General Obstetrics and Gynecology: Obstetrics
Intrauterine growth restriction increases morbidity and mortality among premature neonates

https://doi.org/10.1016/j.ajog.2004.01.036Get rights and content

Abstract

Objective

Intrauterine growth restriction (IUGR) is an important reason for premature delivery and has been reported to be associated with increased mortality, but in some studies paradoxically, improved morbidities. Data on neonatal outcomes for infants with IUGR at each viable gestational age at birth from large numbers of deliveries are lacking. More particularly, data on perinatal outcome related to an antenatal diagnosis of IUGR compared with a neonatal diagnosis are particularly deficient. Therefore, by using a large contemporary database, we evaluated the outcomes of neonates with IUGR and the gestational age–specific associations between growth restriction, morbidity, and mortality.

Study design

With the use of a database formed from a computer-assisted tool that generates clinical progress notes and discharge summaries on neonatal intensive care unit (NICU) admissions, we reviewed data on neonates discharged from 124 NICUs between January 1, 1997, and December 31, 2001. We evaluated singleton, inborn neonates who delivered between 23 and 34 weeks, excluding major congenital anomalies. We compared 3 measures of IUGR: antenatally diagnosed IUGR; a birth weight below the 10th percentile (small for gestational age [SGA]), and newborn infants with either or both of these diagnoses against a control group of gestational age–matched infants meeting none of these criteria whose birth weights were no greater than the 90th percentile.

Results

Our sample included 29,916 prematurely born neonates; 1,451 (4.8%) with IUGR, 2,936 (9.8%) who were SGA, and 3,708 (12.3%) had at least 1 of these 2 markers. There were 22,798 (76%) normally grown control neonates. Within each gestational age group from 25 to 32 weeks, each marker of IUGR was associated with increased mortality, necrotizing enterocolitis, need for respiratory support at 28 days of age, and retinopathy of the premature. When corrected for gestational age, exposure to antenatal steroids, gender, and mode of delivery, these associations remained significant.

Conclusion

IUGR remains a serious problem that is associated with increased morbidity and mortality among prematurely born neonates, regardless of the definition used or whether the diagnosis is made antenatally or after birth. These results are important for obstetric counseling and decision making and for the anticipation and treatment of premature newborn infants.

Section snippets

Material and methods

By using a database formed from a computer-assisted tool that generates clinical progress notes and discharge summaries on neonatal intensive care unit (NICU) admissions, we conducted a retrospective review to describe the outcomes of premature newborn infants cared for by Pediatrix Medical Group, Inc. Ten percent of fields in this database are periodically reviewed for data accuracy and previous audits have confirmed a greater than 98% accuracy in these selected fields. We compared newborn

Results

There are 121,774 records in our de-identified data set, 50,156 neonates had an estimated gestational age at delivery of 22 weeks or more and 34 weeks or less. We excluded 14,364 neonates who were products of pregnancies with multiple fetuses (ie, twins, triplets, or quadruplets), 25,967 neonates who were transported for care from an outside hospital, 1,303 neonates with congenital anomalies or chromosomal defects, and 68 patients with missing data on birth weight.

Our sample population included

Comment

In this article, we evaluated the impact of either a neonatal or antenatal diagnosis of IUGR on mortality and morbidity, using several different definitions. In our analyses, poor intrauterine growth at all gestational ages up to 32 weeks was associated with increased mortality and with serious morbidities often associated with adverse long-term problems. This and other recent studies contradict the notion that growth restriction may be associated with improved outcomes, presumably on the basis

References (18)

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