Neonatal outcome of small for gestational age infants born at 26–33 weeks’ gestation in Chinese neonatal intensive care units

Huang, Yihuang; Zhang, Lan; Sun, Huiqing; Liu, Cuiqing; Yang, Yi; Lee, Shoo K.; Cao, Yun; Jiang, Siyuan

doi:10.21037/tp-20-339

Cited by 7 publications

(13 citation statements)

References 26 publications

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“…Data in this study are in agreement with the literature showing an association of NEC with SGA or BW Z-score. [3,[9][10][11][12]. Data in this study confirmed the association of SGA with maternal hypertension [26].…”

Section: Discussionsupporting

confidence: 82%

“…The controversy about the relationship of NEC with SGA might result from heterogeneity of study design including sample size, inclusion criteria (e.g., BW or GA ), excluding or adjusting for congenital malformations, and from non-linear relationship between the frequency of NEC and severity of growth restriction. In the multicenter Chinese cohort of 24,596 infants born at 26-33 weeks' GA (not excluding congenital malformations) listed above, the frequency of NEC was higher in SGA but on multivariate analysis was not different in those with BW at 3rd-10th centile vs those with BW < 3rd centile; NEC was more frequent in SGA than non SGA only in the subgroup with GA ≥30 weeks [9]. Previous data on 4679 inborn preterm infants at Parkland Hospital have shown that NEC was independently associated with severity of growth restriction assessed by BW Z-score categories using as control the largest quartile, along with several variables including congenital heart disease [11].…”

Section: Accepted Manuscriptmentioning

confidence: 93%

“…multicenter cohorts (10,353 VLBW infants,24,596 infants born at 26-33 weeks' GA, and 20,223 VLBW infants [3,9,12] and a propensity-matched study of 909 infants born at 26-31 weeks' GA [10].…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…30 weeks. 9 Previous data on 4,679 inborn preterm infants at Parkland Hospital have shown that NEC was independently associated with severity of growth restriction assessed by BW Z-score categories using as control the largest quartile, along with several variables including congenital heart disease. 11 In a large, multicenter Korean cohort of 10,353 VLBW infants using machine learning, BW Z-score was independently associated with NEC, along with BW, BW Z-score, maternal age, GA, average birth year temperature, birth year, minimum birth year temperature, maximum birth year temperature, sepsis, and male sex (AUC 0.73).…”

mentioning

confidence: 97%

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Impact of Size for Gestational Age on Multivariate Analysis of Factors Associated with Necrotizing Enterocolitis in Preterm Infants: Retrospective Cohort Study

Sánchez-Rosado,

Reis,

Jaleel

et al. 2023

Am J Perinatol

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Objective: Necrotizing enterocolitis (NEC) primarily affects preterm, especially small for gestational age (SGA), infants. This study was designed: (1) To describe frequency and timing of NEC in SGA versus non-SGA infants and (2) to assess whether NEC is independently associated with the severity of intrauterine growth failure. Study design: Retrospective cohort study of infants without severe congenital malformations born <33 weeks gestational age (GA) from 2009-2021. The frequency and time of NEC were compared between SGA and non-SGA infants. Multivariate logistic regression was used to assess whether NEC was independently associated with intrauterine growth restriction. Severe growth restriction was defined as birthweight Z-score <-2. Results: Among 2940 infants, the frequency of NEC was higher in SGA than in non-SGA infants [25/268 (9.3%) vs 110/2672 (4.1%), respectively, P<0.001]. NEC developed two weeks later in SGA than non-SGA infants. In multivariate analysis, the adjusted odds of NEC increased with extreme prematurity (<28 weeks GA) and with severe but not moderate growth restriction. The adjusted odds of NEC increased with urinary tract infection or sepsis within a week prior to NEC, were lower in infants fed their mother's own milk until discharge and did not change over 5 epochs. NEC was independently associated with antenatal steroid (ANS) exposure in infants with BW Z-score <0. Conclusions: NEC was more frequent in SGA than in non-SGA infants and developed two weeks later in SGA infants. NEC was independently associated with severe intrauterine growth failure and with ANS exposure in infants with BW Z-score <0.

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Section: Discussionsupporting

confidence: 82%

Section: Accepted Manuscriptmentioning

confidence: 93%

Section: Accepted Manuscriptmentioning

confidence: 99%

mentioning

confidence: 97%

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Impact of Size for Gestational Age on Multivariate Analysis of Factors Associated with Necrotizing Enterocolitis in Preterm Infants: Retrospective Cohort Study

Sánchez-Rosado,

Reis,

Jaleel

et al. 2023

Am J Perinatol

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“…A multicenter cohort study in China also showed that the incidence of BPD in the SGA group was 3. 1-fold higher than that non-SGA group (31). Most SGA preterm infants have intrauterine growth restriction (IUGR).…”

Section: Discussionmentioning

confidence: 96%

A prediction nomogram for moderate-to-severe bronchopulmonary dysplasia in preterm infants < 32 weeks of gestation: A multicenter retrospective study

Zhang

Wei

et al. 2023

Front. Pediatr.

