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Effect of antenatal detection of small-for-gestational-age newborns in a risk stratified retrospective cohort.

ABSTRACT: OBJECTIVE:Small-for-gestational-age (SGA) are neonates born with birth weight below the 10th centile for a given week of pregnancy. It is a risk factor of perinatal and neonatal morbidity and mortality. There is an ongoing debate whether prenatal detection of SGA neonates is good predictor of perinatal outcome especially in low risk populations. Our primary aim was to compare the odds ratios for unfavorable outcome in a risk stratified cohort of SGA neonates in regard to prenatal detection status. METHODS:This is a retrospective cohort study analysing the effect of prenatal detection on perinatal outcome. This cohort has been divided into a predefined low-risk and high-risk population. Electronic records of 39,032 singleton deliveries from 2010 through 2016 were analysed. SGA was defined as newborn weight below the 10th percentile on the Fenton growth chart. Detected SGA (dSGA) neonates were those that were admitted for delivery with a prenatal ultrasound diagnosis of abnormal growth. Undetected SGA (uSGA) were neonates that were found to be below the 10th percentile after birth. Perinatal and neonatal outcome was compared. RESULTS:The detection rate in high-risk pregnancies was almost 45.7% versus low risk where it amounted to 18.9%. In both the high-risk and low-risk populations there was a significantly higher risk of composite mortality for undetected SGA compared to approporiate-for-gestational-age (AGA) (OR 7.95 CI 4.76-13.29; OR 14.4 CI 4.99-41.45 respectively). The odds for the composite neonatal outcome were significantly higher for dSGA and uSGA than for AGA in all the studied populations except for the uSGA in high risk population (OR 1.57 CI 0.97-3.53). Importantly, there was not a single case of intrauterine fetal death among detected SGA, in the low risk group. CONCLUSIONS:Prenatal detection of SGA status is related to perinatal outcomes, especially mortality. Therefore, assessment of SGA status even in low-risk pregnancies could help predict potential perinatal and neonatal complications.

SUBMITTER: Kajdy A

PROVIDER: S-EPMC6822749 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Effect of antenatal detection of small-for-gestational-age newborns in a risk stratified retrospective cohort.

Kajdy Anna A Modzelewski Jan J Jakubiak Monika M Pokropek Artur A Rabijewski Michał M

PloS one 20191031 10

<h4>Objective</h4>Small-for-gestational-age (SGA) are neonates born with birth weight below the 10th centile for a given week of pregnancy. It is a risk factor of perinatal and neonatal morbidity and mortality. There is an ongoing debate whether prenatal detection of SGA neonates is good predictor of perinatal outcome especially in low risk populations. Our primary aim was to compare the odds ratios for unfavorable outcome in a risk stratified cohort of SGA neonates in regard to prenatal detecti ...[more]

PMID: 31671164

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Project description:Small for gestational age (SGA) newborns are at risk of developing neonatal hypoglycaemia. SGA newborns comprise a heterogeneous group including both constitutionally small and pathologically growth restricted newborns. The process of fetal growth restriction may result in brain sparing at the expense of the rest of the body, resulting in disproportionally small newborns. The aim of this study was to discover whether body proportionality influences the risk of developing neonatal hypoglycaemia in SGA newborns. A retrospective cohort study was performed in 402 newborns who were SGA without additional risk factors for hypoglycaemia. Body proportionality was classified in two ways: (1) using symmetric (sSGA) or asymmetric (aSGA), defined as head circumference (HC) below or above the 10th percentile, respectively; (2) using cephalization index (HC/birth weight), standardized for gestational age. Hypoglycaemia was observed in 50% of aSGA and 40.9% of sSGA newborns (P-value 0.12). Standardized CI in newborns with hypoglycaemia was higher compared to newborns without hypoglycaemia (median 1.27 (1.21-1.35) versus 1.24 (1.20-1.29); (P 0.002)). Multivariate logistic regression analyses showed both CI and standardized CI to be associated with the occurrence of hypoglycaemia (OR 1.48 (1.24-1.77) and OR 1.44 (1.13-1.83), respectively). The majority of hypoglycaemic events (96.1%) occurred in the first 6 h after birth. Conclusion: Body proportionality might be of influence, depending on the classification used. Larger prospective studies with a clear consensus definition of body proportionality are needed. What is Known: • Neonatal hypoglycaemia is an important complication in newborns. • Small for gestational age (SGA) newborns are more vulnerable to hypoglycaemia. What is New: • Higher incidence of hypoglycaemia was not observed in asymmetric SGA compared to symmetric SGA, but standardized cephalization index was associated with increased likelihood of hypoglycaemia. • Consensus-based definitions of body proportionality in newborns are needed.

