scholarly journals Relation of in-utero exposure to antiepileptic drugs to pregnancy duration and size at birth

2019 ◽  
Author(s):  
Andrea V Margulis ◽  
Sonia Hernandez-Diaz ◽  
Thomas McElrath ◽  
Kenneth J Rothman ◽  
Estel Plana ◽  
...  
Keyword(s):  
Valproic Acid ◽  
Birth Weight ◽  
Antiepileptic Drugs ◽  
Head Circumference ◽  
In Utero ◽  
Z Score ◽  
Reference Drug ◽  
Z Scores ◽  
Effect Measure Modification ◽  
Size At Birth

ABSTRACTBackgroundThe associations of individual antiepileptic drugs (AEDs) with pregnancy duration and size at birth, and potential dose relations, are not well characterized.MethodsThis cohort study used nationwide Swedish register data (1996-2013). Adjusting for smoking, epilepsy and other AED indications, we used linear and quantile regression to explore associations with pregnancy duration, and birth weight, length, and head circumference (the last three operationalized as z-scores). We used logistic regression for preterm delivery, small for gestational age, and microcephaly. Lamotrigine was the reference drug.Results6,720 infants were exposed to AEDs in utero; AED exposure increased over the study period. Relative to lamotrigine-exposed infants, carbamazepine-exposed infants were born, on average, 1.3 days earlier (mean [95% confidence interval]: −1.3 [−2.3 to −0.3]); were 0.1 standard deviations (SDs) lighter (−0.1 [−0.2 to 0.0]); and had a head circumference that was 0.2 SDs smaller (−0.2 [−0.3 to −0.1]). Pregabalin-exposed infants were born, on average, 1.1 days earlier (1.1 [−3.0 to 0.8]); were 0.1 SDs lighter (−0.1 [−0.3 to 0.0]); and had the same head circumference. Levetiracetam-exposed infants were born, on average, 0.5 days earlier (−0.5 [−2.6 to 1.6]); were 0. 1 SDs lighter (−0.1 [−0.3 to 0.0]); and were 0.1 SDs smaller (−0.1 [−0.3 to 0.1]) in head circumference. Valproic acid–exposed infants had, on average, the same duration of gestation and birth weight z-score, but were 0.2 SDs smaller (−0.2 [−0.2 to −0.1]) in head circumference. More negative associations at the left tail of pregnancy duration and birth weight z-score, effect-measure modification, and dose-response relations were noted for some of the associations. Observed associations were generally of smaller magnitude than that of smoking, assessed as a potential confounder in the same models.ConclusionsIn comparison with lamotrigine, valproic acid and carbamazepine had a more negative association with head circumference than other study AEDs.

scholarly journals Impact of size at birth and postnatal growth on metabolic and neurocognitive outcomes in prematurely born school-age children

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yoo Jinie Kim ◽  
Seung Han Shin ◽  
Eun Sun Lee ◽  
Young Hwa Jung ◽  
Young Ah Lee ◽  
...  
Keyword(s):  
Birth Weight ◽  
Preterm Infants ◽  
Gestational Age ◽  
Growth Velocity ◽  
Postnatal Growth ◽  
School Age ◽  
Z Score ◽  
Neurodevelopmental Outcomes ◽  
Neurocognitive Outcomes ◽  
Size At Birth

AbstractPrematurity, size at birth, and postnatal growth are important factors that determine cardiometabolic and neurodevelopmental outcomes later in life. In the present study, we aimed to investigate the associations between the size at birth and growth velocity after birth with cardiometabolic and neurodevelopmental outcomes in preterm infants. Fifty-six preterm infants born at < 32 weeks of gestation or having a birth weight of < 1500 g were enrolled and categorized into small for gestational age (SGA) and appropriate for gestational age (AGA) groups. Anthropometric and cardiometabolic parameters were assessed at school-age, and the Korean Wechsler Intelligence Scale for Children, fourth edition (K-WISC-IV) was used for assessing the intellectual abilities. The growth velocity was calculated by changes in the weight z-score at each time period. Multivariate analysis was conducted to investigate the associations of growth velocity at different periods with cardiometabolic and neurodevelopmental outcomes. Forty-two (75%) were classified as AGA and 25% as SGA. At school-age, despite the SGA children showing significantly lower body weight, lean mass index, and body mass index, there were no differences in the cardiometabolic parameters between SGA and AGA groups. After adjusting for gestational age, birth weight z-score, weight z-score change from birth to discharge and sex, change in weight z-score beyond 12 months were associated with a higher systolic blood pressure, waist circumference, and insulin resistance. Full-scale intelligent quotient (β = 0.314, p = 0.036) and perceptional reasoning index (β = 0.456, p = 0.003) of K-WISC-IV were positively correlated with postnatal weight gain in the neonatal intensive care unit. Although cardiometabolic outcomes were comparable in preterm SGA and AGA infants, the growth velocity at different time periods resulted in different cardiometabolic and neurocognitive outcomes. Thus, ensuring an optimal growth velocity at early neonatal period could promote good neurocognitive outcomes, while adequate growth after 1 year could prevent adverse cardiometabolic outcomes in preterm infants.

