Excess mortality and morbidity among small-for-gestational-age premature infants: a population-based study

OBJECTIVE: We examined the effect of intrauterine growth restriction on mortality and morbidity in the Israel cohort of very low birth weight premature infants. METHODS: The study population included 2764 singleton very low birth weight infants without congenital malformations born from 24 to 31 weeks of gestation during 1995 to 1999. Four hundred six (15%) were born small for gestational age (SGA). The effect of SGA on death, bronchopulmonary dysplasia, and retinopathy of prematurity was assessed using multiple logistic regression analysis. RESULTS: After adjustment for perinatal risk factors, SGA infants had a 4.52-fold risk for death (95% CI, 3.24-6.33), a 3.42-fold risk for bronchopulmonary dysplasia (95% CI, 2.29-5.13), and a 2.06-fold risk for grade 3 to 4 retinopathy of prematurity (95% CI, 1.15-3.66). CONCLUSIONS: SGA premature infants had an increased risk for death, and major morbidity among survivors was increased.     

Early provision of parenteral amino acids in extremely low birth weight infants: relation to growth and neurodevelopmental outcome

OBJECTIVE: To determine if postnatal growth failure exerts an adverse effect on subsequent growth and neurodevelopment. STUDY DESIGN: A secondary analysis of 1018 infants who were enrolled in a randomized, clinical trial of glutamine supplementation was performed to determine whether early provision of parenteral amino acids (AA) is associated with better growth and neurodevelopmental outcomes. Infants were stratified by whether they were provided > or =3 g/kg per day of AA at < or =5 days of life (early; n = 182) or not (late; n = 836). RESULTS: At 36 weeks' postmenstrual age, significant differences were found in weight, length, and head circumference in favor of the infants who received early AA; the odds of having weight less than the 10(th) percentile for age was 4-fold higher for infants in the late group. At 18 months' CA, there were no differences in weight, length, or measures of neurodevelopment between the groups; however, male infants in the late group were twice as likely to have head circumference less than the 10(th) percentile. CONCLUSIONS: Early AA were associated with significantly better growth outcomes at 36 weeks' postmenstrual age, and fewer infants who received early AA were found to have suboptimal head growth at 18 months' CA.     

Twelve‐month neurodevelopmental outcome in preterm infants with and without intrauterine growth restriction

Aim: To evaluate the neurodevelopmental outcome at 12 months’ corrected age in preterm infants with and without severe intrauterine growth restriction. Methods: This prospective follow‐up study included 37 infants with severe intrauterine growth restriction and 36 appropriate‐for‐gestational‐age infants born between 26 and 34 weeks. Neonatal and infant data were prospectively recorded. Infants were assessed at 12 ± 2 months’ corrected age with the Hammersmith Infant Neurological Examination and the Bayley Scale for Infant Development version‐II. Results: Both groups were similar in demographic characteristics and perinatal status. No significant differences in neurodevelopmental performance were found. The mental development index was 98.8 (SD 9.0) vs 98.4 (SD 13.1) (p = 0.9) and the psychomotor development index was 91.7 (SD 9.9) vs 95.5 (SD 13.4) (p = 0.2) for the study and reference groups respectively. Neurological assessment showed no significant differences between the two groups. Conclusion: Although the study group showed a non‐significant trend towards a lower score in the psychomotor development index than the reference group, significant differences at 12 months could not be demonstrated. IUGR infants continued to have significantly lower weight, length and head circumference at 1 year.     

Grades I-II intraventricular hemorrhage in extremely low birth weight infants: effects on neurodevelopment

