1
LITHUANIAN UNIVERSITY OF HEALTH SCIENCES MEDICAL ACADEMY
FACULTY OF MEDICINE
DEPARTMENT OF NEONATOLOGY
AKANDE BLESSING OLUMIDE
SURVIVAL AND MORBIDITY OUTCOMES OF SMALL FOR GESTATIONAL AGE PREMATURE INFANTS WITH GESTATIONAL AGE LESS THAN 32 WEEKS
Master Thesis
Supervisor: Jurate Buinauskiene
KAUNAS, 2019
2 Contents
SURVIVAL AND MORBIDITY OUTCOMES OF SMALL FOR GESTATIONAL AGE
PREMATURE INFANTS WITH GESTATIONAL AGE LESS THAN 32 WEEKS 1
SUMMARY 3
Acknowledgements 5
Conflicts of interest 5
Ethics Committee Approval 5
ABBREVIATIONS LIST. 6
TERMS 7
INTRODUCTION. 8
AIM AND OBJECTIVES 9
LITERATURE REVIEW. 10
Defining preterm based on Gestational Age (GA) and Birth Weight (BW). 10
RESULTS. 17
DISCUSSION 24
CONCLUSION. 25
PRATICAL RECOMMENDATIONS 26
REFERENCES 27
3
SUMMARY
Author: Blessing Olumide AKANDE
Title: Survival and morbidity outcomes of small for gestational age (SGA) premature infants with gestational age less than 32 weeks
Background
Although preterm birth less than 32 weeks gestation is the leading cause of neonatal morbidity and mortality, most data regarding preterm neonatal outcomes and many reports have been limited to only very preterm neonates. The investigation of neonatal outcomes by gestational age and intrauterine growth restriction is needed to further clarify the continuum of mortality and morbidity frequencies among preterm neonates.
Aim: To evaluate the postnatal outcomes of premature infants with less than 32 weeks of gestation and effect of intrauterine growth restriction on their mortality and morbidity.
Objectives:
1. To analyze and summarize the research studies about the factors that affects the survival and morbidity of SGA premature infants.
2. To investigate the mortality of premature infants with less than 32 weeks of gestation and compare the results obtained between premature SGA and AGA (appropriate for gestational age) infants.
3. To investigate the morbidity and length of treatment of premature infants with less than 32 weeks of gestation and compare the results obtained between premature SGA and AGA infants.
Methodology: A retrospective study which includes all preterm infants with a gestational age between 22 and 31 weeks and 6 days, born alive and admitted to the Neonatal department of LUHS hospital between January 1st, 2015 and December 31st, 2015. Newborns were stratified into two groups: group 1 - premature SGA neonates and Group 2 – premature AGA neonates.
Mortality, morbidity and complications associated with prematurity were evaluated. Data were analyzed statistically by c² test, analysis of variance, odds ratio with confidence interval (CI) and multiple logistic regression, with significance set at 5%.
4 Study participants: Preterm infants born alive at less than 32 weeks of gestational age at the Obstetrics and Gynecology department of LUHS hospital in the year 2015 excluding those who are large for gestational age at the time of birth.
Result: Mortality rate of preterm infants at LUHS is not high as 14.3% and 12% of SGAs and AGAs respectively died with most deaths recorded between day 0-6. Respiratory Distress Syndrome is the most common morbidity in both SGAs and AGAs infants and the most used respiratory support was CPAP therapy for both groups. Logistic regression shows that only RDS, Apnea and PVL significantly influenced the duration of stay of the babies and Odd ratios imply that RDS and PVL have two times likelihood of influencing the duration of stay of the patients in the hospital while apnea has 3 times likelihood of affecting the babies stay in the hospital.
Conclusions: Though the rate of preterm infants seems to be on the rise even in developed countries:
1. Survival rate has increased due to increase in monitoring and treatment method of infants by the hospitals though it differs according to different hospital systems.
2. The research shows a low rate of mortality among premature infants of less than 32 weeks born in 2015 at LUHS hospital. 14.3% of SGAs infants died while 12% of AGAs died showing no significance difference in the mortality rate.
3. Longer duration of stay at the hospital was observed in SGA infants generally with infants less than 1000g BW and <28 weeks GA having longer duration. Respiratory Distress Syndrome is the most common morbidity between the two groups and the least common is Necrotizing Enterocolitis. The rate of NEC is higher in SGA infants who were formula fed compared to AGA infants.
5
Acknowledgements
Special thanks to Alfred Onefeli and my supervisor: Prof. Jurate Buinauskiene for their guidance in finishing this project.