Project description:BACKGROUND:Small-for-gestational-age (SGA) is associated with increased neonatal mortality and morbidity. In low and middle income countries an accurate gestational age is often not known, making the identification of SGA newborns difficult. Measuring foot length, chest circumference and mid upper arm circumference (MUAC) of the newborn have previously been shown to be reasonable methods for detecting low birth weight (<?2500?g) and prematurity (gestational age?<? 37?weeks). The aim of this study was to investigate if the three anthropometric measurements could also correctly identify SGA newborns. METHODS:In the current study from a rural area of northeastern Tanzania, 376 live newborns had foot length, chest circumference, and MUAC measured within 24?h of birth. Gestational age was estimated by transabdominal ultrasound in early pregnancy and SGA was diagnosed using a sex-specific weight reference chart previously developed in the study area. Receiver operating characteristic curves were generated for each of the anthropometric measurements and the area under the curve (AUC) compared. Operational cutoffs for foot length, chest circumference, and MUAC were defined while balancing as high as possible sensitivity and specificity for identifying SGA. Positive and negative predictive values (PPV and NPV) were then calculated. RESULTS:Of the 376 newborns, 68 (18.4%) were SGA. The AUC for detecting SGA was 0.78 for foot length, 0.88 for chest circumference, and 0.85 for MUAC. Operational cut-offs to detect SGA newborns were defined as ?7.7?cm for foot length, ?31.6?cm for chest circumference and???10.1?cm for MUAC. Foot length had 74% sensitivity, 69% specificity, PPV of 0.35 and NPV of 0.92 for identifying SGA. Chest circumference had 79% sensitivity, 81% specificity, PPV of 0.49 and NPV of 0.95 for identifying SGA. Finally, MUAC had 76% sensitivity, 77% specificity, PPV of 0.43 and NPV of 0.94 for identifying SGA. CONCLUSION:In a setting with limited availability of an accurate gestational age, all three methods had a high NPV and could be used to rule out the newborn as being SGA. Overall, chest circumference was the best method to identify SGA newborns, whereas foot length and MUAC had lower detection ability. TRIAL REGISTRATION:Clinicaltrials.gov ( NCT02191683 ). Registered 2 July 2014.

Project description:Background: Small for gestational age (SGA) is a key contributor to premature deaths and long-term complications in life. Improved characterization of maternal risk factors associated with this adverse outcome is needed to inform the development of interventions, track progress, and reduce the disease burden. This study aimed to identify socioeconomic, demographic, and clinical factors associated with SGA in Mexico. Methods: We analyzed administrative data from 1,841,477 singletons collected by the National Information Subsystem of Livebirths during 2017. Small-for-gestational-age was defined as being <10th centiles according to the INTERGROWTH-21st standards. The comparison group was defined as being in ≥10th centiles. We fitted logistic regression models to determine odds ratios for the maternal factors associated with SGA. Results: Among the 1,841,477 singletons, 51% were male, 6.7% were SGA, 6.1% were term-SGA, and 0.5% were preterm-SGA. Maternal education presented a protective gradient of being SGA among mothers who achieved 1 to 6 years of education (adjusted odds ratio (aOR)0.95; 95% CI:0.91,0.99), 7 to 9 years (aOR 0.86; 95% CI:0.83,0.89), 10 to 12 years (aOR 0.75; 95% CI: 0.72, 0.79) and > 12 years (aOR 0.63; 95% CI:0.6,0.66) compared with those without education. SGA was particularly likely to occur among primiparous (aOR 1.42; 95% CI: 1.39, 1.43), mothers living in very high deprivation localities (aOR 1.39; 95% CI: 1.36, 1.43), young (aOR 1.04; 95% CI: 1.02, 1.06), advanced age (aOR 1.14; 95% CI 1.09, 1.19), and mothers living in areas above 2,000 m (aOR 1.69; 95% CI: 1.65, 1.73). Antenatal care was associated with a reduced risk of SGA by 30% (aOR 0.7; 95% CI:0.67,0.73), 23% (OR 0.77; 95% CI:0.74,0.8), and 21% (OR 0.79; 95% CI:0.75,0.83), compared with those mothers who never received antenatal care, when women visited the clinic at the first, second and third trimester, respectively. Conclusion: Almost 7% of live births were found to be SGA. Parity, maternal age, education, place of residence, and social deprivation were significantly associated with this outcome. Antenatal care was protective. These findings imply that interventions focusing on early and adequate contact with health care facilities, reproductive health counseling, and maternal education should reduce SGA in Mexico.