Intrauterine growth restriction affects z-scores of anthropometric parameters during the first 6 years in very low-birth-weight-children born at less than 30 weeks of gestation

2019 ◽  
Vol 11 (1) ◽  
pp. 44-48
Author(s):  
Hiromichi Shoji ◽  
Akiko Watanabe ◽  
Atsuko Awaji ◽  
Naho Ikeda ◽  
Mariko Hosozawa ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Gestational Age ◽  
Intrauterine Growth Restriction ◽  
Very Low Birth Weight ◽  
Growth Restriction ◽  
Z Score ◽  
Anthropometric Parameters ◽  
Intrauterine Growth ◽  
Z Scores

AbstractObjective:Little is known about physical constitution outcomes for very preterm infants. Here, we compare z-scores of anthropometric parameters up to 6 years of age in children born with very low birth weight (VLBW) at less than 30 weeks of gestation, with or without intrauterine growth restriction (IUGR).Design:Participants were divided into four subgroups: male (M), small for gestational age (SGA) (n = 30); M, appropriate for gestational age (AGA) (n = 59); female (F), SGA (n = 24); and F, AGA (n = 61). z-Scores of body weight (BW), body length (BL), and body mass index (BMI) were assessed at birth, 1 year corrected age, 3 years of age, and 6 years of age.Results:For boys, BW and BMI were significantly lower among SGA children than among AGA children at all assessments, but there was no difference in BL at 3 or 6 years. For girls, BW and BL were significantly lower among SGA children than among AGA children at all assessments, but no difference was detected in BMI after 1.5 years. No significant variation in the z-score of BW or BMI in either SGA group was observed after 1 year. BL z-score in all groups gradually increased until 6 years of age.Conclusion:IUGR affects BW and BMI in boys and BW and BL in girls during the first 6 years in VLBW children born at less than 30 weeks of gestation. SGA children did not catch up in BW or BMI from 1 to 6 years of age.

scholarly journals Aggressive nutrition in extremely low birth weight infants: impact on parenteral nutrition associated cholestasis and growth

PeerJ ◽  
2016 ◽  
Vol 4 ◽  
pp. e2483 ◽  
Author(s):  
Andreas Repa ◽  
Ruth Lochmann ◽  
Lukas Unterasinger ◽  
Michael Weber ◽  
Angelika Berger ◽  
...  
Keyword(s):  
Body Weight ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Parenteral Nutrition ◽  
Head Circumference ◽  
Postnatal Growth ◽  
The Body ◽  
Extremely Low Birth Weight ◽  
Secondary Outcome ◽  
Z Score