Conflicts of interest
No conflict of interest exists concerning this study.
Ethics Committee Approval
The study “Survival and morbidity outcomes of small for gestational age (SGA) premature infants with gestational age less than 32 weeks” was approved by Ethics Committee at the Lithuanian University of Health Sciences on 2019-04-29 with the number: BEC-MF-381.
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ABBREVIATIONS LIST .
NICU - Neonatal intensive care unit
BW - Birth Weight
VLBW - Very low birth weight
ELBW - Extremely low birth weight
BPD - Bronchopulmonary dysplasia
IVH - Intraventricular hemorrhage
PVL - Periventricular leukomalacia
RDS - Respiratory distress syndrome
NEC - Necrotizing enterocolitis
ROP - Retinopathy of prematurity
GA - Gestational age
BW - Birth weight
SGA - Small for gestational age
AGA - Appropriate for gestational age
SD - Standard deviation
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TERMS
Appropriate for gestational age
Gestational age
Morbidity
Mortality
Newborn
Prematurity
Small for gestational age
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INTRODUCTION.
Preterm newborns are babies given birth to at less than 37 weeks of gestational age.
According to the World Health Organization, an estimate of 15 million babies in the world is given birth to as preterm, with the number on the rise. In a study done in year 2008, Europe has a preterm birth rate of about 5 to 10% of over 5 million births annually with Lithuania having 5.9%
preterm birth rate of the total birth rate of 31287 (1).
Preterm birth is the leading cause of death in children under the age of 5 years and can occur spontaneously or through caesarian section depending on the factors underneath. Common reasons for preterm births are multiple pregnancies, genetic diseases, fetal growth restriction and health of the mother (1). Because the baby is not yet fully matured at less than 37 weeks of gestation, there are morbidities that are related to preterm birth with the level of complication relating to the week of gestation. Thus, babies given birth to as extremely preterm have least chances of survival than other preterm babies of higher gestational age and are also at greatest risk of severe impairment (2). The morbidities, which are classified as either short term or long term depending on the period it occurs. Short term complications such as cardiovascular, respiratory, gastrointestinal and infection do occur in the first 1 month of birth (3) . Long term complication usually affects the cognitive, neurologic and/or sensory developments occur in babies who survived the neonatal period or had to be admitted into the neonatal intensive care unit (4). In developed countries, the mortality rate of preterm infants has reduced, and study has shown that it is due to increase in availability of resources and high organization care in the health sector of these countries (5).
In this study, the aim is to examine the effect of intrauterine growth restriction on mortality and morbidity of premature infants born in the year 2015 at Lithuanian University of Health Sciences hospital with less than 32 weeks of gestation. This is to be achieved by examining factors
affecting the survival and morbidity of small gestational age infants while comparing the mortality of SGA infants with AGA infants. The study also intends to investigate the morbidity and length of the treatment of premature infants with less than 32 weeks of gestation stratified by the birth weight percentiles for gestational age.
9 AIM AND OBJECTIVES
Aim: To evaluate the postnatal outcomes of premature infants with less than 32 weeks of gestation and effect of intrauterine growth restriction on their mortality and morbidity.
Objectives:
1. To analyze and summarize the research studies about the factors that affects the survival and morbidity of SGA premature infants.
2. To investigate the mortality of premature infants with less than 32 weeks of gestation and compare the results obtained between premature SGA and AGA infants.
3. To investigate the morbidity and length of treatment of premature infants with less than 32 weeks of gestation and compare the results obtained between premature SGA and AGA infants.
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LITERATURE REVIEW.
Defining preterm based on Gestational Age (GA) and Birth Weight (BW).
Preterm babies are babies given birth to at less than 37 weeks gestational age. They are classified based on:
1. GESTATIONAL AGE (GA)
• Extremely preterm - (GA < 28 weeks)
• Very preterm - (GA from 28 - 32 weeks)
• Moderate to late preterm - (GA from 32 - 37 weeks).
2. BIRTH WEIGHT
• Low birth weight (LBW) – BW < 2500 g
• Very low birth weight (VLBW) – BW < 1500 g
• Extremely low birth weight (ELBW) – BW < 1000 g
Preterm birth is a global problem with an estimated 15 million babies born preterm in 2010 indicating that about 11.1% of live births worldwide were born preterm. The range of preterm birth has been reported to be higher in low income countries with more than 60% of preterm births occurring in Africa and South Asia (5). On average, 12% of babies are born too early in low income countries compared with 9% in higher-income countries (1). In 2008, preterm birth rates across Europe ranged from 5.5 to 11.1% for all live births, from 4.3 to 8.7% for singleton births, and from 42.2 to 77.8% for multiple births (6).
