Published online May 26, 2009
PEDIATRICS Vol. 123 No. 6 June 2009, pp. e1072-e1077 (doi:10.1542/peds.2008-3288)
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ARTICLE

Weight for Gestational Age Affects the Mortality of Late Preterm Infants

Laurie S. Pulver, MD, MPHa, Ginger Guest-Warnick, MPHa, Gregory J. Stoddard, MPHb, Carrie L. Byington, MDa and Paul C. Young, MDa

a Departments of Pediatrics
b Internal Medicine, University of Utah, Salt Lake City, Utah

BACKGROUND. Late preterm infant mortality is higher than that for term newborns. The association between weight for gestational age (WGA) category and late preterm mortality has not been well described.

OBJECTIVES. Our objectives for this research were as follows: (1) to compare neonatal and infant mortality rates of SGA, AGA, and LGA late preterm, early term, and term newborns; (2) to determine the relative risk of neonatal and infant death for each WGA category; and (3) to examine causes of neonatal and infant death.

METHODS. We reviewed linked birth and death certificate data for all infants from Utah born between 1999 and 2005 with a GA ≥34 weeks. We calculated neonatal and infant mortality rates for each GA/birth weight stratum and estimated mortality rate ratios using AGA term infants as the reference. International Classification of Diseases, Ninth Revision, codes were used to classify cause of death.

RESULTS. There were 343322 newborns with GA ≥34 weeks from 1999 to 2005. Late preterm SGA infants were ~44 times more likely than term AGA newborns to die in their first month and 22 times more likely to die in their first year. When infants dying from congenital conditions were excluded, the differences in mortality rate ratios persisted for SGA infants, especially those born in the late preterm period.

CONCLUSIONS. Being SGA substantially increases the already higher mortality of late preterm and early term newborns. This increased risk cannot be fully explained by an increased prevalence of lethal congenital conditions among SGA late preterm newborns. Clinicians caring for late preterm and early term newborns should be cognizant of their WGA category.

Key Words: birth weight • gestational age size • infant mortality • neonatal mortality • premature infants

Abbreviations: GA—gestational age • SGA—small for gestational age • AGA—appropriate for gestational age • LGA—large for gestational age • WGA—weight for gestational age • ICE—international collaborative effort • SIDS—sudden infant death syndrome

Accepted Feb 12, 2009.


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