MORTALITY AND MORBIDITY PATTERN IN SMALL-FORGESTATIONAL AGE AND APPROPRIATE-FOR-GESTATIONAL AGE VERY PRETERM BABIES: A HOSPITAL BASED STUDY
Abstract
Background: Very preterm babies are important group of paediatric babies who require specialattention. These babies are known to have increased risk of morbidity and mortality. Studying themorbidity and mortality pattern for this important paediatric group can help in better understanding oftheir care in the hospital settings. Objective of the study was to compare the mortality and morbiditypattern in Small-for-gestational age and appropriate–for-gestational age very preterm babies. Thishospital based prospective (cohort) study was conducted at the department of Paediatrics, PostgraduateMedical Institute, Lady Reading Hospital, Peshawar from March 2008 to April 2009. Methods: Onehundred Small-for-gestational age (SGA) live born very preterm babies were compared with 100appropriate-for-gestational age (AGA) very preterm babies having similar gestational ages. Informationregarding gestational age, birth weight, mortality, and morbidity (in terms of various biochemical andclinical markers) were recorded on a pre-designed questionnaire. Data analysis was done using SPSSversion 15. Results were interpreted in terms of descriptive (mean, proportions, standard deviation) andinferential statistical tests (with p-values). Results: There was no difference between the two groups(SGA Vs AGA) with regards to gestational age and gender of the babies The mean weight of SGAbabies was significantly lower as compared to AGA babies (1.1±0.16 Kg Vs 1.5±0.2 Kg; p=0.001). Ascompared to AGA babies, the SGA babies had a higher mortality (40% Vs 22%, p=0.006), and highermorbidity in terms of hyperbilirubinaemia (67% Vs 51%, p=0.02) and hypocalcaemia (24% Vs 10%,p=0.02). The difference in the mortality between the two groups was more prominent in babies withgestational age ≤31 weeks (71.4% for SGA as compared to 39.3 % for AGA very preterm babies withgestational age ≤31 weeks). Conclusion: Very preterm SGA infants have significantly higher mortalityand morbidity in comparison to the AGA babies. In deciding for therapeutic management of thesebabies, they need special attention in terms of factors as gestational age and the biochemical markers, toimprove the outcome for these babies in the hospital settings.Keywords: Very preterm, SGA, AGA, mortality and morbidityReferences
Empana JP, Subtil D, Truffert P. In-hospital mortality of
newborn infants born before 33 weeks of gestation depends on
the initial level of neonatal care: the EPIPAGE study. Acta
Paediatr 2003;92:346–51.
Ghafoor T, Mahmud S, Ali S, Dogar SA. Incidence of
respiratory distress syndrome. J Coll Physicians Surg Pak
;13(5):271–3
Larroque B, Marret S, Ancel PY, Arnaud C, Marpeau L,
Supernant K,et al. White matter damage & intraventricular
hemorrhage in very preterm infants. The EPIPAGE study. J
Pediatr 2003;143(4):477–83
Flidel RO, Friedman S, Lev E, Juster R A, Amitay M, Shinwell
ES. Early onset enteral feeding and nosocomial Sepsis in very
low birth weight infants. Arch Dis Child Fetal Neonatal Ed
;89(4):289–92.
Stoll BJ, Kadams-Chapman I. The high-risk infant. In:
Behrman RE, Kliegman RM, Jensen HB, Stanton BF, (Eds)
Nelson Textbook of Pediatrics 18th ed. Philadelphia: WB
Saunders; 2008. p. 699–711.
J Ayub Med Coll Abbottabad 2009;21(2)
http://www.ayubmed.edu.pk/JAMC/PAST/21-2/Taj.pdf 21
Cloherty JP, Eichenwald EC, Stark AR. Manual of Neonatal
Care 5th Ed. Philadelphia: Lippincott Williams & Wilkins;
p. 45–54.
Kristensen S, Salihu HM, Keith LG, Kirby RS, Fowler KB,
Pass MA. SGA subtypes and mortality risk among singleton
births. Early Hum Dev 2007;83(2):99–105.
Sharma P, Mc Kay R, Rosenkrantz TS, Hussain N.
Comparisons of mortality and pre-discharge respiratory
outcomes in Small-for- gestational age and Appropriate–forgestational age premature infants. BMC Pediatr 2004;4:9.
Bartels DB, Kreienbrock L, Dammano O, Wenzlaff P, Poets
CF. Population based study on the outcome of Small-forgestational-age newborns. Arch Dis Child Fetal Neonatal Ed
;90:53–9.
Reqev RH, Lusky A, Dunlin T, Litmanovitz I, Arnon S,
Reichman B, et al. Excess mortality and morbidity among
Small-for-gestational age premature infants. A population
based study. J Pediatr 2003;143(2):186–91.
Lubchenco L, Hansman C, Dressler M, Boyd E. Intrauterine
growth as estimated from liveborn birth weight data at 24 to 42
weeks of gestation. J Pediatr 1962;32:793–800.
Dubowitz L, Dubowitz V, Goldberg C. Clinical assessment of
gestational age in the newborn infants. J Pediatr 1970;77:1–10.
Lwanga SK,Lemeshow S. Sample size determination in health
studies: a practical manual. Genewa: World Health
Organization; 1991.
Gortner L, Wauer RR, Stock GJ, Reiter HL, Reiss I, Jorch G, et
al. Neonatal outcome in small for gestational age infants: do
they really better? J Perinat Med 1999;27:484–9.
Aucott SW, Donohue PK, Northington FJ. Increased morbidity
in severe early intrauterine growth restriction. Am J Perinatol
;24:435–40.
Thompson PJ, Greenough A, Gamsu HR, Nicolaides KH.
Ventilatory requirements for respiratory distress syndrome in
small-for-gestational-age infants. Eur J Pediatr 1992;151:528–31.
Bardin C, Zelcowitz P, Papageorgiou A. Outcome of small-forgestational age and appropriate-for-gestational age infants born
before 27 weeks of gestation. Pediatrics 1997;100:E4.
Kramer MS, Olivier M, McLean FH, Willis DM, Usher RH.
Impact of intrauterine growth retardation and body
proportionality on fetal and neonatal outcome. Pediatrics
;86:707–13.
Bernstein IM, Horbar JD, Badger GJ, Ohlsson A, Golan A.
Morbidity and mortality among very-low-birth-weight
neonates with intrauterine growth restriction. The Vermont
Oxford Network. Am J Obstet Gynecol 2000;182:198–206.
Tanaka M, Natori M, Ishimoto H, Miyazaki T, Kobayashi T,
Nozawa S. Experimental growth retardation produced by
transient period of uteroplacental ischemia in pregnant
Sprague–Dawley rats. Am J Obstet Gynecol 1994;171:1231–4.
Procianoy RS, Garcia-prats JA, Adams JM, Silvers A, Rudolph
AJ. Hyaline membrane disease and intraventricular
hemorrhage in small-for-gestational age infants. Arch Dis
Child 1980;55:502–5.
Simchen MJ, Beiner ME, Strauss-Liviathan N, Dulitzky M,
Kuint J, Mashiach S, et al. Neonatal outcome in growthrestricted versus appropriately grown preterm infants. Am J
Perinatol 2000;17:187–92.
Published
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