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Figure 1: Average annual percentage change for preterm birth by country, 1996–2008.* Data series begins in 2000.
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4285908/
12 Small for Gestational Age.
Small-for-gestational age (SGA) refers to an infant born with a birth weight less than the 10th percentile for gestational age. It is very important to differentiate from fetal growth restriction which refers to the fetus who does not achieve the expected in utero growth potential due to gene alteration or environmental factors (7).
Morbidities in small gestational age preterm infants.
Morbidities can be divided into short term complications and long-term complications based on the time of occurrence: Short term complications are morbidities which occur in the neonatal period (first month of birth) while long-term complications (e.g., neurodevelopmental disabilities such as cerebral palsy) occur in patients who survived the neonatal period and are discharged from the neonatal intensive care unit (NICU) (3).
The short-term complications most commonly seen are hypothermia, respiratory abnormalities, cardiovascular abnormalities, intracranial hemorrhage, hypoglycemia, necrotizing enterocolitis, infection, and retinopathy of prematurity. Preterm birth has been found to be a major cause of low body weight of an infant which is associated with morbidities such as respiratory distress syndrome, cardiovascular disorders, compromised immune system, neurological impairments that may lead to infant mortality (8).
There is also under-development of other systems such as cardiac, respiratory and gastrointestinal system.
Morbidities that can occur include:
• Intraventricular hemorrhage (IVH)
• Periventricular leukomalacia (PVL)
• Necrotizing enterocolitis (NEC)
• Bronchopulmonary dysplasia (BPD)
• Retinopathy of prematurity (ROP)
• Infection (early and late onset)
• Neurodevelopmental impairment (NDI) These are due to the:
Underdevelopment of respiratory system: The immaturity of the lungs especially in infants born at less than 32 weeks of gestation results in impaired gas exchange which leads to
13 insufficient oxygenation of tissues which results to the need for the use of supplemental oxygen for days longer than 28 days postnatally as in the case of Bronchopulmonary Dysplasia (BPD) (9). In infants of < 26 GA, structural immaturity is caused by surfactant deficiency leading to Respiratory Distress Syndrome (RDS) (10). The infants also have noncompliant lungs and an extremely compliant chest wall, causing inefficient respiratory mechanics and immature respiratory control leading to apnea and bradycardia (11).
Underdevelopment of cardiac system: A large patent ductus arteriosus limits the availability of oxygen and nutrients to other tissues and organs compromising pulmonary gas exchange because of overperfusion and edema of the lungs (12).
Underdevelopment of Gastrointestinal tract: There is decreased structural integrity and functionality of the gut which affects the digestion, absorption of energy, protein including other nutrients necessary for growth. These deficiencies can result in a “leaky” gut barrier facilitating the penetration of bacteria from the lumen. Inability of the GI tract to absorb nutrients nor store fat predisposes the infant to hypoglycemia, hypocalcemia and the inability to maintain body temperature (13; 14).
Poor immune system: The immune system of a preterm is very poor and can’t detect pathogens nor protect the baby against infections (15). This is linked with multiple factors such as decreased production of immunoglobulins (IgA, IgM, IgG) and defensins, changes in the expression of toll-like receptors (TLRs) such as TLR4 and TLR9 who are responsible for activating the innate immune system, and the upregulation of pro-inflammatory toll-like receptors and/or pro-inflammatory cytokines such as TNF-α, IL-6, IL-8, and IL-1β. Poor immune system in preterm infants usually leads to late onset sepsis or neonatal sepsis which makes them more likely to have poor neurodevelopmental outcome (3).
Incomplete retina vasculature: retina vasculature begins at approximately 8 weeks of gestation growing from the optic disc to the peripheral retina at 34 weeks nasally and shortly after birth temporally. Failure of retina complete vasculature in preterm infants leads to ophthalmological findings which varies from minimal sequelae to bilateral retinal detachment and total blindness (16).
Immature cerebral vasculature and structure: This leads to impaired cognitive, motor skills and sensory deficit which persist to adulthood: thereby requiring recurrent admission to the hospital (4).
Factors affecting survival and morbidity of preterm infants< 32 weeks.
