Morbidity and Mortality in Small-for-Gestational-Age Infants: A Secondary Analysis of Nine MFMU Network Studies
Morbidity and Mortality in Small-for-Gestational-Age Infants: A Secondary Analysis of Nine MFMU Network Studies
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DOI：
10.1055/s-0036-1586502
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发表时间：
2017-03-01
影响因子：
2
通讯作者：
Chauhan, Suneet P.
中科院分区：
文献类型：
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作者：
Mendez-Figueroa, Hector;Truong, Van Thi Thanh;Chauhan, Suneet P.
目的比较小于胎龄儿(SGA)和适胎儿(AGA)的新生儿发病率和死亡率。方法收集9个母婴医学单位网络研究的资料，包括24周及以上的非异常单胎和90%的EGA。采用多因素分析，比较SGA和AGA的发病率和死亡率。结果在9项研究中，有71,744名独生子女符合纳入标准，其中13%(n=9,415)的独生子女符合标准，87%(n=62,329)的独生子女符合入选标准。在SGA中，死产的可能性(8.8比2.5每1000名新生儿；调整后的优势比[AOR]3.98，95%可信区间[CI]：2.92-5.42)和新生儿死亡率(14.0比5.5每1,000名新生儿；AOR 3.18，95%CI：2.55-3.95)是AGA的三倍。在胎龄大于或等于32周的新生儿亚组中，SGA组死产风险(AOR 3.32，95%CI：2.16~5.12)和新生儿死亡率(AOR 2.50；95%CI：1.38~4.54)显著高于AGA组(P<0.05)。从35周开始，SGA的死产风险几乎是AGA的4倍。结论SGA的死产风险和新生儿死亡率显著高于AGA。实践中的修改或新的管理方案可能是必要的。
Objective To compare the neonatal morbidity and mortality among small-for-gestational-age (SGA; birth weight < 10% for estimated gestational age [EGA]) versus appropriate-for-gestational-age (AGA; birth weight at 10-89%) newborns.Methods Data from nine Maternal-Fetal Medicine Units Network studies were used and included nonanomalous singletons at 24 weeks or more and birth weight < 90% for EGA. Using multivariable analysis, we compared the morbidity and mortality between SGA and AGA. Random-effect logistic regressions were utilized with adjustment for 10 variables.Results Among the nine studies 71,744 singletons met the inclusion criteria, with 13% (n = 9,415) SGA and 87% (n = 62,329) AGA. Among SGA, the likelihood of stillbirth (8.8 vs. 2.5 per 1,000 births; adjusted odds ratio [aOR] 3.98, 95% confidence interval [CI]: 2.92-5.42) and neonatal mortality (14.0 vs. 5.5 per 1,000 births; aOR 3.18, 95% CI: 2.55-3.95) was threefold higher compared with AGA. For the subgroup of newborns of EGA of 32 weeks or more, SGA, compared with AGA, had significantly higher risk of stillbirth (aOR 3.32, 95% CI: 2.16-5.12) and neonatal mortality (aOR 2.50; 95% CI: 1.38-4.54). From 35 weeks onward, the risk of stillbirth among SGA is almost four times higher than for AGA.Conclusion The risk of stillbirth and neonatal mortality is significantly higher with SGA than with AGA. Modification in practice or new management schema may be warranted.