Customized birthweight centiles predict SGA pregnancies with perinatal morbidity

OBJECTIVES: To determine the following: (1) the proportion of babies reclassified as small or appropriately grown using customized and population centiles; and (2) the relative risks of perinatal morbidity, including abnormal umbilical Doppler studies, in babies classified as small for gestational age (SGA) and appropriate for gestational age (non-SGA) using the two centile calculations. DESIGN: Cohort study in SGA and general hospital populations. SETTING: National Women's Hospital, Auckland, NZ. POPULATION: A cohort of SGA pregnancies (n= 374) and a general obstetric population (n= 12,879). METHODS: Pregnancy outcomes were compared between 'non-SGA both' (> or =10th% by population and customized centiles) and those who were 'SGA both' (<10th% by population and customized centiles), 'SGA customized only' (SGA by customized but non-SGA by population centiles) and 'SGA population only' (SGA by population but non-SGA by customized centiles). MAIN OUTCOME MEASURES: Maternal and newborn morbidity and perinatal death. RESULTS: In the SGA cohort 271 (72%) babies were 'SGA both', 27 (7%) were 'SGA customized only', 32 (9%) were 'population SGA only' and 44 (12%) were 'non-SGA both'. In the general obstetric population 863 (6.7%) babies were 'SGA both', 445 (3.5%) were 'customized SGA only', 285 (2.2%) were 'population SGA only' and 11,286 (88%) were 'non-SGA both'. Perinatal death and newborn morbidity including nursery admission and long hospital stay were increased and comparable between 'SGA both' and 'customized SGA only' in both study populations. Newborn morbidity was low and comparable between 'population SGA only' and 'non-SGA both'. No perinatal deaths occurred in 'population SGA only' babies. Abnormal Doppler studies were more common in 'SGA both' or 'customized SGA only' but not in 'population SGA only' groups compared with 'non-SGA both'. CONCLUSIONS: Customized birthweight centiles identified small babies at risk of morbidity and mortality. Use of customized centiles is likely to detect more babies at risk of perinatal morbidity and mortality than would be detected by population centiles.     

Customised birthweight centiles are useful for identifying small-for-gestational-age babies in women with type 2 diabetes

Background: Customised birthweight centiles identify small-for-gestational-age (SGA) babies at increased risk of morbidity more accurately than population centiles, but they have not been validated in obese populations.
Aims: To compare the rates of SGA by population and customised birthweight centiles in babies of women with type 2 diabetes and examine perinatal outcomes in customised SGA infants.
Methods: Data were from a previous retrospective cohort study detailing pregnancy outcomes in 212 women with type 2 diabetes. Customised and population birthweight centiles were calculated; pregnancy details and neonatal outcomes were compared between groups that delivered infants who were SGA (birthweight < 10th customised centile) and appropriate weight for gestational age (AGA) (birthweight 10–90th customised centile).
Results: Fifteen (7%) babies were SGA by population centiles and 32 (15%) by customised centiles. Two babies of Indian women were reclassified from SGA to AGA by customised centiles. Nineteen babies were reclassified from AGA to SGA by customised centiles; of these, 15 (79%) were born to Polynesian women, five (26%) were born less than 32 weeks and two (11%) were stillborn. Customised SGA infants, compared with AGA infants, were more likely to be born preterm (19 (59%) vs 20 (16%), P  < 0.001) and more likely to be stillborn (4 (13%) vs 0 P  = 0.001). After excluding still births, admission to the neonatal unit was also more common (19 of 28 (68%) vs 43 of 127 (34%), P  < 0.001).
Conclusions: In our population more babies were classified as SGA by customised compared with population centiles. These customised SGA babies have high rates of morbidity.     

Association between pregnancy complications and small-for–gestational-age birth weight defined by customized fetal growth standard versus a population-based standard

Objective.?To derive coefficients for developing a customized growth chart for a Mid-Western US population, and to estimate the association between pregnancy outcomes and smallness for gestational age (SGA) defined by the customized growth chart compared with a population-based growth chart for the USA.