In preterm infants, survival rate has increased over the period (Figure 2) and studies show that it depends majorly on Gestational Age, birth weight (BW), gender, plurality, the use of antenatal corticosteroid therapy and variant medical practices (17; 18). Study has shown survival rate is higher with
• Increasing Gestational Age
14
• 100 g increments in birth weight at a given GA
• Female gender
• Use of antenatal glucocorticoids
• Singleton birth
• High antenatal and delivery care
• Formula feeding (19).
Figure 3: Survival from 1993 through 2015 following Live Birth in the NICHD Neonatal Research Network includes all participating centers. Liveborn infants were included regardless of whether active treatment was initiated. Whisker bars indicate 95% confidence intervals calculated with the Clopper-Pearson method.
Source: Stoll BJ, Hansen NI, Bell EF, et al. Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993–2012. JAMA. 2015;314(10):1039–1051 for 1993–2012 and courtesy of the NICHD Neonatal Research Network for 2013–2015.
15 A study done in 2016 comparing outcome of mortality or major morbidity in very-preterm/very low birth weight infants (BW< 1500g) with 8 countries considered (Australia/New Zealand,
Canada, Israel, Japan, Spain, Sweden, Switzerland, and the United Kingdom) shows that outcome rates differs from 26% to 42%. This is due to different care practices and health care organizational factors in these countries (20). In an EPIPAGE -2 study done in France in 2011, survival rate was said to have increased across all GA groups except at 22 through 23 weeks (21;
18) and was studied to be due to antenatal corticosteroid use, induced preterm deliveries, cesarean deliveries, and surfactant use (18; 22).
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RESEARCH METHODOLOGY AND METHODS
Research planning (organization): Lithuanian University of Health Sciences Hospital, Kaunas.
Object of study: The research is focused on preterm infants with a gestational age between 22 and 31 weeks and 6 days, born alive and admitted to the Neonatal department of LUHS hospital between January 1st, 2015 and December 31st, 2015
Participant selection (population, sample): The selection included 99 babies born at less than 32 weeks of GA.
Research method: It was done a retrospective study. All preterm infants with a gestational age between 22 and 31 weeks and 6 days, born alive and admitted to the Neonatal department of LUHS hospital between January 1st, 2015 and December 31st, 2015 were included. Newborns were stratified into two groups: group 1 - premature SGA neonates and Group 2 – premature AGA neonates. Mortality, morbidity and complications associated with prematurity were evaluated.
Method of data analysis: Data were analyzed statistically by c² test, analysis of variance, odds ratio with confidence interval (CI) and multiple logistic regression, with significance set at 5%.
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RESULTS.
In 2015, 106 preterm babies of less than 32 GA were given birth at the Lithuanian University of Health Sciences Hospital in Kaunas but based on the criteria of this paper,99 babies were included into this research based on weight at specific gestational age. 7 babies were recorded to be of small gestational age and 92 babies of appropriate for gestational age.
Table 1: Maternal characteristics of the SGA and AGA neonates
Sign Small for
Gestational Age
(n=7)
Appropriate for
Gestational Age
(n=92)
p-value
Average number of
pregnancies
2.7±1.6 2.1±1.3 0.78 History of infant deaths, the
number (%)
1(14) 11(12) 0.69
Pregnancy and delivery complications, the number (%)
Infection 1 (14) 11 (12) 0.69
Gestational diabetes 0 1 (1) -
Hypertension and preeclampsia
2 (29) 11(12) 0.01
Other diseases 4 (57) 69(75) 0.12
Primiparous 1(14.3) 42(45.6) 0.00*
Multiparous 6(85.7) 50(54.3) 0.01
Singleton pregnancy 6(85.7) 69(75.0) 0.39
Twin pregnancy 1(14.3) 13(14.1) 0.97
Triplet pregnancy 0(0) 3(3.3) -
Vaginal birth 2(28.6) 43(46.7) 0.04
Caesarian section 5(71.4) 49(53.3) 0.10
Maternal disease 4(57.1) 42(45.6) 0.25
* Data are given as average ± SD or n (%), significant at 0.05 probability level.
Maternal characteristics of the small gestational age (SGA) and appropriate gestational age (AGA) neonates are presented in Table 1. The two groups are significantly (p<0.05) different based on Hypertension and preeclampsia, Primiparous and Multiparous. On the other hand, effect of gestational age was not significant (p>0.05) on Average number of pregnancies, History
18 of infant deaths, the number, Infection, Other diseases, Singleton pregnancy, Twin pregnancy, Caesarian section and Maternal disease.
