DOUBLE JEOPARDY OF BEING BORN PRETERM VERY-LOW-BIRTH-WEIGHT (VLBW) SMALL FOR GESTATIONAL AGE (SGA) – SHORT AND LONG-TERM OUTCOME
Regev R1, Reichman B2
Neonatal Department and Neonatal Follow-up Clinic, Meir Medical Center, Kfar Saba1 and the Women and Children’s Health Research Unit, Gertner Institute, Sheba Medical Center,
סיכון כפול במקרה של לידת פגים במשקל לידה נמוך מאד וקטנים לגיל ההיריון – מעקב לטווח הקצר והרחוק
רגב ר1, ריכמן ב2
מחלקת פגים ותינוקות ומרפאת מעקב פגים,מרכז רפואי מאיר, כפר סבא1, מסד הנתונים הישראלי של תינוקות במשקל לידה נמוך מאד, מרכז גרטנר,מרכז רפואי שיבא, תל השומר 2 (מסונפים לביה"ס לרפואה ע"ש סאקלר, אוניברסיטת תל אביב)
Aim: Presenting an update on short and long term outcome of premature VLBW-SGA infants.
Intrauterine unfavorable environment which results in intrauterine growth retardation causes hormonal and vascular fetal adaptation in all body organs. It was believed to result in early maturation and better outcome. The impact of being born premature VLBW (birth weight <1500g) and SGA (<3rd percentile for birth weight) on outcome has been controversial in regard to neonatal mortalities. as well as on long term outcome. Data from the Israeli national VLBW infant database, which comprise 99% of all VLBW live births in Israel, showed that nearly 15% of VLBW are born SGA, are at an increased risk for death (4.52-fold risk (95% CI, 3.24-6.33), and major morbidity among survivors [3.42- fold risk for bronchopulmonary dysplasia (95% CI, 2.29-5.13), and 2.06-fold risk for grade 3 to 4 retinopathy of prematurity (95% CI, 1.15-3.66)]. The association between major central nervous system lesions such as Intraventricular Hemorrhage (IVH) and Periventricular Leukomalacia (PVL) and SGA is still controversial. Fetal Brain-sparing effect, which was thought to be an advantage, probably does not result in better developmental outcome. Recent reported neurodevelopmental data in these infants has shown an increased risk of cerebral palsy (CP), neurodevelopment delay and compromised mental health, which may persist into adulthood. Analysis of data attributes intrauterine unfavorable environment as well as postnatal factors, including poorer growth, as contributing factors. Thus intrauterine growth should probably be viewed as a direct linear relationship between appropriateness of intrauterine growth and outcome in the presence on history of VLBW.