The Impact of Small-for-gestational-age on Neonatal Outcome Among Very-low-birth-weight Infants

Tsai, Li-Yi; Chen, Yi‐Ling; Yau, Kuo-Inn Tsou; Mu, Shu‐Chi

doi:10.1016/j.pedneo.2014.07.007

Cited by 69 publications

(66 citation statements)

References 35 publications

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“…7,11 Em geral, os recém-nascidos LIG têm maior dificuldade de adaptação à vida extrauterina, objetivada por um menor índice de Apgar ao 5º minuto. 7,11,13 Neste estudo, identificaram-se apenas diferenças estatisticamente significativas no índice de Apgar ao primeiro minuto, assim como, maior necessidade de indução de trabalho de parto, mais cesarianas, mais corticoterapia pré-natal nos LIG, o que pode traduzir o grande investimento nestes recém-nascidos. Não se identificaram diferenças estatisticamente significativas relativamente à incidência de casos de DMH ou de DBP.…”

Section: Discussionunclassified

“…Não se identificaram diferenças estatisticamente significativas relativamente à incidência de casos de DMH ou de DBP. Também aqui a literatura não é consensual, 11 tendo-se concluído que, apesar de não haver diferenças no número de casos de DMH, os LIG necessitaram mais de apoio ventilatório.…”

Section: Discussionunclassified

“…O conceito de maturação pulmonar acelerada em resposta ao stress in utero, foi proposto em 1980 e suportado em vários estudos. 1,9 A generalização da utilização da corticoterapia a partir da década de 1990 e o aumento da produção de glicocorticoides adrenais induzido pelo baixo peso, 11,13 em oposição à hipoxia e acidose a que o feto LIG está sujeito, poderão explicar a razão pela qual se mantém a controvérsia.…”

Section: Aig (N = 248) Lig (N = 34) P or (Ic 95%)unclassified

“…11 Estão também referidos quatro estudos, dois que corroboram as diferenças já descritas e outros dois não encontraram diferenças estatisticamente significativas, tal como acontece na presente série.…”

Section: Aig (N = 248) Lig (N = 34) P or (Ic 95%)unclassified

“…3,[11][12][13] Por esse motivo, continuam a ser considerados como tendo risco de maior morbilidade e mortalidade. 6,7,10 No entanto, alguns autores assumem que os recém-nascidos LIG prematuros têm uma maturação pulmonar acelerada devido ao stress intrauterino e, portanto, tendem a ter menor morbilidade respiratória, quando comparados com os recém-nascidos com peso adequado à idade gestacional (AIG).…”

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Morbilidade e mortalidade em grandes prematuros - leves vs adequados para a idade gestacional

Neves

Morais

Mimoso

2018

Acta Pediátrica Port

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Introdução: A influência de nascer leve para a idade gestacional sobre a morbilidade e mortalidade permanece controversa. O objetivo deste estudo foi avaliar a morbilidade e mortalidade dos recém-nascidos com idade gestacional inferior a 32 semanas comparando os leves com os de peso adequado à idade gestacional. Métodos: Estudo retrospetivo analítico dos processos clínicos de recém-nascidos com idade gestacional inferior 32 semanas internados, num período de 10 anos, na unidade de cuidados intensivos neonatais duma maternidade de nível III. Foram excluídos gémeos, recém-nascidos com anomalias congénitas graves e recém-nascidos grandes para a idade gestacional. Adotaram-se as curvas de Fenton, considerando-se ser leves para a idade gestacional se percentil do peso de nascimento inferior a 10, adequados para a idade gestacional se percentil entre 10 e 90 e grandes para a idade gestacional se percentil superior a 90. Análise estatística através do SPSS17 com significância para p<0,05. Resultados: Foram incluídos 282 recém-nascidos, tendo sido classificados como leves para a idade gestacional 34 (12,1%). Nestes ocorreram significativamente maior número de nascimentos na nossa maternidade (p = 0,020), partos por cesariana (p < 0,001) e partos induzidos (p < 0,001). Ao primeiro minuto o índice de Apgar foi inferior (p = 0,003), não havendo diferenças ao quinto e 10º minutos. Os adequados à idade gestacional tiveram uma maior incidência de hemorragia peri-intraventricular (p = 0,028). Não houve diferenças estatisticamente significativas nos restantes parâmetros de morbilidade avaliados e na mortalidade. Discussão: Nesta série de recém-nascidos grandes prematuros, ser leve para a idade gestacional não representou maior risco de morbilidade e mortalidade significativa. Palavras-chave: Doenças do Prematuro; Idade Gestacional; Morbilidade; Mortalidade Infantil; Prematuro; Recém-Nascido; Recém-Nascido de Muito Baixo Peso Abstract Introduction: The influence of being small for gestational age on morbidity and mortality is controversial. The aim of this study was to assess the morbidity and mortality of small for gestational age newborns compared to appropriate for gestational age in infants with gestational age less than 32 weeks. Methods: We performed an analytical retrospective study of medical records of newborns with gestational age less than 32 weeks hospitalised over a 10-year period in the neonatal intensive care unit of a level III maternity hospital. Twins, babies with serious birth defects and large for gestational age infants were excluded. Small for gestational age was defined as birth weight below the 10th percentile, appropriate for gestational age between the 10th and 90th percentile; and large for gestational age as over the 90th percentile, according to Fenton growth charts. Results: The study included 282 newborns and 34 (12.1%) were classified as small for gestational age. These showed significantly greater number of births in our hospital (p = 0.020), caesarean delivery (p < 0.001) and induced delivery (p...