Method.?A retrospective cohort study of an ultrasound database using 54,433 pregnancies meeting inclusion criteria was conducted. Coefficients for customized centiles were derived using 42,277 pregnancies and compared with those obtained from other populations. Two adverse outcome indicators were defined (greater than 7 day stay in the neonatal unit and stillbirth [SB]), and the risk for each outcome was calculated for the groups of pregnancies defined as SGA by the population standard and SGA by the customized standard using 12,456 pregnancies for the validation sample.

Results.?The growth potential expressed as weight at 40 weeks in this population was 3524?g (standard error: 402?g). In the validation population, 4055 cases of SGA were identified using both population and customized standards. The cases additionally identified as SGA by the customized method had a significantly increased risk of each of the adverse outcome categories. The sensitivity and specificity of those identified as SGA by customized method only for detecting pregnancies at risk for SB was 32.7% (95% confidence interval [CI] 27.0–38.8%) and 95.1% (95% CI: 94.7–95.0%) versus 0.8% (95% CI 0.1–2.7%) and 98.0% (95% CI 97.8–98.2%)for those identified by only the population-based method, respectively.

Conclusion.?SGA defined by customized growth potential is able to identify substantially more pregnancies at a risk for adverse outcome than the currently used national standard for fetal growth.     

Brain growth in preterm infants is affected by the degree of growth restriction at birth

Abstract

Objective: Documentation of examination of brain structural development by magnetic resonance imaging (MRI) beyond the neonatal period is scarce for both preterm and small for gestational age (SGA) infants.

Aim: To investigate structural brain development during infancy in preterm children born SGA by MRI.

Methods: A total of 205 preterm infants, 139 appropriate for gestational age (AGA) and 66 SGA, of which 33 had birth weight (BW)?<?3rd percentile and 33 had BW 3rd–10th percentile, were examined prospectively by brain MRI at the corrected age of 5 months. The total volume of the brain, ventricles and cerebellum, the area of vermis and corpus callosum, and the height of the pituitary, mesencephalon and pons were estimated on MRI.

Results: Brain volume was smaller in the SGA?<?3rd percentile infants, independent of other perinatal factors. Chronic lung disease was an independent predictor of low brain volume. Pituitary height was greater in SGA?<?3rd percentile than in AGA infants. The corpus callosum area was less in SGA?<?3rd percentile than in SGA of 3rd–10th percentile infants.

Conclusions: Preterm infants born SGA with BW?<?3rd percentile had differences in brain structural measurements at the corrected age of 5 months, compared with preterm AGA infants, which could have implications for their neurocognitive development.     

Perinatal outcome of pregnancies complicated with extreme birth weights at term

Objective: The objective of this study is to investigate whether an abnormal birthweight at term, either small for gestational age (SGA,??95th centile for gestational age), is a risk factor for perinatal complications as compared with birthweight appropriate for gestational age (AGA).

Methods: A population-based retrospective cohort analysis of all singleton pregnancies delivered between 1991 and 2014 at Soroka Medical Center. Congenital malformations and multiple pregnancies were excluded. A multivariable generalized estimating equation regression model was used to control for maternal clusters and other confounders.

Results: During the study period, 228,242 births met the inclusion criteria, of them 91% were AGA (n?=?207,652), 4.7% SGA, and 4.3% LGA. SGA significantly increased the risk for perinatal mortality (aOR 5.6, 95%CI 4.5–6.8) and low 5-min Apgar scores (aOR 2.2, 95%CI 2.0–2.4), while LGA did not. SGA and LGA were both significant risk factors for cesarean delivery. LGA was significantly associated with shoulder dystocia and post-partum hemorrhage (aOR =13.6, 95%CI 10.9–17.0, and aOR 1.7, 95%CI 1.2–2.6, respectively).

Conclusions: Extreme birthweights at term are significantly associated with adverse maternal and neonatal outcomes. As opposed to SGA, LGA is not independently associated with perinatal mortality.     

Customized weight curves for Spanish fetuses and newborns

Abstract

Objectives: To construct a model of customized birthweight curves for use in a Spanish population.

Materials and methods: Data of 20 331 newborns were used to construct a customized birthweight model. Multiple regression analysis was performed with newborn weight as the dependent variable and gestational age (GA), sex and maternal (M) weight, height, parity and ethnic origin as the independent variables. Using the new model, 27?507 newborns were classified as adequate for GA (AGA), large for GA (LGA) or small for GA (SGA). The results were compared with those of other customized and non-customized models.