Table 2. Main characteristics of the neonates Indicator Small for
Gestational Age
(n=7)
Appropriate for
Gestational Age
(n=92)
p-value
Birth weight, g 708±243 1244±366 0
Height, cm 33±5 37.5±4 0.59
Birth way, the number (%):
Natural 2 (28.6) 47(51) 0.01
Caesarean section 5(71.4) 45(49) 0.04 Apgar score
at 1 min 5±2.4 6±2 0.76
at 5 min 7.1±1.2 7.2±1.6 0.97
Gender, the number (%)
Boys 5(71.4) 52(56.5) 0.19
Girls 2(28.6) 40(43.5) 0.08
Gestational age, the number (%)
<28 weeks (30) 3(42.90) 27(29.3) 0.10 28-31 weeks (69) 4(57.1) 65(70.7) 0.22 Birth weight, the number (%)
<1000 g 6(85.7) 21(23) 0.00*
1000-1499 g 1(14.3) 49(53) 0.00*
1500-1999 g 0 29(32) -
≥2000 g 0 1(1) -
Table 2 shows the general characteristics of the neonates considering the birth way, Apgar score, gender, gestational age at birth and birth weight. The average birth weight of SGAs infants is 708g and for AGAs is 1244g which has no significant difference.
19 Table 3: Morbidity and mortality of the Small Gestational Age and Appropriate for
Gestational Age Neonates.
Table 3 shows that RDS is the most common morbidity among the preterm infants with 85.7%
of SGAs and 82.6% of AGAs affected; another common morbidity present in both groups is Hyperbilirubinemia. In SGAs,71.4% of the infants had infections and 42.9% had
Bronchopulmonary Dysplasia. Among the AGAs, 50% had Patent foramen ovale and 40.2% had Ductus arteriosus. The table also gives information on the mortality recorded in the 2 groups indicating that only 1 infant died among the SGAs and 11 deaths were recorded among the AGAs with 6 recorded deaths before day 6 of life. Bronchopulmonary Dysplasia, Patent foramen ovale, IVH and Necrotizing Enterocolitis effects on the weight at gestational age at birth were
significantly different for both groups.
Indicator SGA
(n=7)
AGA (n=92)
p-value
Apnoe 1(14.3) 17(18.5) 0.46
RDS 6(85.7) 76(82.6) 0.81
Bronchopulmonary Dysplasia
3(42.9) 22(23.9) 0.02 Hyperbilirubinaemia 4(57.1) 61(66.3) 0.41 Ductus arteriosus 2(28.6) 37(40.2) 0.16 Patent foramen ovale 1(14.3) 46(50) 0.00*
IVH 1(14.3) 25(27.2) 0.04
PVL 2(28.6) 26(28.3) 0.97
NEC 2(40) 2(8) 0.00*
Infections 5(71.4) 25(27.2) 0.00*
Neonatal deaths the number (%)
1(14.3) 11(12) 0.65 Age 0-6 days 1(100) 6(55) 0.00*
Age ≥ 7 days 0 5(45) -
20 Figure 3: Comparism of common infections found in SGA and AGA neonates.
NEC prevalence among SGA neonates was higher than AGA neonates with 8% of AGAs found to have it and 40% of SGAs treated for NEC. It has statistical difference between both groups of neonates at (p< 0.05).
Table 4 Respiratory support in the groups.
0 10 20 30 40 50 60 70
Pneumonia Sepsis Meningitis Necrotizing Enterocolitis
Infections
AGA SGA
<28 weeks
28 – 31 weeks Total
n=33 (31%)
SGA (n=3)
AGA (n=30)
p Total n=73 (69%)
SGA (n=4)
AGA (n=69)
p
Surfactant (n=27)
12(36) 2(67) 10(33) 0.00* 15(21) 1 (25) 14(20) 0.46 CPAP
(n=63)
19(57) 2(67) 17(57) 0.37 44(60) 3(75) 41(59) 0.17 Mechanical
ventilation (n=29)
27(82) 2(67) 25(83) 0.19 3(4) 1(25) 2(3) 0.00*
Oxygen via 7(21) 1(33) 6(20) 0.07 15(21) 1(25) 14(20) 0.46
21 In infants less than 28 weeks, there’s significant difference between SGA and AGA infants only in the use of surfactant; for infants of 28-31 weeks of gestation, there’s significant difference in the use of mechanical ventilation as respiratory support for the two groups.
Table 5. Length of in-hospital stay according the place of treatment and neonatal gestational age and birth weight.
Average duration of in-hospital stay (days)
SGA (n=7)
AGA (n=92)
p-value Total length of in-
hospital stay.
