Mortality and morbidity of the small for gestational age (SGA) very low birth weight (VLBW) Malaysian infant

Abstract

Objective: To compare the neonatal course of small for gestational age (SGA) and appropriate for gestational age (AGA) preterm infants 1500 g or less birthweight.

Method: A total of 116 infants SGA infants 32 weeks or less were matched with 116 AGA infants of the same gestation, ethnic group, sex and where possible inborn or outborn status.

Results: Significantly more SGA infants had a 1-minute Apgar scores of 3 or less, odds ratio (OR) 2.54 (95% Confidence Interval (CI) 1.25, 5.20) and a Critical Risk Index in Babies (CRIB) score > 5, OR 2.09 (95% CI 1.07, 4.09). They were significantly more likely to have hypotension, 35.5 versus 22.3%, OR 1.90 (95% CI 1.01, 3.59). There was no difference in the frequency of respiratory distress syndrome, mechanical ventilation, infection or rate of congenital malformation. Mortality before hospital discharge was significantly greater for the SGA infant (52.6 versus 28.4%, OR 2.79 (95% CI 1.56, 5.02)). This difference remained significant after exclusion of congenital abnormalities. Survivors had a longer mean duration of stay, (54.4 versus 41.2 days, p < 0.001).

Conclusion: The higher mortality seen in SGA infants appears to be due to a poorer condition at birth. There is no evidence that SGA infants have more mature lungs so antenatal corticosteroids should not be withheld on these grounds.