Adverse effects of small for gestational age differ by gestational week among very preterm infants.
Adverse effects of small for gestational age differ by gestational week among very preterm infants.
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DOI：
10.1136/archdischild-2017-314171
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发表时间：
2019-03
期刊：
影响因子：
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通讯作者：
DeMauro SB
中科院分区：
文献类型：
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作者：
Jensen EA;Foglia EE;Dysart KC;Simmons RA;Aghai ZH;Cook A;Greenspan JS;DeMauro SB
描述极早产儿中与出生小于胎龄儿（SGA）独立相关的死亡、3-4级脑室内出血（IVH）、支气管肺发育不良（BPD）和3-5期早产儿视网膜病变的额外风险，按完整孕周分层。使用Optum新生儿数据库的回顾性队列研究。研究婴儿出生时妊娠< 32周，没有严重的先天性异常。SGA定义为出生体重<第10百分位数。采用校正风险差异（aRD）评估了SGA婴儿中与SGA出生独立相关的额外结局风险。在从717家美国医院抽样的6，708名婴儿中，743名（11.1%）为SGA。与非SGA婴儿相比，SGA婴儿的每项研究结果的未校正发生率均较高，但幸存者中的3-4级IVH除外。与SGA分娩独立相关的额外风险因结局和胎龄而异。死亡的最高aRD（0.27; 95% CI 0.13，0.40）发生在妊娠24周出生的婴儿中，并随着胎龄的增加而下降。相比之下，存活者中BPD的aRD峰值（0.32; 95% CI 0.20，0.44）以及死亡或BPD（0.35; 95% CI 0.24，0.46）和死亡或重大发病（0.35; 95% CI 0.24，0.45）的复合终点发生在妊娠27周。SGA婴儿中死亡或发生一种或多种评估的发病率的风险调整概率与出生约2-3周的非SGA婴儿相似。与出生SGA相关的新生儿发病率和死亡率的过度风险因不良结局和胎龄而异。
To characterize the excess risk for death, grade 3–4 intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), and stage 3–5 retinopathy of prematurity independently associated with birth small-for-gestational-age (SGA) among very preterm infants, stratified by completed weeks of gestation. Retrospective cohort study using the Optum Neonatal Database. Study infants were born < 32 weeks gestation without severe congenital anomalies. SGA was defined as a birth weight <10th percentile. The excess outcome risk independently associated with SGA birth among SGA babies was assessed using adjusted risk differences (aRD). Of 6,708 infants sampled from 717 US hospitals, 743 (11.1%) were SGA. SGA compared to non-SGA infants experienced higher unadjusted rates of each study outcome except grade 3–4 IVH among survivors. The excess risk independently associated with SGA birth varied by outcome and gestational age. The highest aRD for death (0.27; 95% CI 0.13, 0.40) occurred among infants born at 24 weeks gestation and declined as gestational age increased. In contrast, the peak aRDs for BPD among survivors (0.32; 95% CI 0.20, 0.44) and the composites of death or BPD (0.35; 95% CI 0.24, 0.46) and death or major morbidity (0.35; 95% CI 0.24, 0.45) occurred at 27 weeks gestation. The risk-adjusted probability of dying or developing one or more of the evaluated morbidities among SGA infants was similar to that of non-SGA infants born approximately 2–3 weeks less mature. The excess risk for neonatal morbidity and mortality associated with being born SGA varies by adverse outcome and gestational age.