NEONATAL NEUROLOGICAL OUTCOME OF SMALL FOR GESTATIONAL AGE VERSUS PREMATURE INFANTS

摘要

Introduction Neonates born prematurely or small forgestational age (SGA) as a consequence of intrauterine growth restriction (IUGR) have a higher risk of neurological injury due to fetal hypoxia. Hypoxic ischemic encephalopathy (HIE) and intraventricular hemorrhage (IVH) are the main clinical forms of brain injury. The patterns and underlying mechanisms of neurological injury are interrelated. Aim of the study The purpose of the study was to evaluate the neurological outcome of SGA newborns versus neonates born preterm. Materials and methods A 3 year randomized case – control study was conducted between the 1st of January 2014 and the 31th of December 2016, at the Emergency County Hospital, Timisoara. 170 SGA newborns and 170 AGA newborns matched 1:1 for gestational age and birth month were included in the study. Patients were divided in 4 subgroups according to gestational age: 101 SGA newborns born at term (SGATerm) and 69 SGA newborns born preterm (SGA-Preterm), 101 AGA neonates born at term (AGA-Term) and 69 AGA neonates born preterm (AGA-Preterm). Results and discussions Preterm neonates had difficulties of early neonatal adaptation, as indicated by a low APGAR score. Preterm neonates irrespective of birth weight, had a higher incidence of both HIE (26.1% SGA Preterm versus 11.8% SGA Term and 11.5% AGA Preterm compared to 0.0% AGA Term ) and IVH (20.3% SGA Preterm versus 7.9% SGA Term and 15.9% AGA Preterm compared to 0.0% AGA Term ). Conclusions Neonates born preterm have a poorer neurological outcome compared to term newborns, regardless of birth weight. SGA is an additional, aggravating factor for neurological injury. More extensive studies on the different subgroups of SGA newborns are required in order understand the underlying mechanisms.