BackgroundParenteral nutrition associated cholestasis (PNAC) is a frequently observed pathology in extremely low birth weight (ELBW) infants. Its pathogenesis is determined by the composition and duration of parenteral nutrition (PN) as well as the tolerance of enteral feeds (EF). “Aggressive” nutrition is increasingly used in ELBW infants to improve postnatal growth. Little is known about the effect of “aggressive” nutrition on the incidence of PNAC. We analyzed the influence of implementing an “aggressive” nutritional regimen on the incidence of PNAC and growth in a cohort of ELBW infants.MethodsELBW infants were nourished using a “conservative” (2005–6;n= 77) or “aggressive” (2007–9;n= 85) nutritional regimen that differed in the composition of PN after birth as well as the composition and timing of advancement of EFs. We analyzed the incidence of PNAC (conjugated bilirubin > 1.5 mg/dl (25 µmol/l)) corrected for confounders of cholestasis (i.e., NEC and/or gastrointestinal surgery, sepsis, birth weight, Z-score of birth weight, time on PN and male sex), growth until discharge (as the most important secondary outcome) and neonatal morbidities.ResultsThe incidence of PNAC was significantly lower during the period of “aggressive” vs. “conservative “nutrition (27% vs. 46%,P< 0.05; adjusted OR 0.275 [0.116–0.651],P< 0.01). Body weight (+411g), head circumference (+1 cm) and length (+1 cm) at discharge were significantly higher. Extra-uterine growth failure (defined as a Z-score difference from birth to discharge lower than −1) was significantly reduced for body weight (85% vs. 35%), head circumference (77% vs. 45%) and length (85% vs. 65%) (P< 0.05). The body mass index (BMI) at discharge was significantly higher (11.1 vs. 12.4) using “aggressive” nutrition and growth became more proportionate with significantly less infants being discharged below the 10th BMI percentile (44% vs. 9%), while the percentage of infants discharged over the 90th BMI percentile (3% vs. 5%) did not significantly increase.Discussion“Aggressive” nutrition of ELBW infants was associated with a significant decrease of PNAC and marked improvement of postnatal growth.

scholarly journals Clinical profile of children with developmental delay and microcephaly

2013 ◽  
Vol 04 (03) ◽  
pp. 288-291 ◽  
Author(s):  
Anju Aggarwal ◽  
Hema Mittal ◽  
Rahul Patil ◽  
Sanjib Debnath ◽  
Anuradha Rai
Keyword(s):  
Cerebral Palsy ◽  
Child Development ◽  
Developmental Delay ◽  
Head Circumference ◽  
Inborn Error ◽  
Inborn Error Of Metabolism ◽  
Z Score ◽  
Developmental Quotient ◽  
Congenital Infections ◽  
Z Scores

ABSTRACT Aim: To study the profile of children with developmental delay and microcephaly. Materials and Methods: Children attending child development clinic with developmental delay were evaluated as per protocol. Z scores of head circumference were calculated using WHO charts. Clinical, radiological and etiological profile of those with microcephaly and those without was compared. Results: Of the 414 children with developmental delay 231 had microcephaly (z score ≤ -3). Mean age of children with microcephaly was 35.1 ± 27.9 months (range 4-184), males (72.7%). Comorbidities were epilepsy (42.9%), visual abnormality (26.4%), hearing abnormality (16.9%). Mean DQ was 29.75 + 17.8 in those with microcephaly was significantly lower compared to the rest (P = 0.002). Secondary microcephaly was associated with cerebral palsy in 69.7%. Other causes were congenital infections (4), inborn error of metabolism (3), post-meningoencephalitis (5), malformations (12), and syndromic (13). Neuroimaging was done in 118 (51.1%) cases of which 104 (88.1%) were abnormal. On comparison children with microcephaly had more epilepsy, lower developmental quotient, vision abnormalities findings as compared to normocephalic children with developmental delay (P &003E; 0.05). Conclusion: Microcephaly was associated with lower, DQ, higher comorbidities in children with developmental delay. Spastic CP is commonly associated with microcephaly.

scholarly journals Catch-up growth and nutritional status of preterms born at a Ugandan tertiary hospital: An Observational study.

2020 ◽  
Author(s):  
Flaviah Namiiro ◽  
Anthony Batte ◽  
Joseph Rujumba ◽  
Nicolette Nabukeera ◽  
Ian Munabi ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Nutritional Status ◽  
Head Circumference ◽  
Maternal Age ◽  
Anthropometric Measurements ◽  
World Health ◽  
Z Scores ◽  
The Mean ◽  
Catch Up