Results: The resulting formula for the calculation of optimal neonatal weight was:

Optimum weight (g)?=?3289.681?+?135.413*GA40–14.063*GA40²–0.838*GA40^3?+?113.889 (if multiparous)?+?165.560 (if origin?=?Asia)?+?161.550 (South America)?+?67.927 (rest of Europe)?+109.265 (North Africa)?+?9.392*Maternal-Height?+?4.856*Maternal-Weight–0.098*Maternal-Weight^2?+?0.001*Maternal-Weight^3?+?67.188*Sex?+?GA40*(6.890*Sex?+?9.032 (If multiparous)?+0.006*Maternal-Height^3?+?0.260*Maternal-Weight)?+?GA40² (?0.378*Maternal-Height – 0.008*Maternal-Height²)?+?GA40³ (?0.032*Maternal-Height).

Weight percentiles were obtained from standard data using optimum weight variation coefficient. Agreement between our customized model and other Spanish models was “good” (κ?=?0.717 and κ?=?0.736; p?<?0.001).

Conclusions: Our model is comparable to other Spanish models, but offers the advantage of being customized, updated and freely available on the web. The 30.6% of infants classified as SGA using our model would be considered as AGA following a non-customized model.     

Assessment of Antepartum Fetal Growth by Customized “GROW” Curves Versus Noncustomized Growth Curves in Correlation with Neonatal Growth Pattern

Objective

To study the antepartum fetal growth between customized “GROW” curves and noncustomized growth curves with neonatal growth pattern.

Method

Fetal growth scans are performed between 30 and 35 weeks to singleton mother. Estimated fetal weights (EFWs) were determined using ultrasound variables (biparietal diameter, head circumference, abdominal circumference, and femur length). This EFW is plotted on SONOCARE software [noncustomized growth curves developed by Medialogic solutions (P) Ltd., Chennai, India] and customized “GROW” curves to determine the type of antenatal fetal growth as AGA, small for gestational age (SGA), or large for gestational age (LGA). The fetuses were followed longitudinally till birth, and the newborns’ growth patterns were determined according to birth weight at the gestational age of delivery (<10th percentile for gestational age as SGA and >90th percentile as LGA) and compared to antenatal prediction of fetal growth patterns determined by noncustomized growth curves and customized “GROW” curves.

Results

According to noncustomized growth curve at antenatal period, 93 % fetuses are AGA; 5.6 % are LGA, and 1 % are SGA. According to customized GROW curves, when the same EFW is plotted on GROW curves, 83 % are found to be AGA, 6.8 % LGA, and 10 % SGA. At postnatal period, according to newborn growth curve, 87.8 % are AGA, 8.8 % LGA, 3.4 % SGA. Sensitivity of customized “GROW” curves is more than that of noncustomized growth curves (45.45 vs. 18.18 %) for detection of SGA fetus.

Conclusion

Antenatal predictions of SGA baby by ultrasonography can be almost doubled with customized “GROW” curves than noncustomized growth curves. Customized GROW curves also better predict perinatal morbidities like neonatal jaundice and NICU admission. Antenatal serial fetal growth monitoring should be done with customized GROW curves.     

Erythropoietin in amniotic fluid as a potential marker in distinction between growth restricted and constitutionally small fetuses

Abstract

Objective: To determine if there is any difference in amniotic fluid erythropoietin (EPO) concentration between fetuses small for gestational age (SGA) and appropriate for gestational age (AGA), and between the constitutionally small (CSF) and growth-restricted (GRF) fetuses.

Methods: EPO concentrations in the amniotic fluid samples were determined by EpoELISA test in 38 pregnancies with SGA and 15 pregnancies with AGA fetuses. In the SGA group we measured Ponderal index (PI) and skin-fold thickness (SFT). If PI and/or SFT were below 10th percentile the neonate was GRF. If both PI and SFT were above 10th percentile the neonate was CSF.

Results: Higher levels of EPO were detected in the SGA in comparison to the AGA fetuses (p?<?0.01). EPO concentration was higher in GRF compared to CSF (p?<?0.05). The EPO cut-off level between SGA and AGA was 6.81?IU/L (sensitivity 92.3%; specificity 73.3%), and between GRF and CSF was 9.8?IU/L (sensitivity 81%; specificity 80%).

