Key result
Congenital heart disease is linked to ~16.5-fold higher predischarge morbidity or mortality in SGA infants.
Why the study?
The clinical characteristics, congenital anomalies, and genetic disorders associated with predischarge morbidity and mortality among small for gestational age infants admitted to a level IV neonatal intensive care unit required identification.
Do congenital anomalies (such as congenital heart disease), genetic disorders, and severity of small for gestational age status increase the risk of predischarge morbidity or mortality in NICU-admitted SGA infants?
Cohort (n=293)
No
Do congenital anomalies (such as congenital heart disease), genetic disorders, and severity of small for gestational age status increase the risk of predischarge morbidity or mortality in NICU-admitted SGA infants?
Among NICU-admitted SGA infants, predischarge morbidity and mortality are strongly driven by congenital heart disease and multiple congenital anomalies rather than the severity of birth weight percentile alone.
Answers are grounded in this paper and cite their sources.
May inform risk stratification by anomalies in SGA infants; leaves open prospective validation of targeted interventions.
Objective: To identify factors associated with predischarge morbidity and mortality among small for gestational age infants. Study Design: We conducted a retrospective single-center cohort study of small for gestational age infants admitted to a level IV neonatal intensive care unit. We determined the association of clinical characteristics, congenital anomalies, and genetic disorders with the primary outcome of predischarge morbidity or mortality and characterized morbidity and mortality across congenital anomaly subgroups. Results: Among 293 small for gestational age infants, 18 (6.1%) had a genetic disorder and 103 (35.2%) had a major congenital anomaly, with congenital heart disease (CHD) representing the largest subgroup. The primary outcome of morbidity or mortality occurred in 93 infants (31.7%); 74 infants (25.3%) experienced morbidity and 19 (6.5%) died. CHD (adjusted odds ratio [aOR]: 16.5, 95% CI 6.44-45.7) and multiple congenital anomalies (aOR: 17.8, 95% CI 4.64-71.1) were found to be strongly associated with morbidity or mortality, after accounting for sex, maternal race, and intubation > 7 days. Statistically significant associations were also found with the presence of musculoskeletal anomalies as well as genetic disorders in infants without congenital anomalies, though in limited sample sizes. CHD was the largest contributor to morbidity, whereas multiple congenital anomalies accounted for the greatest proportion of mortality. Infants with abdominal wall defects and central nervous system anomalies experienced no morbidity or mortality. Conclusion: Congenital heart disease and multiple congenital anomalies were strongly associated with morbidity and mortality among SGA infants, whereas the degree of SGA alone was not. These findings suggest that risk is not explained by the degree of SGA alone and may be more strongly associated with congenital disease and other underlying factors.
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Cinkus-Rios et al. (2026) conducted a cohort in Small for gestational age (SGA) infants admitted to a level IV neonatal intensive care unit (n=293). Congenital heart disease (CHD) vs. No major congenital anomaly was evaluated on Composite of predischarge morbidity (acute kidney injury, intraventricular hemorrhage grade ≥II, necrotizing enterocolitis stage ≥II, bronchopulmonary dysplasia grade ≥2, or shock) or mortality prior to NICU discharge (OR 16.5, 95% CI 6.44-45.7). Congenital heart disease (aOR 16.5, 95% CI 6.44-45.7) and multiple anomalies (aOR 17.8, 95% CI 4.64-71.1) strongly increased predischarge morbidity or mortality in SGA infants.
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