Abstract Introduction Advances in neonatal care have led to the increasing survival of preterm/low birth weight infants worldwide. However, there is limited data on growth outcomes following preterm births especially in low and middle income countries. We assessed the catch-up growth, nutritional status and associated factors of Ugandan children who were born preterm/ low birth weight at Mulago National Referral Hospital.Methods: We enrolled children aged 22-38 months who had been born as preterm with low birth weight and their mothers. Participants were identified and recruited from the follow up clinic for preterm babies discharged from the neonatal unit of Mulago Hospital. Anthropometric measurements for mothers and children were taken. The children’s weight for height z-scores, height for age z-scores, weight for age z-scores, head circumference and mid upper arm circumference (MUAC) were taken and the mothers’ body mass index were generated based on the World Health Organization standards. Results: Of the 251 children and mother pairs recruited, 129 children (51.4%) were male, the mean age was 29.7 months (SD±4.5) and the mean maternal age was 29.9 (SD±5.3). 101(40.1%) of the children enrolled had attained catch up growth on the normal anthropometric measurements for their age. Among the participants, the prevalence of wasting, underweight and stunting was: 8 (3.2%), 36 (14.4%) and 106 (42.2%) respectively. Factors associated with stunting were male sex (AOR 2.36, 95% CI 1.42 to 3.95); p=0.001), maternal age ≤ 25years: AOR 2.27 (95%CI 1.13, 4.52); p= 0.020, and maternal height <150cm: AOR 5.57(95%CI 1.90, 16.94); P=0.002. Associations with underweight in the children were; birth weight ≤1500 gms: AOR 2.38(95%CI 1.14, 4.95); p=0.020 and post-natal hospitalization of more than 14 days: AOR 5.93(95%CI 1.96, 17.90); p=0.002. For 246 (98.8%) participants, MUAC was normal (≥ 12.5 cm) and for 216 (86.8%) the head circumference was within normal range for age.Conclusion: Of the children born preterm/LBW 40.1% of the participants had attained the expected catch up growth at 2 to 3 years of age, 42.2% were observed to be stunted while 14.4% were underweight both higher than the national levels. Targeted interventions are specifically needed for children born with very low birth weight, those requiring long postnatal hospitalization, males and those born to short or young mothers.

scholarly journals Genetic Interactions with Intrauterine Diabetes Exposure in Relation to Obesity: The EPOCH and Project Viva Studies

2021 ◽  
Vol 13 (2) ◽  
pp. 279-288
Author(s):  
Maggie A. Stanislawski ◽  
Elizabeth Litkowski ◽  
Ruby Fore ◽  
Sheryl L. Rifas-Shiman ◽  
Emily Oken ◽  
...  
Keyword(s):  
Cohort Study ◽  
Genetic Variants ◽  
Significant Interaction ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Maternal Diabetes ◽  
In Utero ◽  
In Utero Exposure ◽  
Z Score ◽  
Z Scores

To examine whether BMI-associated genetic risk variants modify the association of intrauterine diabetes exposure with childhood BMI z-scores, we assessed the interaction between 95 BMI-associated genetic variants and in utero exposure to maternal diabetes among 459 children in the Exploring Perinatal Outcomes among Children historical prospective cohort study (n = 86 exposed; 373 unexposed) in relation to age- and sex-standardized childhood BMI z-scores (mean age = 10.3 years, standard deviation = 1.5 years). For the genetic variants showing a nominally significant interaction, we assessed the relationship in an additional 621 children in Project Viva, which is an independent longitudinal cohort study, and used meta-analysis to combine the results for the two studies. Seven of the ninety-five genetic variants tested exhibited a nominally significant interaction with in utero exposure to maternal diabetes in relation to the offspring BMI z-score in EPOCH. Five of the seven variants exhibited a consistent direction of interaction effect across both EPOCH and Project Viva. While none achieved statistical significance in the meta-analysis after accounting for multiple testing, three variants exhibited a nominally significant interaction with in utero exposure to maternal diabetes in relation to offspring BMI z-score: rs10733682 near LMX1B (interaction β = 0.39; standard error (SE) = 0.17), rs17001654 near SCARB2 (β = 0.53; SE = 0.22), and rs16951275 near MAP2K5 (β = 0.37; SE = 0.17). BMI-associated genetic variants may enhance the association between exposure to in utero diabetes and higher childhood BMI, but larger studies of in utero exposures are necessary to confirm the observed nominally significant relationships.

scholarly journals Clinical and biochemical characteristics and bone mineral density of homozygous, compound heterozygous and heterozygous carriers of three novel IGFALS mutations

2017 ◽  
Vol 176 (6) ◽  
pp. 657-667 ◽  
Author(s):  
Emregül Işık ◽  
Belma Haliloglu ◽  
Jaap van Doorn ◽  
Hüseyin Demirbilek ◽  
Sitha A Scheltinga ◽  
...  
Keyword(s):  
Birth Weight ◽  
Head Circumference ◽  
Compound Heterozygous ◽  
Z Score ◽  
Mineral Density ◽  
Ternary Complex Formation ◽  
Igf I ◽  
Heterozygous Carriers ◽  
Low Serum ◽  
Igfbp 3

