Mortality and morbidity in preterm small-for-gestational-age infants: a population-based study

Objective: We sought to evaluate the impact of severity of growth restriction on mortality and major neonatal morbidity among very-low-birthweight small-for-gestational-age infants.

Study design: This was a population-based observational study using data collected by the Israel National Very-Low-Birth-Weight Infant Database 1995 through 2007 including infants 24-31 weeks' gestation, with birthweight (BW) ≤ 50th percentile without major malformations. Four BW percentile groups were considered: < 3rd, 3rd-< 10th, 10th-< 25th, and a reference group 25th-50th percentile. Univariate and multivariable logistic regression analyses were performed.

Results: Infants of BW 3rd-< 10th percentile were at increased risk for grades 3-4 retinopathy of prematurity (odds ratio [OR], 2.07; 95% confidence interval [CI], 1.54-2.78), bronchopulmonary dysplasia (OR, 2.52; 95% CI, 2.03-3.12), necrotizing enterocolitis (OR, 1.32; 95% CI, 1.04-1.68), and mortality (OR, 2.37; 95% CI, 1.94-2.90). The risk was further increased among infants of BW < 3rd percentile.

Conclusion: Growth restriction severity may serve as a clinical marker of degree of risk for neonatal mortality and various morbidities.