RATES OF SGA INFANTS BETTER PREDICTED USING MATERNAL FACTORS
Ego A, Subtil D, Grange G, Thiebaugeorges O, Senat MV, Vayssiere C, Zeitlin J. Customized versus population-based birth weight standards for identifying growth restricted infants: a French multicenter study. Am J Obstet Gynecol. 2006;194:1042-1049.
Newborns who are small for gestational age (SGA) are identified at birth in order to investigate whether they need additional healthcare. However, it is difficult to determine if their SGA status is really that of being small for age, or whether there are other factors, including maternal ones, that have led to the infant being born smaller than anticipated.
This French retrospective chart review study analyzed the birth data of 56,606 singleton births during the years 1997-2002 at 5 different hospitals. The researchers compared the characteristics of these infants to a predetermined national standard.
The data analyzed were the birth weight and gestational ages of the infants, maternal height and weight, maternal hypertension and preeclampsia history, maternal smoking, and type of delivery (cesarean delivery). The neonatal factors analyzed were the Apgar score, whether there had been admission to the neonatal intensive care unit, and the length of hospital stay.
Upon analysis, it was determined that of the entire group of neonates (56,000+), 1.8% of the infants had been falsely identified at birth as being SGA when they were not, and 2.7% of the infants were found to be SGA and were missed at birth. The factors most closely identified with these changes were maternal age and smoking behaviors, history of preeclampsia and hypertension, and cesarean delivery histories. These all produced more SGA infants during this investigation. In the infants that were not found to be SGA, admission to the neonatal intensive care unit and length of hospital stay were better predictors. They also had lower neonatal death rates.
The researchers hypothesized that the maternal characteristics were more likely to predict SGA in infants than neonatal factors. This will help identify those infants most in need of neonatal healthcare services. The researchers suggested that cultural comparisons be done in future studies to see if these data bear out during additional analyses.
PREMATURE INFANTS NEED TO BE FITTED CORRECTLY IN CAR SEATS
Howard-Salsman KD. Car seat safety for high-risk infants. Neonatal Netw. 2006;25(2):117-129.
Premature infants must be secured in safety car seats to go home from the hospital just like all other infants and children. However, infant car seats are not designed for infants who weigh less than 5 pounds.
This article presented information about the correct use of infant care seats for premature infants. Information was presented on the problems that preterm infants may have if placed in an "oversized" infant care seat. These include that the premature infant's head will drop forward or to the side due to its large size and weight relative to the rest of the body, putting the infants at risk for airway occlusion, apnea, and possible brain/spinal cord injury. If placed upright in the car seat, the infant may slouch forward, compressing the lungs upon the infant's abdominal organs, again predisposing the preemie to respiratory difficulties. Gastroesophageal reflux may also occur due to this upright position. Premature infants may also be at risk for overheating if blankets are used to prop the infant in place within these car seats.
The author recommended that hospitals follow the American Academy of Pediatrics guidelines about preterm infant car seat use by having a certified individual assess each preterm infant while they are sitting in the car seat prior to discharge. That way, the position can be changed and the parents taught how to correctly use an infant car seat for a premature infant. The use of an infant car bed can also be discussed at that time for infants who need to be placed supine or prone due to healthcare needs.
All individuals who work with parents of premature infants should encourage use of the information carried on the American Academy of Pediatrics Web site(http://www.aap.org) and the National Highway Traffic Safety Association Web site (http://www.nhtsa.dot.gov).