Conclusion: The preliminary results of this study suggest that amniotic fluid erythropoietin concentration is elevated in growth-restricted fetuses and could potentially be used for distinction between growth restricted and constitutionally small fetuses. Confirmation of these results on a larger group of pregnant women is needed.     

Identifying risk factors for premature rupture of membranes in small for gestational age neonates: a population-based study

Objective. To determine the prevalence and risk factors for premature rupture of membranes (PROM) among pregnancies complicated with small for gestational age (SGA) neonates.

Methods. A computerised database was used to identify deliveries of SGA neonates in pregnancies complicated with PROM between the years 1988 and 2002. Pregnancies with PROM and SGA neonates were compared to those with SGA and without PROM. Demographic, obstetric, clinical and labour characteristics were evaluated. Multiple logistic regression analysis was used to determine independent risk factors for PROM in pregnancies complicated by SGA. Statistical analysis was performed with SPSS package.

Results. There were 120 982 deliveries included out of which 6074 (5.99%) presented with appropriate for gestational age (AGA) neonates and PROM. A total of 1077 delivered SGA infants complicated with PROM (5.5%). After adjustment for confounding variables, the following characteristics were significantly associated with PROM and SGA: Jewish ethnicity, parity and cervical incompetence. The following complications were associated with PROM and SGA: arrest of labour, fetal distress, failed induction, cesarean delivery, clinical chorioamnionitis and placenta accreta. No significant differences regarding low Apgar scores and perinatal mortality rates were noted.

Conclusions. The risk of PROM among patients with SGA is lower than in AGA infants. Parity and cervical incompetence are risk factors for PROM among women who delivered SGA neonates. In this population there is a higher rate of arrest of labour, chorioamnionitis, fetal distress and cesarean delivery. Neonatal outcome and perinatal mortality are similar in both groups.     

Small for gestational age as an independent risk factor for long-term pediatric gastrointestinal morbidity of the offspring*

Objective: The concept of neonatal programming has begun to emerge as an important component of adult health. Scarce data exist regarding perinatal risk factors for long-term gastrointestinal (GI) morbidity of the offspring. We aimed to evaluate the association between birthweight (BW) at term and long-term pediatric GI morbidity.

Study design: A population-based cohort analysis was performed, comparing the risk of long-term GI morbidity (up to the age of 18 years) in children delivered at term according to their BW. The study included all term deliveries occurring between 1991 and 2014 at a single regional tertiary medical center. Multiple gestations and fetuses with congenital malformations were excluded. BW was subdivided into: small for gestational age (small for gestational age (SGA) – BW?≤?5th centile), appropriate for gestational age (AGA ?5th centile?Results: During the study period, 225,600 term singleton deliveries met the inclusion criteria. Of them, 4.6% (n?=?10,415) were SGA and 4.3% (n?=?9796) were LGA. During the 18-years follow-up period, 11,791 (5.2%) children were hospitalized with GI morbidity. Hospitalizations were significantly more common in the SGA group, as compared with the AGA and LGA groups (6.6 versus 5.2 versus 4.5%, respectively, p?p?p?Conclusions: SGA offspring are at an increased and independent risk for long-term pediatric GI morbidity.     

The utility of an obesity-specific small for gestational age standard for pregnancies complicated by maternal obesity*

Introduction: An obesity-specific standard for small for gestational age (SGA) pregnancies may help identify additional at risk pregnancies.

Methods: This was a retrospective cohort study of all non-anomalous singleton neonates born in Texas from 2006–2011. Analysis was limited to births between 34 and 42?weeks gestation. Two SGA birth weight standards (birth weight ≤10th centile) were generated, one using the entire population (SGA_pop) and another using obese pregnancies (SGA_cust). The outcomes of interest included: risks of stillbirth, neonatal death, 5-minute Apgar score below 7, NICU admission, and assisted ventilation?>6?h.

