Small for gestational age very preterm infants present a higher risk of developing bronchopulmonary dysplasia

Article type: Research Article

Authors: Rocha, G.^{a; *} | de Lima, F. Flor^{a; b} | Machado, A. Paula^c | Guimarães, H.^{a; b} | Proença, E.^d | Carvalho, C.^d | Martins, L.G.^d | Martins, T.^e | Freitas, A.^f | Dias, C.P.^f | Silva, A.^g | Barroso, A.^g | Diogo, I.^h | Cassiano, G.^h | Ramos, H.^h | Abrantes, M.M.ⁱ | Costa, P.ⁱ | Salazar, A.^j | Vieira, F.^j | Fontes, D.^j | Barroso, R.^k | Marques, T.^k | Santos, V.^l | Scortenschi, E.^l | Santos, C.^l | Vilela, F.^l | Quintas, C.^m | The Hypertensive Disorders of Pregnancy Study Group:

Collaborators: Proença, Elisa | Carvalho, Carmen | Martins, Luís Guedes | Martins, Teresa | Freitas, Alice | Dias, Clara Paz | Silva, Albina | Barroso, Almerinda | Diogo, Isabel | Cassiano, Gonçalo | Ramos, Helena^; | Costa, Paula | Salazar, Anabela | Vieira, Filipa | Fontes, Dora^; | Marques, Tânia | Santos, Vera | Scortenschi, Ecaterina | Santos, Celeste | Vilela, Fernanda | Quintas, Conceição

Affiliations: Centro Materno Infantil do Norte, Porto, Portugal | Hospital Pedro Hispâno, Matosinhos, Portugal | Hospital da Senhora da Oliveira, Guimarães, Portugal | Hospital de Braga, Braga, Portugal | Centro Hospitalar Lisboa Central, Maternidade Dr Alfredo da Costa, Lisboa, Portugal | Maria Margarida Abrantes-Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisboa, Portugal | Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisboa, Portugal | Centro Hospitalar Lisboa Ocidental, Hospital São Francisco Xavier, Lisboa, Portugal | Rosalina Barroso-Hospital Prof. Dr Fernando Fonseca, Amadora, Portugal | Hospital Prof. Dr Fernando Fonseca, Amadora, Portugal | Centro Hospitalar do Algarve,Hospital de Faro, Faro, Portugal | Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal | [a] Department of Neonatology, Centro Hospitalar São João, Porto, Portugal | [b] Faculty of Medicine, University of Porto, Porto, Portugal | [c] Department of Obstetrics and Gynaecology, Centro Hospitalar São João, Porto, Portugal | [d] Centro Materno Infantil do Norte, Porto, Portugal | [e] Hospital Pedro Hispâno, Matosinhos, Portugal | [f] Hospital da Senhora da Oliveira, Guimarães, Portugal | [g] Hospital de Braga, Braga, Portugal | [h] Centro Hospitalar Lisboa Central, Maternidade Dr Alfredo da Costa, Lisboa, Portugal | [i] Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisboa, Portugal | [j] Centro Hospitalar Lisboa Ocidental, Hospital São Francisco Xavier, Lisboa, Portugal | [k] Hospital Prof. Dr Fernando Fonseca, Amadora, Portugal | [l] Centro Hospitalar do Algarve, Hospital de Faro, Faro, Portugal | [m] Centro Hospitalar de Vila Nova de Gaia/Espinho, Hospital de Vila Nova de Gaia, Vila Nova de Gaia, Portugal | Centro Materno Infantil do Norte, Porto, Portugal | Hospital Pedro Hispâno, Matosinhos, Portugal | Hospital da Senhora da Oliveira, Guimarães, Portugal | Hospital de Braga, Braga, Portugal | Centro Hospitalar Lisboa Central, Maternidade Dr Alfredo da Costa, Lisboa, Portugal | Maria Margarida Abrantes-Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisboa, Portugal | Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisboa, Portugal | Centro Hospitalar Lisboa Ocidental, Hospital São Francisco Xavier, Lisboa, Portugal | Rosalina Barroso-Hospital Prof. Dr Fernando Fonseca, Amadora, Portugal | Hospital Prof. Dr Fernando Fonseca, Amadora, Portugal | Centro Hospitalar do Algarve,Hospital de Faro, Faro, Portugal | Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal

Correspondence: [*] Address for correspondence: Gustavo Rocha, Department of Neonatology/Centro Materno-infantil, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200 –319 Porto, Portugal. Tel.: +351 225512100/Ext. 1949; Fax: +351 225512273; E-mail: gusrocha@sapo.pt.

Abstract: INTRODUCTION:Several studies assessed the influence of a low birth weight on bronchopulmonary dysplasia (BPD), but not all could find a significant association. Our aim was to assess the association between low birth weight and BPD in preterm infants, prospectively recruited at 11 level III Portuguese neonatal centers. METHODS:Obstetrical and neonatal data on mothers and preterm infants with gestational ages between 24 and 30 weeks, born during 2015 and 2016 after a surveilled pregnancy, were analyzed. Neonates were considered small for gestational age (SGA) when their birthweight was below the 10th centile of Fenton's growth chats and BPD was defined as the dependency for oxygen therapy until 36 weeks of corrected age. Statistical analysis was performed using IBM SPSS® statistics 23 and a p-value <0.05 was considered statistically significant. RESULTS:Out of 614, a total of 494 preterm infants delivered from 410 women were enrolled in the study; 40 (8.0%) infants with SGA criteria. SGA were more often associated with a single pregnancy, had greater use of antenatal corticosteroids, increased prevalence of gestational hypertensive disorders, C-section, rupture of membranes below 18 hours, rate of intubation in the delivery room, use of surfactant treatment, oxygen therapy, mechanical ventilation need, BPD, cystic periventricular leukomalacia, nosocomial sepsis and pneumonia; had lower prevalence of chorioamnionitis, and lower Apgar scores. The multivariate analysis by logistic regression, adjusted for BPD risk factors revealed a significant association between SGA and BPD: OR = 5.2 [CI: 1.46–18.58]; p = 0.01. CONCLUSION:The results of this study increase the scientific evidence that SGA is an independent risk factor for BPD.

DOI: 10.3233/NPM-180129

Journal: Journal of Neonatal-Perinatal Medicine, vol. 12, no. 4, pp. 419-427, 2019