Population based study on the outcome of small for gestational age newborns

Abstract

Objective: To explore whether and how population based data from a regional quality control programme can be used to investigate the hypothesis that small for gestational age (SGA) very low birthweight infants (VLBW, ,1500 g) are at increased risk of death, severe intraventricular haemorrhage (IVH), and periventricular leucomalacia (PVL), but at decreased risk of respiratory distress syndrome (RDS). Methods: Analyses of population based perinatal/neonatal data (1991-96) from a quality control programme in Lower Saxony, Germany. After assessment of data validity and representativeness, exclusion criteria were defined: birth weight .90th centile, severe malformations, siblings of multiple births, and gestational age (GA) ,25 or .29 weeks. Outcomes of interest were death, severe IVH, PVL, and RDS. Multivariable analyses were performed by Cox proportional hazard and logistic regression models. Results: Within the data validation procedure, an increase in proportions of both VLBW (from 0.95% in 1991 to 1.11% in 1996; +17%) and SGA (from 22.7% to 27.4%; +21%) infants became apparent (p,0.05). The study population consisted of 1623 infants (173 SGA). Mortality was 12.1% (n = 196), with an adjusted hazard ratio for SGA infants of 2.54, 95% confidence interval (CI) 1.70 to 3.79. Both groups were at similar risk of severe IVH (adjusted odds ratio 0.93, 95% CI 0.5 to 1.65) and PVL (1.54, 95% CI 0.78 to 2.87), but SGA infants had less RDS (0.57, 95% CI 0.35 to 0.93). Male sex, multiple birth, hypothermia (,35.5˚C), and sepsis were associated with IVH and RDS. Infants admitted to hospitals with ,36 VLBW admissions/year had increased mortality (adjusted hazard ratio 1.56, 95% CI 1.12 to 2.18). Conclusions: SGA VLBW infants are at increased risk of death, but not of IVH and PVL, and at decreased risk of RDS. That mortality is higher in smaller hospitals needs further investigation.

The CD95/CD95L pathway is involved in phagocytosis-induced cell death of monocytes and may account for sustained inflammation in neonates

“…Although acute bacterial infection can be controlled in many cases, the accompanying inflammatory reaction, sometimes starting before birth, may be excessive and hardly controllable (3). Inflammation may even persist after resolution of infection, because sepsis predisposes to inflammatory diseases exclusively manifesting during the neonatal period, i.e., bronchopulmonary dysplasia and periventricular leukomalacia (2,(4)(5)(6)(7). As for this, Dammann et al coined the term "sustained inflammation" to describe a prolonged inflammatory reaction after an initial activation of the neonatal immune system, with an inability to resolve the resultant inflammation (8,9).…”

The First Sixty Minutes in Preterm Neonates’ Life: Predicted Morbidities and Interventions

“…The fatality rate is estimated to be 39.3% in mildly hypothermic babies, 51.6% in moderately hypothermic babies and 80% in severely hypothermic babies [4]. Birth weight acts as the key element in predicting hypothermia at admission in very low birth weight (VLBW) [5,6]. Mean rectal temperature on admission to neonatal intensive care unit (NICU) increases by 0.21°C (95% CI, 0.04 to 0.4) with each 100 gm increase in birth weight [7].…”

“…Moreover, it isn't a handy device in resource-limited settings such as developing countries. The warm moist environment of the incubator represents an ideal media for bacteria to proliferate which increases the risk of staphylococcal infection [38] 6]., respectively; P < .0001) [39]. A randomized controlled trial that compared between HHG and cold dry gas concluded that in the HHG group, 69% of preterm neonates were normothermic compared with 55% in the cold, dry gas group (unadjusted OR 1.8, 95% CI 1.01-3.19) [40].…”

“…Since the head constitutes a major portion of the body surface area in neonates and the brain plays the role of a prime heat-generating organ, head covering has been an effective technique in preventing temperature reduction in neonates [14]. But all these techniques are still insufficient in very preterm neonates.Ambient temperature of delivery room: According to WHO's recommendation the temperature of delivery rooms' should be adjusted at no less than 25°C, while the International Liaison Committee on Resuscitation (ILCOR) 2010 recommends that it should be ≥ 26 °C [3][4][5][6][7][8][9][10][11][12][13][14][15]. However, these suggestions aren't feasible targets.…”

Modifying effect of maternal nutritional status on the impact of maternal multiple micronutrient supplementation on birthweight in Indonesia

“…Low birthweight (LBW), caused by either short gestation or fetal growth restriction or both, is closely associated with fetal and neonatal morbidity and death (Chard et al, 2001, Yasmin et al, 2001, Bartels et al, 2005. Poor fetal growth, as measured by LBW and small for gestational age (SGA), is also linked with growth retardation and adult chronic diseases (Barker, 2007, Bonamy et al, 2008, Meas et al, 2008, Pandolfi et al, 2008.…”