, and C F Poets Population based study on the outcome of small for gestational age newborns Arch. Dis. Child. Fetal Neonatal Ed., January 1, 2005; 90(1): F53 - F59. [Abstract] [Full Text] [PDF]

				D. Brodsky and H. Christou Current Concepts in Intrauterine Growth Restriction J Intensive Care Med, November 1, 2004; 19(6): 307 - 319. [Abstract] [PDF]

				Other articles noted: 25 Jul 03 to 7 Nov 03 Evid. Based Nurs., January 1, 2004; 7(1): e1 - 1. [Full Text] [PDF]

				I. M. Bernstein The Assessment of Newborn Size Pediatrics, June 1, 2003; 111(6): 1430 - 1431. [Full Text] [PDF]