Project description:BACKGROUND:Japan has an exceptionally high proportion of low-weight births and underweight women. It has been suggested that an appropriate increase in gestational weight gain (GWG) for underweight women will help to prevent low birth weight. The current strategy aims to raise the desired value of GWG equally for all pregnant women within the underweight category. However, it remains elusive whether or not the relationship between GWG and birth weight for gestational age (BW/GA) are uniformly equivalent for all the women. METHODS:We performed a retrospective cohort analysis of women who delivered their newborns at Tokyo Medical and Dental University Hospital from 2013 to 2017. First, in order to examine the direct effect of an increase or decrease in GWG on BW/GA, we analyzed the correlation between inter-pregnancy differences in GWG and BW/GA using a sub-cohort of women who experienced two deliveries during the study period (n = 75). Second, we dichotomized the main cohort (n = 1114) according to BW/GA to verify our hypothesis that the correlation between GWG and BW/GA differs depending on the size of the newborn. RESULTS:The inter-pregnancy difference in BW/GA was not correlated with that of GWG. However, the correlation between BW/GA of siblings was high (r = 0.63, p = 1.9 × 10- 9). The correlation between GWG and BW/GA in women who delivered larger-sized newborns was higher (r = 0.17, p = 4.1 × 10- 5) than that in women who delivered smaller-sized newborns (r = 0.099, p = 1.9 × 10- 2). This disparity did not change after adjustment for pre-pregnancy BMI. The mean birth weight in the dichotomized groups corresponded to percentile 52.0 and 13.4 of the international newborn size assessed by INTERGROWTH-21st standards. CONCLUSIONS:In our study, GWG was positively correlated with BW/GA for heavier neonates whose birth weights were similar to the average neonatal weight according to world standards. However, caution might be required for low-birth-weight neonates because increased GWG does not always result in increased birth weight.