Results: Using the population standard, the prevalence of SGA complicated by obesity was 8.1%, compared with 10.3% using the obesity-specific standard. 10,457 additional pregnancies were identified as SGA. Compared to obese AGA pregnancies, the aHR for stillbirth was 5.45 [4.28, 6.94] for SGA_pop, and 1.21 [0.54, 2.74] for SGA_cust-pop. The risks for the following neonatal complications were slightly higher for SGA_cust-pop group compared to AGA group: neonatal death aOR 1.40 [1.05, 1.87], low 5-minute Apgar 1.31 [1.09, 1.57], and NICU admission 1.13 [1.03, 1.25]. These risks were lower than SGA_pop.

Conclusions: Using an obesity-specific SGA standard, a subgroup of pregnancies with marginally increased risk for neonatal complications was identified.     

Dysglycaemia in small-for-gestational-age neonates: a matched case–control study in monochorionic twins

Objective: Small-for-gestational-age (SGA) neonates (birth weight <10th centile) are at higher risk of altered glucose homeostasis compared to appropriate for gestational age (AGA) neonates. The aim of this matched case–control study was to estimate the incidence of hypoglycaemia and/or hyperglycaemia in monochorionic (MC) twins with selective intrauterine growth restriction (sIUGR).

Methods: We included all MC twins with sIUGR (2002–2013). Neonates in the SGA group were matched with their AGA co-twin. We recorded the occurrence of hypoglycaemia and hyperglycaemia in the first 48?h after birth and studied the association with SGA.

Results: In this retrospective study were 126 twin pairs included. The incidence of hypoglycaemia in the SGA group and AGA group was 29.6% and 17.4%, respectively, hyperglycaemia occurred in 8.7% of the SGA neonates and in 2.6% of the AGA co-twins. Multivariate analysis showed an independent association of SGA with hypoglycaemia (OR 1.97, CI 1.23–3.18, p?≤?0.01), but not with hyperglycaemia (OR 2.57, CI 1.64–10.28, p?=?0.182). Low gestational age (GA) at birth (OR 1.65, CI 1.09–2.48, p?=?0.02) showed an independent association with hyperglycaemia.

Conclusions: The risk of hypoglycaemia is almost twofold higher in SGA neonates compared to their MC AGA twins. Low GA appeared to be an independent risk factor for hyperglycaemia in SGA neonates.     

Ovarian reserve in young women with low birth weight and normal puberty: a pilot case–control study

Aim.?Studies indicate that women born small for gestational age (SGA) have impaired ovarian function. The origin of this ovarian dysfunction is still debatable. The aim of this study was to compare ovarian ageing between girls born appropriate for gestational age (AGA) and SGA. Therefore, we measured Luteinizing hormone (LH), Follicle-stimulating hormone (FSH), E2, Anti-Müllerian hormone (AMH) levels and the pituitary response to endogenous Gonadotropin-releasing hormone (GnRH) in adolescent girls born SGA and AGA.

Methods.?A case–controlled pilot study consisting of seven SGA women (birth weight?<10th percentile AGA) and 13 AGA women with regular menstrual cycles, age 19.9 (±0.42). Early follicular FSH, LH, Oestradiol (E2) and AMH levels were measured. After baseline samples, 100?μg GnRH was administered intravenously and at 30, 60 and 90?min blood samples were taken to measure gonadotropin levels and to compute the response to endogenous GnRH.

Results.?Mean follicular phase LH, FSH, E2 and AMH levels did not significantly differ between young women born SGA and AGA. Furthermore, the response to endogenous GnRH showed no significant differences either.

Conclusions.?We concluded against extension of this pilot study. Based on our observations it seems unlikely that limited ovarian reserve is a predominated problem in adolescent SGA.     

Birth weight centiles,risk of intrapartum compromise,and adverse perinatal outcomes in term infants

Objective: The objective of this study is to evaluate the association between birth weight centiles and the risk of intrapartum compromise and adverse neonatal outcomes in term pregnancies.

Methods: Retrospective study of 32?468 term singleton births at a major tertiary maternity hospital in Australia. Data comprised gestation, mode, and indication for delivery and adverse perinatal outcomes. Fetal sex and gestational age-specific birth weight centiles were the main exposure variable.

Results: Neonates?<21st birth weight centile had an increased risk of intrapartum compromise, the highest risk was in babies?<3rd centile (OR 4.04, 95% CI 3.34–4.89). The risk of adverse perinatal outcomes was increased in neonates?<21st and?>91st birth weight centiles. The highest risk was in those?<3rd centile (OR 2.35, 95% CI 2.00–2.75).