OBJECTIVE: To quantify the effect of grades I-II intraventricular hemorrhage (IVH) on the neurosensory and cognitive outcomes of extremely low birth weight infants. STUDY DESIGN: Of 706 extremely low birth weight infants without major malformations admitted to our center from 1992 to 2000, 537 survived to 20 months' corrected age (CA) and had cranial ultrasound studies performed, of whom 490 (91%) had complete neurodevelopmental assessments. Infants with severe cranial ultrasound abnormalities or meningitis were excluded, leaving a population of 362 infants, 258 of whom had a normal cranial ultrasound and 104 had an isolated grade I-II IVH. The groups had similar birth weight (808 vs 801 grams) and gestational age (26.5 vs 26.3 weeks). Outcomes of infants with normal cranial ultrasound were compared with those with grades I-II IVH at 20 months' CA. Outcomes included the Bayley Scales of Infant Development Mental Developmental Index (MDI) and major neurosensory abnormality. Logistic regression was used to assess the effect of grades I-II IVH on outcomes while adjusting for other risk factors. RESULTS: Extremely low birth weight infants with grades I-II IVH had a significantly lower mean MDI score than infants with normal cranial ultrasound (74 +/- 16 vs 79 +/- 14, P = .006). They had higher rates of MDI <70 (45% vs 25%; OR, 2.00; 95% CI, 1.20 to 3.30; P = .008), major neurologic abnormality (13% vs 5%; OR, 2.60; 95% CI, 1.06 to 6.36; P = .036), and neurodevelopmental impairment (47% vs 28%; OR, 1.83; 95% CI, 1.11 to 3.03; P = .018) at 20 months' CA, even when adjusting for confounding factors. CONCLUSIONS: Extremely low birth weight infants with grades I-II IVH have poorer neurodevelopmental outcomes at 20 months' CA than infants with normal cranial ultrasound. Advanced radiologic imaging may indicate additional brain injury associated with grade I-II IVH, which could explain these outcomes.     

Management of preterm infants with intrauterine growth restriction

Preterm intrauterine growth restriction (IUGR) is strongly associated with increased mortality and morbidity. In the management of these infants, complications of preterm birth can be amplified by the effect of suboptimal fetal growth. It is important that pregnancies with IUGR are detected before birth, so that delivery can be arranged in a high-risk maternity unit with the appropriate neonatal staff in attendance. The provision of full support for resuscitation and stabilisation of these infants is crucial to the short-term and long-term health of these infants, who have suffered chronic hypoxia and malnutrition in utero. The long term outcome studies of these infants are retrospective and they include SGA infants. The effects of prematurity affect the outcome of IUGR infants. IUGR is associated with cerebral palsy in those delivered more than 32 weeks gestation. Infants less than 32 weeks of gestation may have poor developmental outcome if the head growth is affected, these infants may have associated cognitive and behavioural problems. Children who fail to grow by 2-4 years are at risk of long term growth problems. This paper outlines the acute and long-term management of these infants.     

Cardiorespiratory events detected by home memory monitoring and one-year neurodevelopmental outcome

OBJECTIVE: To determine if infants with cardiorespiratory events detected by home memory monitoring during early infancy have decreased neurodevelopmental performance. STUDY DESIGN: Infants (n = 256) enrolled in the Collaborative Home Infant Monitoring Evaluation also completed the Bayley Scales of Infant Development II at 92 weeks' postconceptional age. Infants were classified as having 0, 1 to 4, or 5+ cardiorespiratory events. Events were defined as apnea >or=20 seconds or heart rate <60 to 80 bpm or <50 to 60 bpm, for >or=5 to 15 seconds, depending on age. RESULTS: For term infants, having 0, 1 to 4, and 5+ cardiorespiratory events was associated with unadjusted mean Mental Developmental Index (MDI) values (+/-SD) of 103.6 (10.6), 104.2 (10.7), and 97.7 (10.9), respectively, and mean Psychomotor Developmental Index (PDI) values of 109.5 (16.6), 105.8 (16.5), and 100.2 (17.4). For preterm infants, having 0, 1 to 4, and 5+ cardiorespiratory events was associated with unadjusted mean MDI values of 100.4 (10.3), 96.8 (11.5), and 95.8 (10.6), respectively, and mean PDI values of 91.7 (19.2), 93.8 (15.5), and 94.4 (17.7). The adjusted difference in mean MDI scores with 5+ events compared with 0 events was 5.6 points lower in term infants ( P = .03) and 4.9 points lower in preterm infants ( P = .04). CONCLUSIONS: Having 5+ conventional events is associated with lower adjusted mean differences in MDI in term and preterm infants.