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Am J Perinatol
DOI: 10.1055/a-2533-2533
Original Article

Risk and Causes of Early Mortality among Extremely Preterm Infants Born Small for Gestational Age

Olasunkanmi Kehinde
1   Department of Health and Human Studies, Elizabeth City State University, Elizabeth City, North Carolina
,
Dmitry Tumin
2   Department of Academic Affairs, Brody School of Medicine at East Carolina University, Greenville, North Carolina
3   Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, North Carolina
,
Uduak S. Akpan 
3   Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, North Carolina
,
Martha Naylor
3   Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, North Carolina
› Institutsangaben Funding None.
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Abstract

Objective

Extreme preterm (EPT) delivery, occurring before 28 weeks of gestation, carries high morbidity and mortality risks. Small for gestational age (SGA) infants, approximately 8 to 20% of EPT neonates, face increased risks. Mortality risk varies with gestational age and birth weight, with mixed reports on specific morbidities. This study aims to determine mortality rates and common causes of death among EPT SGA infants.

Study Design

The study used data from the CDC National Vital Statistics System, covering births and deaths from 2016 to 2021, with follow-up through 2022. It included infants born between 22 and 27 weeks gestation who were admitted to the neonatal intensive care unit. The outcome was all-cause in-hospital mortality within 30 days of birth, with causes of mortality classified based on the International Classification of Diseases, 10th revision codes. SGA was the primary independent variable.

Results

Based on a sample of n = 96,134 infants, we estimated 13% were born SGA and 30-day mortality rates were higher among SGA compared with non-SGA infants (31 vs. 13%). On multivariable analysis, SGA infants had higher 30-day mortality than non-SGA (odds ratio: 3.82; confidence interval 95% [CI]: 3.64, 4.01; p < 0.001), and were more likely to have death ascribed to complications of short gestation rather than other causes of death (relative risk ratio: 1.42; 95% CI: 1.27, 1.59; p < 0.001).

Conclusion

SGA infants receiving intensive care have a high mortality risk, especially due to complications of short gestation and low birth weight complications.

Key Points

  • EPT infants face high mortality risk.

  • Mortality risk is increased for infants born SGA.

  • Mortality in SGA EPT infants is frequently attributed to complications of prematurity and small size.

Keywords

extreme prematurity - small for gestational age - causes of death - National Vital Statistics system


Publikationsverlauf

Eingereicht: 09. September 2024

Angenommen: 04. Februar 2025

Accepted Manuscript online:
05. Februar 2025

Artikel online veröffentlicht:
06. März 2025

© 2025. Thieme. All rights reserved.

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