Objective: To explore whether and how population based data froma regional qua lity control programme can be used to investigate the hypothesis that small for gestational age (SGA) very low birthweight infants (VLBW, 90th centile, severe malformations, siblings of multiple births, and gestatio nal age (GA) 29 weeks. Outcomes of interest were death, severe IVH, PV L, and RDS. Multivariable analyses were performed by Cox proportional hazard and logistic regression models. Results: Within the data validation procedure, on i ncrease in proportions of both VLBW (from 0.95%in 1991 to 1.11%in 1996; +17 %) and SGA (from 22.7%to 27.4%; +21%) infants became apparent (p < 0.05) . The study population consisted of 1623 infants (173 SGA). Mortality was 12.1 %(n = 196), with an adjusted hazard ratio for SGA infants of 2.54, 95%confide nce interval (CI) 1.70 to 3.79.Both groups were at similar risk of severe IVH (adjusted odds ratio 0.93, 95%CI 0.5 to 1.65) and PVL (1.54, 95%CI 0.78 to 2.87), but SGA infants had less RDS (0.57, 95%CI 0.35 to 0.93). Male sex , multiple birth, hypothermia ( < 35.5°C), and sepsis were associated with IVH and RDS. Infants admitted to hospitals with < 36 VLBW admissions/year had incre ased mortality (adjusted hazard ratio 1.56, 95%CI 1.12 to 2.18). Conclusions : SGA VLBW infants are at increased risk of death, but not of IVH and PVL, and a t decreased risk of RDS. That mortality is higher in smaller hospitals needs fur ther investigation.
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