118.5±158.03 50.4±29.7 0.00*
The place of treatment
NICU 52.4±48 34.7±20.1 0.06
Neonatal unit 67.5±112.4 16.7±18.1 0.00*
Gestational age
< 28 weeks 266.5±283.5 72.7±43.5 0
28 – 31 weeks 59.4±45.2 42.1±16.4 0.08
Birth weight
<1000 g 132.8±168.1 76.2±42.6 0.00*
1000 – 1499 g 33 46±19 0.14
1500 -1999 g 0 34.5±9.8 -
≥2000 g 0 28 -
mask (n=21)
22 This table shows that SGA infants have longer stay in the hospital than AGA infants. There’s significant difference between the 2 groups in those less than 1000g BW and in their duration of stay at the neonatal unit.
Table 6: Risk ratio (RR) and 95% confidence intervals (CI) for duration of hospital stay, Logistic regression analysis.
Dependent variable: Duration of stay
Independent Variables Coefficient Odd Ratio
GA -2.31484 0.09
RDS 0.802203 2.23*
HYPERB -2.32717 0.10
ATO 0.110734 1.12
IVH 0.096225 1.10
APNEA 1.112514 3.04*
FOA 0.101934 1.11
INFECTIONS -0.424425 0.65
PVL 0.572783 2.00*
BPD 0.307940 1.36
GENDER -0.920289 0.40
BW(SGA/AGA) -0.987930 0.37
MODE OF DELIVERY -0.550271 0.58
Model X2 31.852
p-value 0.00254*
*= significant at 0.05 probability level
23 Table 6 indicates that the model fitted well to the data (X2= 31.852, p=0.00254). Out of the thirteen independent variables subjected to the analysis, only RDS, Apnea and PVL significantly influenced the duration of stay of the babies. The Odd ratios imply that RDS and PVL have two times likelihood of influencing the duration of stay of the patients in the hospital while apnea has 3 times likelihood of affecting the babies stay in the hospital.
Table 7. The feeding types in the groups.
Table 7 shows that most of the babies depended on formula only for their nutritional need and there’s a statistically significant difference between SGA infants and AGA infants.
Feeding type SGA n=7(%)
AGA n=92(%)
p-value Maternal breast milk
only 0 0 -
Formula only 7(100) 63(68) 0.013 Mixed feeding types 0 29(32) -
24
DISCUSSION
Preterm birth is one of the main risk factors for a low body weight in an infant and though the rate of preterm birth seems to be increasing, the mortality rate is reducing despite the gestational age.
Most common preterm infants’ morbidities found in this study are RDS, Hyperbilirubinemia, Patent foramen Ovale, Ductus arteriosus and Bronchopulmonary dysplasia; these morbidities can be classified as short-term complications as they occurred during the stay of infants in the hospital. Long term complications outcomes are beyond the scope of this study. The study shows most preterm infants were born through Caesarian section and many of the mothers had no pregnancy or delivery complications which means preterm births are not directly linked with maternal morbidities as so many other factors can cause it. Many of the infants in this study were appropriate for gestational age as at the time of their births and were born between 28-31+6 days GA; they had shorter duration of stay. Infants of Small Gestational Age tends to stay longer at the hospital especially those of less than 28 weeks GA and those less than 1000g of Birth Weight, but these have no effects on mortality of the infants as only 1 infant died among the 7 SGAs infants born in 2015 at LUHS Hospital Department of Neonatology. This study also shows a high rate of NEC at 40% among SGA infants compared to AGA infants with 8% affected; this supports studies that have proven that formula feeding increases the incidence rate of NEC in preterm infants compared to breast milk (19).
25
CONCLUSION.
Though the rate of preterm infants seems to be on the rise even in developed countries:
1. Survival rate has increased due to increase in monitoring and treatment method of infants by the hospitals though it differs according to different hospital systems.
2. The research shows a low rate of mortality among premature infants of less than 32 weeks born in 2015 at LUHS Hospital. 14.3% of SGAs infants died while 12% of AGAs died showing no significance difference in the mortality rate.
3. Longer duration of stay at the hospital was observed in SGA infants generally with infants less than 1000g BW and <28 weeks GA having longer duration. Respiratory Distress Syndrome is the most common morbidity between the two groups and the least common is Necrotizing Enterocolitis. The rate of NEC is higher in SGA infants who were formula fed compared to AGA infants.
26
PRATICAL RECOMMENDATIONS
No practical recommendations.
27
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