Differential Morbidity in Preterm Small versus Appropriate for Gestational Age: Perhaps Unverifiable.

Abstract

OBJECTIVE:

The objective of this study was to determine the morbidity of preterm small for gestational age (SGA) infants compared with appropriate for GA (AGA).

STUDY DESIGN:

This is a secondary analysis of the randomized trial evaluating magnesium sulfate for the prevention of cerebral palsy (CP). We compared outcomes of preterm (< 37 weeks) nonanomalous infants who were SGA (birth weight < 10% for GA) versus AGA (birth weight 10-89% for GA). We compared (1) the parent trial primary outcome, a composite of stillbirth, infant death by 1 year of age, or moderate to severe CP at 2 years of age and (2) composite neonatal morbidity (CNM).

RESULTS:

Of the 1,948 infants who met inclusion criteria, 95% were AGA and 5% were SGA. The primary outcome was similar (10 and 15%, p = 0.08), as was the CNM (24 and 25%, p = 0.89). Sample size calculations indicate that detection of a one-third higher rate of CNM among SGA compared with AGA infants requires more than 93,900 preterm births; for a one-third difference in moderate to severe CP, more than 1.4 million infants.

CONCLUSION:

Owing to the prohibitive sample size required, ascertaining a difference in sequela between preterm SGA and AGA infants is possibly unverifiable.

• Authors: Caroline C Marrs, Hector Mendez-Figueroa, Ibrahim A Hammad, Suneet P Chauhan
• Journal: American journal of perinatology (Am J Perinatol) Vol. 32 Issue 13 Pg. 1251-6 (Nov 2015) ISSN: 1098-8785 [Electronic] United States
• PMID: 26023905 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial)
• Copyright: Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Chemical References

• Calcium Channel Blockers
• Magnesium Sulfate

Topics

• Calcium Channel Blockers (therapeutic use)
• Case-Control Studies
• Cerebral Palsy (epidemiology, prevention & control)
• Double-Blind Method
• Female
• Fetal Growth Retardation (epidemiology)
• Humans
• Infant, Extremely Premature
• Infant, Newborn
• Infant, Premature
• Infant, Small for Gestational Age
• Magnesium Sulfate (therapeutic use)
• Multivariate Analysis
• Perinatal Care
• Pregnancy
• Regression Analysis
• Treatment Outcome