Conclusions: Fetal size measurements near term may be used as part of screening test for identifying fetuses at an increased risk of intrapartum compromise and adverse perinatal outcomes.     

Iron status at birth and at 4 weeks in term small-for-gestation infants in comparison with appropriate-for-gestation infants

Objective.?To determine body iron stores at birth in term small-for-gestational age (SGA) infants as compared to appropriate-for-gestational age (AGA) infants.

Methods.?In this prospective study, mother–infant pairs with gestation of?≥37 weeks and birth weight of at least 1.5?kg were enrolled. Asymmetric SGA infants were taken as cases and term AGA infants as controls. Maternal, cord blood, and infant blood samples at 4 weeks were obtained for measurement of various iron indices – cord serum ferritin, serum ferritin at 4 weeks, and correlation among maternal and neonatal iron indices – Hb, serum iron, ferritin, and total iron binding capacity (TIBC).

Results.?There were 50 SGA and 50 AGA mother–infant pairs. Cord serum ferritin levels were low in SGA group as compared to AGA [median (IQR): 68 (30,136) vs. 141 (63,259), p?=?0.007]. The proportion of infants with ‘low’ cord ferritin (<40?μg/l) were more in SGA [p?=?0.05]. There was no correlation among various maternal and neonatal cord iron parameters. The serum ferritin levels at 4 weeks were similar in both the groups (p?=?0.16).

Conclusions.?Term SGA infants have lesser total iron stores as compared to AGA infants at birth. Future studies can be designed to look at long-term neurodevelopmental outcome of the SGA babies with low as well as normal ferritin and also the role of early iron supplementation in term SGA neonates.     

Pregnancies complicated by both preeclampsia and growth restriction between 34 and 37 weeks’ gestation are associated with adverse perinatal outcomes

Objective: To determine whether adverse outcomes were more common in late preterm pregnancies complicated by preeclampsia and growth restriction compared to those affected by preeclampsia alone.

Methods: This was a retrospective cohort study of 8927 singleton pregnancies with preeclampsia. Pregnancies with small for gestational age (SGA) neonates (birth weight <10th percentile) were compared to those appropriate for gestational age (AGA) neonates. Maternal outcomes included cesarean delivery (CD) rate, CD for fetal heart rate (FHR) abnormalities, abruption, postpartum hemorrhage (PPH), maternal transfusion, acute renal failure, and peripartum cardiomyopathy. Neonatal outcomes studied included respiratory distress syndrome (RDS), jaundice, hypoglycemia, seizure, asphyxia, neonatal death, and intrauterine fetal demise (IUFD).

Results: Women with preeclampsia and SGA infants were more likely to experience abruption (5.3% versus 3.0%, p?p?p?p?p?p?p?=?0.015), and IUFD (1.5% versus 0.3%, p?Conclusions: Preeclamptic women and their neonates were more likely to experience adverse perinatal outcomes when SGA pregnancies were compared to those with AGA neonates.     

Pregnancy-induced hypertension and infant mortality: Roles of birthweight centiles and gestational age

OBJECTIVE: To assess the effect of pregnancy-induced hypertension (PIH) on infant mortality in different birthweight centiles (small for gestational age [SGA], appropriate for gestational age [AGA], and large for gestational age [LGA]) and gestational ages (early preterm, late preterm, and full term). DESIGN: Retrospective cohort study. SETTING: Linked birth and infant death data set of USA between 1995 and 2000. POPULATION: A total of 17 464 560 eligible liveborn singleton births delivered after 20th gestational week. METHODS: Multivariate logistic regression models were applied to evaluate the association between PIH and infant mortality, with adjustment of potential confounders stratified by birthweight centiles and gestational age. MAIN OUTCOME MEASURE: Infant death (0-364 days) and its three components: early neonatal death (0-6 days), late neonatal death (7-27 days), and postneonatal death (28-364 days). RESULTS: PIH was associated with decreased risks of infant mortality, early neonatal mortality, and late neonatal mortality in both preterm and term SGA births, and PIH was associated with lower postneonatal mortality in preterm SGA births. PIH was associated with decreased risks of infant mortality, early neonatal mortality, late neonatal mortality and postneonatal mortality in preterm AGA births. Decreased risk of infant mortality and early neonatal mortality was associated with PIH in early preterm LGA births. CONCLUSIONS: The association between PIH and infant mortality varies depending on different birthweight centiles, gestational age, and age at death. PIH is associated with a decreased risk of infant mortality in SGA births, preterm AGA births, and early preterm LGA births.     

