Propensity-Matched Comparison of Very Preterm Small- and Appropriate-for-Gestational-Age Neonates

Objective Comparison of mortality and major morbidities between very preterm (< 32 wk gestational age) small-for-gestational-age (SGA) and appropriate-for-gestational-age (AGA) neonates. Methods A retrospective observational study of neonates born between 26–31 wk gestational age from January 2015 to December 2019 was done in level-3 neonatal intensive care unit of a high-risk perinatal center in South India. Results Of the 1,178 very preterm neonates born in the study period, 909 were eligible for inclusion. After propensity score matching for gestational age, gender, and antenatal steroid use, 592 (444 AGA and 148 SGA) were included in the final analysis. SGA neonates had increased odds of necrotizing enterocolitis (NEC) ≥ stage 2A [adjusted odds ratio (aOR): 2.2; 95% CI : 1.15–4.21], abnormal composite outcome, i.e., any one of the mortality or major morbidities (aOR: 2.99; 95% CI: 1.96–4.57), hypoglycemia requiring intravenous fluids (aOR: 2.11; 95% CI: 1.05–4.23), and anemia requiring blood transfusions (aOR: 3.13; 95% CI: 1.98–4.93); and a trend towards increased odds of bronchopulmonary dysplasia (aOR: 1.9, 95% CI: 0.92–3.91). Mortality, intraventricular hemorrhage ≥ grade 2, periventricular leukomalacia ≥ grade 2, and retinopathy of prematurity requiring treatment were not different. Conclusions SGA neonates have higher odds of having NEC ≥ stage 2A, abnormal composite outcome, hypoglycemia, and anemia compared to appropriately grown neonates.