Am J Perinatol 2000; Volume 17(Number 04): 187-192
DOI: 10.1055/s-2000-9423
Copyright © 2000 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

NEONATAL OUTCOME IN GROWTH-RESTRICTED VERSUS APPROPRIATELY GROWN PRETERM INFANTS

Michal J. Simchen1 , Mario E. Beiner1 , Nurit Strauss-Liviathan1 , Mordechai Dulitzky1 , Jacob Kuint2 , Shlomo Mashiach1 , Eyal Schiff1
  • Department of
  • 1Obstetrics & Gynecology Sheba Medical Center, Tel Hashomer, Israel
  • 2Department of Neonatology, Sheba Medical Center, Tel Hashomer, Israel
Further Information

Publication History

Publication Date:
31 December 2000 (online)

ABSTRACT

The objective of this paper is to examine whether growth-restricted preterm infants have a different neonatal outcome than appropriately grown preterm infants. All consecutive, singleton preterm deliveries between 27-35 weeks' gestation were included over a 4-year period. Infants with congenital anomalies and infants of diabetic mothers were excluded. Infants were categorized as small-for-gestational-age (SGA) when birth weight was at or below the 10th percentile, and appropriate-for-gestational-age (AGA) when between the 11th and 90th percentiles. Outcome variables included: neonatal death, respiratory distress syndrome (RDS), sepsis, intraventricular hemorrhage (IVH), and necrotizing enterocolitis (NEC). Neonatal morbidity and mortality were examined by univariate and stepwise multivariate logistic regression analyses. Factors controlled for during the analysis included: maternal age; gestational age; mode of delivery; presence of preeclampsia, HELLP syndrome, prolonged premature rupture of membranes (PROM), placental abruption, placenta previa, prenatal steroid exposure, infant gender, and low Apgar score. Seventy-six infants were included in the SGA group and 209 in the AGA group. SGA infants had a higher mortality rate (p = 0.003). They also had more culture-proven sepsis episodes (p = 0.001). No differences were found with respect to the other outcomes. The results were similar when analyzed separately for the group of infants born at or below 32 weeks' gestation. Growth-restricted preterm infants were found to have both higher mortality and infection rates compared with AGA preterm infants. Growth restriction in the preterm neonate was not found to protect against other neonatal outcomes associated with prematurity. When considering elective preterm delivery for this high-risk group of pregnancies, the increased risks in the neonatal period should be taken into account.

REFERENCES

  • 1 Fetal growth restriction. In: Cunningham FG, MacDonald PC, Gant NF, et al, eds. Williams Obstetrics, 20th ed. Stamford, CT: Appleton & Lange 1997: 839-853
  • 2 Tyson J E, Kennedy K, Broyles S, Rosenfeld C R. The small for gestational age infant: accelerated or delayed pulmonary maturation? Increased or decreased survival?.  Pediatrics. 1995;  95 534-538
  • 3 Piper J M, Xenakis E MJ, McFarland M, Elliott B D, Berkus M D, Langer O. Do growth-retarded premature infants have different rates of perinatal morbidity and mortality than appropriately grown premature infants?.  Obstet Gynecol . 1996;  87 169-174
  • 4 Procianoy R S, Garcia-Prats J A, Adams J M. Hyaline membrane disease and intraventricular hemorrhage in small for gestational age infants.  Arch Dis Child . 1980;  55 502-505
  • 5 Laatikainen T J, Raisanen I J, Salminen K R. Corticotropin-releasing hormone in amniotic fluid during gestation and labor and in relation to fetal lung maturation.  Am J Obstet Gynecol . 1988;  59 891-895
  • 6 Owen J, Baker S L, Hauth J C, Goldenberg R L, Davis R O, Copper R L. Is indicated or spontaneous preterm delivery more advantageous for the fetus?.  Am J Obstet Gynecol . 1990;  163 868-872
  • 7 Friedman S A, Schiff E, Kao L, Sibai B M. Neonatal outcome after preterm delivery for preeclampsia.  Am J Obstet Gynecol . 1995;  172 1785-1788
  • 8 Schiff E, Friedman S A, Mercer B M, Sibai B M. Fetal lung maturity is not accelerated in preeclamptic pregnancies.  Am J Obstet Gynecol . 1993;  169 1096-1101
  • 9 Usher R, McLean F. Intrauterine growth of live-born caucasian infants at sea level: standards obtained from measurements in 7 dimensions of infants born between 25 and 44 weeks of gestation.  J Pediatr . 1969;  74 901-910
  • 10 Lieberman J R, Frased D, Weitzman S, Glezerman M. Birthweight curves in southern Israel populations.  Isr J Med Sci . 1993;  29 198-203
  • 11 Usher R. Clinical and therapeutic aspects of fetal malnutrition.  Pediatr Clin North Am . 1970;  17 178
  • 12 Gluck L, Kulovich M. Lecitin/sphingomyelin ratios in amniotic fluid in normal and abnormal pregnancy.  Am J Obstet Gynecol . 1975;  115 539-546
  • 13 Stahlman M T. Acute respiratory disorders in the newborn. In: Avery G, ed. Neonatology, Pathophysiology and Management of the Newborn Philadelphia: Lippincott 1981: 376-377
  • 14 Yoon J J, Kohl S, Harper R G. The relationship between maternal hypertensive disease of pregnancy and the incidence of idiopathic RDS.  Pediatrics . 1980;  65 735-739
  • 15 Koenig J M, Christensen R D. Incidence, neutrophil kinetics, and natural history of neonatal neutropenia associated with maternal hypertension.  N Engl J Med . 1989;  321 557-562
  • 16 Pena I C, Teberg A J, Finello K M. The premature small-for-gestational-age infant during the first year of life: comparison by birth weight and gestational age.  J Pediatr . 1988;  113 1066-1073
  • 17 Dahms B B, Krauss A N, Auld P AM. Pulmunary function in dysmature infants.  J Pediatr . 1974;  84 434-437
  • 18 Rigo J, Beke A, Papp Z, Paulin F. Neonatal outcome after preterm delivery for preeclampsia.  Am J Obstet Gynecol . 1996;  174 1080-1081
  • 19 Bernstein I M, Horbar J D, Badger G J, Golan A, Ohisson A. Intrauterine growth restriction in very low birth weight newborns: neonatal outcome [abstract].  Am J Obstet Gynecol . 1997;  176 s31