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BackgroundModerate-to-severe bronchopulmonary dysplasia (msBPD) is a serious complication in preterm infants. We aimed to develop a dynamic nomogram for early prediction of msBPD using perinatal factors in preterm infants born at <32 weeks' gestation.MethodsThis multicenter retrospective study conducted at three hospitals in China between January 2017 and December 2021 included data on preterm infants with gestational age (GA) < 32 weeks. All infants were randomly divided into training and validation cohorts (3:1 ratio). Variables were selected by Lasso regression. Multivariate logistic regression was used to build a dynamic nomogram to predict msBPD. The discrimination was verified by receiver operating characteristic curves. Hosmer-Lemeshow test and decision curve analysis (DCA) were used for evaluating calibration and clinical applicability.ResultsA total of 2,067 preterm infants. GA, Apgar 5-min score, small for gestational age (SGA), early onset sepsis, and duration of invasive ventilation were predictors for msBPD by Lasso regression. The area under the curve was 0.894 (95% CI 0.869–0.919) and 0.893 (95% CI 0.855–0.931) in training and validation cohorts. The Hosmer−Lemeshow test calculated P value of 0.059 showing a good fit of the nomogram. The DCA demonstrated significantly clinical benefit of the model in both cohorts. A dynamic nomogram predicting msBPD by perinatal days within postnatal day 7 is available at https://sdxxbxzz.shinyapps.io/BPDpredict/.ConclusionWe assessed the perinatal predictors of msBPD in preterm infants with GA < 32 weeks and built a dynamic nomogram for early risk prediction, providing clinicians a visual tool for early identification of msBPD.

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Evaluation of screening performance of first‐trimester competing‐risks prediction model for small‐for‐gestational age in Asian population

Nguyen-Hoang

Papastefanou

Sahota

et al. 2024

Ultrasound in Obstet & Gyne

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ObjectivesTo examine the external validity of the new Fetal Medicine Foundation (FMF) competing risk model for the prediction of small for gestational age (SGA) at 11‐14 weeks of gestation in Asian population.MethodsThis is a secondary analysis of a multicenter prospective cohort study in 10,120 women with singleton pregnancies undergoing routine assessment at 11‐14 weeks of gestation. We applied the FMF competing risk model for the first‐trimester prediction of SGA combining maternal characteristics and medical history with measurements of mean arterial pressure (MAP), uterine artery pulsatility index (UtA‐PI), and serum placental growth factor (PlGF). We obtained risks for different cut‐offs of birth weight percentile and gestational age at delivery. We examined the predictive performance in terms of discrimination and calibration.ResultsThe predictive performance of the competing risk model for SGA was similar to that reported in the FMF study. Specifically, the combination of maternal factors with MAP, UtA‐PI, and PlGF yielded the best performance for the prediction of preterm SGA <10th percentile (SGA<10th) and preterm SGA <5th percentile (SGA<5th), with the areas under the curves (AUCs) of 0.765 (95% confidence interval [CI], 0.720‐0.809) and 0.789 (95%CI, 0.736‐0.841), respectively. Combining maternal factors, MAP, and PlGF yielded the best model for predicting preterm SGA <3rd percentile (SGA<3rd), with an AUC of 0.797 (95%CI, 0.744‐0.850). After excluding preeclampsia (PE) cases, the combination of maternal factors with MAP, UtA‐PI, and PlGF yielded the best performance for the prediction of preterm SGA<10th and SGA<5th, with AUCs of 0.743 (95%CI, 0.691‐0.795) and 0.762 (95%CI, 0.700‐0.824), respectively. However, the best model for predicting preterm SGA<3rd without PE was the combination of maternal factors and PlGF, with an AUC of 0.786 (95%CI, 0.723‐0.849). The FMF competing risk model including maternal factors, MAP, UtA‐PI, PlGF achieved DRs of 42.2%, 47.3%, and 48.1%, at the fixed FPR of 10%, for the prediction of preterm SGA with birth weight <10th, 5th and 3rd percentiles, respectively. The calibration of the new model was satisfactory.ConclusionThe screening performance of the new FMF first trimester competing risk model for SGA in an independent large cohort of Asian women is comparable to that reported in the original FMF study on a mixed European population.This article is protected by copyright. All rights reserved.

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Neonatal outcome of small for gestational age infants born at 26–33 weeks’ gestation in Chinese neonatal intensive care units

Cited by 7 publications

References 26 publications

Impact of Size for Gestational Age on Multivariate Analysis of Factors Associated with Necrotizing Enterocolitis in Preterm Infants: Retrospective Cohort Study

Impact of Size for Gestational Age on Multivariate Analysis of Factors Associated with Necrotizing Enterocolitis in Preterm Infants: Retrospective Cohort Study

A prediction nomogram for moderate-to-severe bronchopulmonary dysplasia in preterm infants < 32 weeks of gestation: A multicenter retrospective study

Evaluation of screening performance of first‐trimester competing‐risks prediction model for small‐for‐gestational age in Asian population

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