Vertically transmitted infections and extrauterine growth restriction in preterm neonates: a new risk factor

Vieira, Verônica Cheles; Lima, Raquel Cristina Gomes; Queiroz, Daiane Borges; Medeiros, Danielle Souto de

doi:10.1590/1806-93042021000100006

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Revista Brasileira de Saúde Materno Infantil

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ORIGINAL ARTICLES • Rev. Bras. Saude Mater. Infant. 21 (1) • Jan-Mar 2021 • https://doi.org/10.1590/1806-93042021000100006 copy

Vertically transmitted infections and extrauterine growth restriction in preterm neonates: a new risk factor

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

to investigate the association between Vertically Transmitted Infections (VTI) and Extrauterine Growth Restriction (EUGR) among premature infants in Neonatal Intensive Care Units (NICU).

Methods:

part of a large non-concurrent cohort study with medical records analysis. We evaluated EUGR in premature infants at a gestational age at birth of > 32 weeks and <36 weeks and presented a corrected gestational age of 36 completed weeks during a 27-day birth follow-up. Premature infants with major congenital anomalies were excluded. We analyzed associations among EUGR, VTI and covariables related to maternal disease, birth characteristics, perinatal morbidities and clinical practices.

Results:

out of the 91 premature infants, 59.3% (CI95%=48.9-69.0%) developed EUGR. VTI were observed in 4.4%o of the population; all premature infants affected by VTI had EUGR. The VTI found were syphilis, cytomegalovirus disease and toxoplasmosis. The final analysis has showed a positive association between VTI and EUGR (RR=1.57; CI95%o=1.07-2.30); the female covariables (RR=1.50; CI95%=1.11-2.02), moderate premature classification (RR=1.41; CI95%=1.06-1.87) and small for gestational age (RR=2.69; CI95% 1.853.90) have also influenced this outcome.

Conclusion:

this study revealed VTI as an important morbidity factor, with impact on the increased risk of EUGR between premature infants affected by these diseases.

Key words:
Premature infant; Growth; Malnutrition; Vertical transmission

Variables	Total	EUGR present	Bivariate analysis		Multivariate analysis
Variables	Total	EUGR present	RR (CI95%)	p	RR (CI95%)	p
Vertically transmitted infections *				<0.001†		0.02†
No	87 (95.6%)	50 (57.5%)	1.00		1.00
Yes	4 (4.4%)	4 (100%)	1.74 (1.45 - 2.09)		1.57 (1.07 - 2.30)
Hypertensive disease during pregnancy *				0.010†
No	64 (70.3%)	33 (51.6%)	1.00
Yes	27 (29.7%)	21 (77.8%)	1.51 (1.10 - 2.06)
Sex*				0.047†		0.008†
Male	50 (55.0%)	25 (50.0%)	1.00		1.00
Female	41 (45.0%)	29 (70.7%)	1.41 (1.01 - 1.99)		1.50 (1.11 - 2.02)
Birth weight * (g)				<0.001†
≥ 1.500	70 (76.9%)	35 (50.0%)	1.00
< 1.500	21 (23.1%)	19 (90.5%)	1.81 (1.38 - 2.38)
Gestational age*				0.018†		0.017†
Late Preterm	62 (68.1%)	32 (51.6%)	1.00		1.00
Moderate Preterm	29 (31.9%)	22 (75.9%)	1.47 (1.07 - 2.02)		1.41 (1.06 - 1.87)
Small for gestational age*				<0.001†		<0.001†
No	51 (56.0%)	17 (33.3%)	1.00		1.00
Yes	40 (44.0%)	37 (92.5%)	2.78 (1.86 - 4.14)		2.69 (1.85 - 3.90)
Intrauterine growth restriction				<0.001†
No	72 (84.7%)	36 (50.0%)	1.00
Yes	13 (15.3%)	12 (92.3%)	1.85 (1.39 - 2.44)
Early sepsis				0.329†
No	40 (44.0%)	26 (65.0%)	1.00
Yes	51 (56.0%)	28 (54.9%)	0.84 (0.60 - 1.19)
Late sepsis				0.601†
No	74 (81.3%)	43 (58.1%)	1.00
Yes	17 (18.7%)	11 (64.7%)	1.11 (0.74 - 1.67)
Respiratory distress syndrome				0.230†
No	71 (78.0%)	40 (56.3%)	1.00
Yes	20 (22.0%)	14 (70.0%)	1.24 (0.87 - 1.77)
The necessity of resuscitation in the delivery room			0.369†
No	54 (59.3%)	30 (55.6%)	1.00
Yes	37 (40.7%)	24 (64.9%)	1.17 (0.83 - 1.64)
Use of oxygen at 36 weeks				0.612†
No	71 (94.7%)	46 (64.8%)	1.00
Yes	4 (5.3%)	2 (50.0%)	0.77 (0.28 - 2.10)

Asymmetric numeric variables	Median	EUGR present Median (min-max)	RR (CI95%)	p
Number of days without enteral
feeding (in days)	1 (0 - 9)	1 (0 - 7)	0.99 (0.89 - 1.11)	0.905†
Time of supplemental oxygen use	4 (0 - 24)	4 (0 - 23)	1.00 (0.96 - 1.03)	0.846†

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[1] Authors’ contribution

Study conception and design: Vieira VC, Lima RG and Medeiros DS. Data collection: Vieira VC, Lima RG and Queiroz DB. Statistical analysis and interpretation: Vieira VC and Medeiros DS. Drafting: Vieira VC. Critical review: Lima RG and Queiroz DB. All authors approved the final version of the article.