J Korean Med Sci.  2022 Jun;37(24):e198. 10.3346/jkms.2022.37.e198.

Effects of Ponderal Index on Neonatal Mortality and Morbidities in Extremely Premature Infants

• Hwang JK
• Kang HN
• Ahn JH
• Lee HJ
• Park HK
• Kim CR

• KMID: 2530509
• DOI: http://doi.org/10.3346/jkms.2022.37.e198

Abstract

Background
To evaluate how intrauterine stress affects extremely premature infants in terms of intrauterine growth restriction. We hypothesized that extremely premature infants with mildly-low ponderal index (MPI) would have better neonatal outcomes.
Methods
We selected 2,721 subjects of 23 to 28 weeks of gestation between 2013 and 2015 from Korean Neonatal Network database. They were divided into 4 groups based on ponderal index (PI) percentile; PI ≤ 3rd as severely-low PI (SPI, n = 82), 3rd < PI ≤ 10th as MPI (n = 190), 10th < PI ≤ 90th as adequate PI (API, n = 2,179), and PI > 90th as high PI (HPI, n = 270).
Results
The mortality in MPI and API groups was comparable (16.3% vs. 16.9%). It was significantly lower than that in the SPI and HPI groups (30.5% and 24.9%, respectively; P = 0.001). The MPI and API groups had better neonatal morbidities compared with the SPI and/or HPI groups, while the MPI group (8.2%) showed a lower incidence of severe intraventricular hemorrhage (IVH) than the other groups (SPI, 21.3%; API, 15.0%; HPI, 19.7%, respectively; P = 0.004). The MPI group had a trend of a bottom in neonatal mortality and morbidities in extremely premature infants.
Conclusion
The MPI and API groups had lower mortality, massive pulmonary hemorrhage, severe bronchopulmonary dysplasia or death, pulmonary hypertension and neonatal seizure rates than the SPI and/or HPI groups, while the MPI group showed a lower incidence of severe IVH than the other groups. We speculate that the lower incidence of neonatal morbidities and mortality in the MPI group indicating mild intrauterine stress might accelerate fetal maturation resulting in better outcomes in extremely premature infants.

Keyword

Extremely Premature Infants; Ponderal Index; Intrauterine Growth Restriction; Mortality; Morbidity; Korean Neonatal Network

Figure

• 

  Fig. 1 Study subjects. The proportion of finally enrolled subjects (n = 2,721) among 3,019 subjects between 23 and 28 weeks of gestation was 90.1%.KNN = Korean Neonatal Network, VLBWI = very low birthweight infant, GA = gestational age, SPI = severely-low ponderal index, MPI = mildly-low ponderal index, API = adequate ponderal index, HPI = high ponderal index.

• 

  Fig. 2 Summary of Significant Variables for Neonatal Outcomes in the Four PI Groups.The significant variables for neonatal outcomes among 4 PI groups were sBPD or death, Death, MPH, PH, sIVH and neonatal seizure. MPI had a trend of a bottom in mortality and morbidities.asIVH in the MPI (8.2%) group was lower than all the other groups (SPI, 21.3%; API, 15.0%; HPI, 19.7%, respectively; P = 0.004).The alphabets on the bars mean P < 0.05; S, vs SPI; M, vs MPI; A, vs API; H, vs HPI.PI = ponderal index, SPI = severely-low ponderal index, MPI = mildly-low ponderal index, API = adequate ponderal index, HPI = high ponderal index, sBPD = severe bronchopulmonary dysplasia, MPH = massive pulmonary hemorrhage, PH = pulmonary hypertension, sIVH = severe intraventricular hemorrhage.

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