İntrauterin Büyüme Geriliği Olan Bebeklerin Perinatal Morbidite, Mortalite ve Uzun Dönem Nörogelişimsel Sonuçlarının Gebelik Haftalarına ve Persentil Gruplarına Göre Karşılaştırılması

Abstract

Çevik H. 2019. The comparison of perinatal morbidity, mortality rates and long term neurodevelopmental outcomes of infants who have in utero growth restriction, according to gestational age and percentile groups Hacettepe University Faculty of Medicine, Department of Pediatrics, Thesis in Pediatrics

The term “Small for gestational age” (SGA) describes infants having birth weight less than the tenth percentile for gestational age. Problems seen more commonly in SGA babies compared to AGA peers include need for neonatal intensive care, hypoglycemia, polycytemia, indirect hyperbilirubinemia, sepsis, convulsions, hypotension, necrotizing enterocolitis and need for mechanical ventilation. Mortality risk is also significantly increased in those babies. As the birth weight percentile decreases, the frequency of morbidity and mortality increases. In our study, we aimed to determine the perinatal problems that SGA may have and the prevalance of these problems, to find a specific risk percentile for common clinical conditions by calculating the actual percentiles between 0 and 10 and to evaluate and compare the effects of these clinical problems on the neurodevelopmental status of SGA babies by using Bayley III. The study was carried out in Hacettepe University Faculty of Medicine, Department of Pediatrics Division of Neonatology between March 2019 and June 2019. We recruited infants from the birth registry records born between September 2017 and September 2018, at any gestational weeks whose birth weight is less than the 10th percentile for gestational age, discharged with mother or from the neonatal intensive care unit. These babies were seperated into three groups based on their actual percentiles as mild (birth weight above 5th percentile and below 10th percentile), moderate (birth weight between 3rd-5th percentiles) and severe (birth weight below 3rd percentile) SGA. The information about their diagnosis and treatments was obtained from hospital records. Bayley-III was applied to 34 cases in order to assess their psychomotor development levels. A total of 117 patients were included to the study. The number of cases in the severe SGA group was 26, whereas the moderate SGA group consisted of 22 patients and the mild SGA group had 69 patients. Out of all patients, 73 were female and 44 were male. The mean percentile of all cases was 5,14±4,28 There was a significant difference among SGA groups in terms of perinatal morbidity including sepsis (p:0,039), NEC (p:0,021), hypotension (p:0,009), need for transfusion (p:0,006) and mechanical ventilation (p:0,015), the length of stay (p:0,020) and of mortality (p:0,014). Out of 34 cases assessed with Bayley III at adjusted 9-15. months, 24 (70,6%) infants were girls and 10 (29,6%) were boys. The mean gestational age of the babies was 38,21±1,34 weeks. The mean percentile of the cases was 5,44±3,30 (p<0,001). There were no significant difference among catch-up growth rates and Bayley scores of three percentile groups at average 13 months. Language scores were associated to mode of delivery which shows significantly higher scores for babies born with cesarean section (p: 0,007). In this study we found that perinatal outcomes and mortality were significantly different from each other based on percentile groups and as the percentile decreases, the morbidity and mortality rates increase. Our study indicates that instead of evaluating SGA babies as a one large group below 10th percentile, new percentile thresholds should be established to determine short-term adverse outcomes and long-term neurodevelopmental prognosis for SGA babies. The number of studies about this topic is very limited. We therefore think that multicenter studies with larger groups should be carried out to estimate prognosis in infants from different SGA groups and in this way, it will be possible to recognize babies with high risk percentiles in the early period and to intervene in the earlier period.

Keywords: SGA infant, perinatal, actual percentile, neurodevelopment