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.
KEYWORD
SGA - IUGR - preterm - neonatal outcome - neonatal sepsis