Project description:IntroductionFetal growth restriction (FGR) is associated with increased risk for stillbirth, perinatal morbidity, cerebral palsy, neurodevelopmental disorders and cardiovascular disease later in life. Identifying small-for-gestational-age (SGA) fetuses is crucial for the diagnosis of FGR. The aim of this study was to investigate the association between antenatal identification of SGA fetuses and severe adverse perinatal and childhood outcome.Material and methodsA register-based cohort study of all newborns delivered in Stockholm in 2014 and 2017.Inclusion criteriasingleton pregnancies without chromosomal aberrations or structural abnormalities, with a gestational age at delivery between 22+0 and 43+0 (n = 48 843). Data from childbirth records were linked to data from nationwide Swedish registers. Pregnancy including offspring data were reviewed. Adverse outcomes for non-identified and identified SGA newborns were compared using logistic regression models. Primary outcome was a composite outcome called severe adverse outcome, defined as at least one of the following: stillbirth, severe newborn distress (Apgar score <4 at 5 min, pH <7 or resuscitation activities >10 min), severe neonatal outcome (hypoxic ischemic encephalopathy 2-3, necrotizing enterocolitis, neonatal seizures, intraventricular hemorrhage grade 3-4, bronchopulmonary disease or death at <1 year), severe childhood outcome (cognitive impairment or motor impairment or cerebral palsy or hearing impairment or visual impairment or death at 1-3 years old). Secondary outcomes were stillbirth, severe newborn distress, severe neonatal outcome, severe childhood outcome.ResultsNo association was found between antenatal identification of SGA fetuses and severe adverse outcome using the complete composite outcome (adjusted odds ratio [aOR] 1.19, 95% confidence interval [CI] 0.93-1.53). In subgroup analyses, non-identified SGA fetuses had an almost fivefold increased risk for stillbirth (aOR 4.79, 95% CI 2.63-8.72) and an increased risk for severe newborn distress (aOR 1.36, 95% CI 1.02-1.82), but a decreased risk for severe childhood outcome (aOR 0.63, 95% CI 0.40-0.99). No association was found between antenatal identification of SGA and severe neonatal outcome.ConclusionsNon-identified SGA fetuses have an increased risk for stillbirth and severe newborn distress. Conversely, identified SGA fetuses have an increased risk for severe childhood outcome.

Project description:ObjectiveThis study aimed to estimate the effect of antenatal corticosteroid administration on neonatal mortality and morbidity in preterm small-for-gestational age infants through a systematic review and meta-analysis.Data sourcesA predefined, systematic search was conducted through Ovid MEDLINE, Embase, Scopus, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trial Registry Platform, and ClinicalTrials.gov yielding 5324 articles from 1970 to 2019.Study eligibility criteriaEligible studies compared neonatal morbidity and mortality among small-for-gestational age infants delivered preterm who received antenatal corticosteroids with those who did not.MethodsThe primary outcome was neonatal mortality. Secondary outcomes were respiratory distress syndrome, necrotizing enterocolitis, intraventricular hemorrhage and periventricular leukomalacia, bronchopulmonary dysplasia or chronic lung disease of prematurity, or neonatal sepsis. We assessed heterogeneity by means of Higgins I2 statistic and Cochran's Q test and calculated pooled odds ratios with 95% confidence intervals using random effects models.ResultsA total of 16 observational cohort and case-control studies published from 1995 to 2018 met the selection criteria for the systematic review and included 8989 preterm small-for-gestational age infants. Antenatal corticosteroid administration was explicitly reported among 8376 small-for-gestational age infants; 4631 (55.3%) received antenatal corticosteroids and 3741 (44.7%) did not. Of note, 13 studies including 6387 preterm small-for-gestational age infants were then included in the meta-analysis. Neonatal mortality was significantly lower among infants who received antenatal corticosteroids than those who did not (12 studies: 12.8% vs 15.1%; pooled odds ratio, 0.63; 95% confidence interval, 0.46-0.86), with significant heterogeneity between studies (I2=55.1%; P=.011). There was no significant difference in respiratory distress syndrome (12 studies: odds ratio, 0.89; 95% confidence interval, 0.69-1.15), necrotizing enterocolitis (7 studies: odds ratio, 0.93; 95% confidence interval, 0.70-1.22), intraventricular hemorrhage and periventricular leukomalacia (10 studies: odds ratio, 0.82; 95% confidence interval, 0.56-1.20), bronchopulmonary dysplasia or chronic lung disease of prematurity (8 studies: odds ratio, 1.11; 95% confidence interval, 0.88-1.41), or neonatal sepsis (6 studies: odds ratio, 1.13; 95% confidence interval, 0.86-1.49).ConclusionThese data indicate that antenatal corticosteroid administration reduces neonatal mortality in small-for-gestational age infants delivered preterm, with no apparent effect on neonatal morbidity. This supports the use of antenatal corticosteroids to reduce neonatal mortality in pregnancies with small-for-gestational age infants at risk of preterm birth.

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Effect of antenatal detection of small-for-gestational-age newborns in a risk stratified retrospective cohort.

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Effect of antenatal detection of small-for-gestational-age newborns in a risk stratified retrospective cohort.

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