Feeding tolerance of preterm infants appropriate for gestational age (AGA) as compared to those small for gestational age (SGA)

Abstract

Preterm infants are often considered too unstable to be fed enterally so they are exposed to complications related to a prolonged enteral fasting. Our study aims to compare feeding tolerance of adequate for gestational age (AGA) versus small for gestational age (SGA) infants and to evaluate which perinatal factors affect feeding tolerance (measured as time to achieve full enteral feeding, FEF). Inborn infants with a gestational age (GA) less than 32 weeks, born from January 2006 to December 2010, were eligible for this study. We enrolled 310 infants. The time to FEF was longer for SGA infants than for AGA, while a longer GA was associated to a reduced time to FEF. A beneficial effect was observed for antenatal steroids, while Apgar score below 7, the administration of inotrops or caffeine, the occurrence of sepsis or NEC and the presence of PDA were associated to a longer time to FEF. When evaluated jointly with a multivariate analysis, GA (p?<?0.0001), antenatal steroids prophylaxis (p?=?0.002), SGA (p?<?0.0001) and occurrence of NEC (p?=?0.0002) proved to have independent prognostic impact on the time to FEF. Feeding tolerance is better as GA increases, and worsen in SGA infants. Antenatal betamethasone is effective in reducing the time to FEF in both AGA and SGA.     

Pregnancy outcome and placental pathology in small for gestational age neonates in relation to the severity of their growth restriction

Purpose: To investigate neonatal outcome and placental pathology in pregnancies complicated with small for gestational age neonates (SGA), in relation to the severity of growth restriction.

Methods: The medical records and placental histology reports of all neonates with a birth-weight (BW) ≤10th percentile, born between 24–42 weeks, during 2010–2015, were reviewed. Placental lesions were classified into maternal and fetal vascular malperfusion (MVM and FVM) lesions. Results were compared between neonates with BW <5th percentile (severe SGA group), neonates with BW between 5th–10th percentile (mild SGA group) and a control group of appropriate for gestational age (AGA) neonates. Composite neonatal outcome was defined as one or more of early complications.

Results: Overall, 753 neonates were included, 238 in the severe SGA group, 266 in the mild SGA group, and 249 in the control group. The severe SGA group had higher rates of composite adverse neonatal outcome as compared with the mild SGA and control groups (37.2 versus 17.6%, versus 24.5%, respectively, p?p?Conclusions: Worse neonatal outcome and more placental MVM and FVM lesions correlate with the severity of neonatal growth restriction in a “dose-dependent” manner.     

Ultrasound prediction of growth abnormalities in fetuses with gastroschisis

Objective.?We seek to determine whether (1) mean abdominal circumference (AC) of fetuses with gastroschisis is smaller than published normative values, (2) diagnosis of AC ≤2.5th percentile is supported by postnatal diagnosis of small-for-gestational age (SGA) and (3) adverse neonatal outcomes are more common in fetuses affected by gastroschisis with a sonographically measured small AC.

Methods.?Retrospective review of pregnancies complicated with gastroschisis between 2000 and 2008. Patient demographics, method of closure, length of stay, use of ventilator support and gastrointestinal complications were compared.

Results.?Seventy-four fetuses were identified with 368 ultrasound observations. Mean AC of fetuses with gastroschisis fell between the 2.5th and 50th percentile for gestational age. Thirty patients had AC measurements ≤2.5th of which 50% were SGA at delivery. Eleven of the 74 fetuses were diagnosed with intrauterine growth restriction (IUGR) and all were SGA. Birth weight was lower in those with a small AC (2104?g vs. 2665?g, p?<?0.001). There were no other differences in outcomes.

Conclusion.?AC values fell within the normal range of normative curves. Fifty percent of fetuses with small AC were SGA at birth. Neonatal outcomes in patients with small AC are similar to those with a normal AC.