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Section: Discussionunclassified

Section: Aig (N = 248) Lig (N = 34) P or (Ic 95%)unclassified

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Morbilidade e mortalidade em grandes prematuros - leves vs adequados para a idade gestacional

Neves

Morais

Mimoso

2018

Acta Pediátrica Port

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Validation of the Colorado Retinopathy of Prematurity Screening Model

et al. 2018

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The Colorado Retinopathy of Prematurity (CO-ROP) model uses birth weight, gestational age, and weight gain at the first month of life (WG-28) to predict risk of severe retinopathy of prematurity (ROP). In previous validation studies, the model performed very well, predicting virtually all cases of severe ROP and potentially reducing the number of infants who need ROP examinations, warranting validation in a larger, more diverse population. OBJECTIVE To validate the performance of the CO-ROP model in a large multicenter cohort. DESIGN, SETTING, PARTICIPANTS This study is a secondary analysis of data from the Postnatal Growth and Retinopathy of Prematurity (G-ROP) Study, a retrospective multicenter cohort study conducted in 29 hospitals in the United States and Canada between January 2006 and June 2012 of 6351 premature infants who received ROP examinations. MAIN OUTCOMES AND MEASURES Sensitivity and specificity for severe (early treatment of ROP [ETROP] type 1 or 2) ROP, and reduction in infants receiving examinations. The CO-ROP model was applied to the infants in the G-ROP data set with all 3 data points (infants would have received examinations if they met all 3 criteria: birth weight, <1501 g; gestational age, <30 weeks; and WG-28, <650 g). Infants missing WG-28 information were included in a secondary analysis in which WG-28 was considered fewer than 650 g. RESULTS Of 7438 infants in the G-ROP study, 3575 (48.1%) were girls, and maternal race/ethnicity was 2310 (31.1%) African American, 3615 (48.6%) white, 233 (3.1%) Asian, 40 (0.52%) American Indian/Alaskan Native, and 93 (1.3%) Pacific Islander. In the study cohort, 747 infants (11.8%) had type 1 or 2 ROP, 2068 (32.6%) had lower-grade ROP, and 3536 (55.6%) had no ROP. The CO-ROP model had a sensitivity of 96.9% (95% CI, 95.4%-97.9%) and a specificity of 40.9% (95% CI, 39.3%-42.5%). It missed 23 (3.1%) infants who developed severe ROP. The CO-ROP model would have reduced the number of infants who received examinations by 26.1% (95% CI, 25.0%-27.2%). CONCLUSIONS AND RELEVANCE The CO-ROP model demonstrated high but not 100% sensitivity for severe ROP and missed infants who might require treatment in this large validation cohort. The model requires all 3 criteria to be met to signal a need for examinations, but some infants with a birth weight or gestational age above the thresholds developed severe ROP. Most of these infants who were not detected by the CO-ROP model had obvious deviation in expected weight trajectories or nonphysiologic weight gain. These findings suggest that the CO-ROP model needs to be revised before considering implementation into clinical practice.

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Usefulness of ultrasound fetal anthropometry in primary and secondary screening to identify small for gestational age: A meta‐analysis

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2019

J of Clinical Ultrasound

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Purpose This study was performed to evaluate the usefulness of ultrasound fetal anthropometry in primary and secondary screening to identify small for gestational age (SGA). Methods Ten databases, for example, PubMed (MEDLINE), were searched to include all English‐language studies published since 2015 that provided true‐positive and false‐positive and true‐negative and false‐negative results of SGA identification. A bivariate diagnostic meta‐analysis was performed to summarize the sensitivity and specificity as well as positive and negative likelihood ratios (PLR and NLR, respectively) of ultrasound fetal anthropometry for identification of SGA. Results Sensitivity and NLR are important in primary screening. Both femur length and anthropometric formulas showed low sensitivity, although abdominal circumference showed moderate sensitivity. Abdominal circumference, femur length, and anthropometric formulas did not have sufficiently low NLR. However, specificity and PLR are important in secondary screening. Abdominal circumference, femur length, and anthropometric formulas all showed high specificity. Neither abdominal circumference nor femur length had sufficiently high PLR, but anthropometric formulas showed sufficiently high PNL. Conclusions Abdominal circumference, femur length, and anthropometric formulas are unsuitable in primary screening to identify SGA. However, anthropometric formulas, but not abdominal circumference and femur length, are useful in secondary screening to identify SGA.

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The Impact of Small-for-gestational-age on Neonatal Outcome Among Very-low-birth-weight Infants

Abstract: Our data provide evidence that SGA may be associated with increased risks of neonatal mortality, ROP, and BPD in VLBW infants.

Cited by 69 publications

References 35 publications

Morbilidade e mortalidade em grandes prematuros - leves vs adequados para a idade gestacional

Morbilidade e mortalidade em grandes prematuros - leves vs adequados para a idade gestacional

Validation of the Colorado Retinopathy of Prematurity Screening Model

Usefulness of ultrasound fetal anthropometry in primary and secondary screening to identify small for gestational age: A meta‐analysis

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