Objective Acid-labile subunit (ALS) deficiency (ACLSD), caused by homozygous or compound heterozygous IGFALS mutations, is associated with moderate short stature, delayed puberty, low serum IGF-I and ALS and extremely low serum IGFBP-3. Its effect on birth weight, head circumference, bone mineral density (BMD), serum IGF-II and IGFBP-2 is uncertain, as well as the phenotype of heterozygous carriers of IGFALS mutations (partial ACLSD). Design From all available members of five Turkish families, carrying three mutations in exon 2 of IGFALS (c.1462G > A, p.Asp488Asn (families A, B, E); c.251A > G, p.Asn84Ser (families C and E) and c.1477del, p.Arg493fs (family D)), clinical, laboratory and BMD data were collected. Methods Auxological and biochemical findings were expressed as SDS for age and gender. Ternary complex formation in serum was investigated by size-exclusion chromatography. BMD using DXA bone densitometry was adjusted for height and age (Ha-BMD z-score). Results In ACLSD (n = 24), mean ± s.d. height SDS (−2.7 ± 1.2), head circumference SDS (−2.3 ± 0.5) and body mass index (BMI) (−0.6 ± 1.0 SDS) were lower than those in partial ACLSD (n = 26, P ≤ 0.01) and birth weight SDS (n = 7) tended to be lower (−2.2 ± 1.1 vs −0.6 ± 0.3 in partial ACLSD (P = 0.07)). Serum IGF-I was −3.7 ± 1.4 vs −1.0 ± 1.0, IGF-II: −5.6 ± 0.7 vs −1.3 ± 0.7, ALS: <−4.4 ± 1.2 vs −2.1 ± 0.9 and IGFBP-3: −9.0 ± 1.9 vs −1.6 ± 0.8 SDS respectively (P < 0.001). Ha-BMD z-score was similar and normal in both groups. Conclusions To the known phenotype of ACLSD (i.e. short stature, reduced serum levels of IGF-I and ALS, extremely low serum IGFBP-3 and disturbed ternary complex formation), we add reduced birth weight, head circumference and serum IGF-II.

scholarly journals Lipid-based nutrient supplement increases the birth size of infants of primiparous women in Ghana

2015 ◽  
Vol 101 (4) ◽  
pp. 835-846 ◽  
Author(s):  
Seth Adu-Afarwuah ◽  
Anna Lartey ◽  
Harriet Okronipa ◽  
Per Ashorn ◽  
Mamane Zeilani ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Fetal Growth ◽  
Head Circumference ◽  
Controlled Trial ◽  
Birth Length ◽  
Group Differences ◽  
Z Score ◽  
Nutrient Supplement ◽  
Primiparous Women

ABSTRACT Background: The International Lipid-Based Nutrient Supplements Project developed a small-quantity (20 g/d) lipid-based nutrient supplement (LNS) for pregnant and lactating women. Objective: We evaluated the effects of prenatal LNS supplementation on fetal growth. Design: In a community-based, partially double-blind, individually randomized controlled trial, 1320 women ≤20 wk pregnant received 60 mg Fe/400 μg folic acid (IFA), or 1–2 Recommended Dietary Allowances of 18 micronutrients, including 20 mg Fe (MMN), or LNS with the same micronutrients as the MMN group, plus 4 minerals and macronutrients contributing 118 kcal (LNS) daily until delivery. Fetal growth was compared across groups by using intention-to-treat analysis. The primary outcome was birth length. Results: This analysis included 1057 women (IFA = 349, MMN = 354, LNS = 354). Groups did not differ significantly in mean birth length, length-for-age z score (LAZ), head circumference, or percentage low birth length but differed in mean birth weight (P = 0.044), weight-for-age z score (WAZ; P = 0.046), and BMI-for-age z score (BMIZ; P = 0.040), with a trend toward differences in low birth weight (P = 0.069). In pairwise comparisons, the LNS group had greater mean birth weight (+85 g; P = 0.040), WAZ (+0.19; P = 0.045), and BMIZ (+0.21; P = 0.035) and a lower risk of low birth weight (RR: 0.61, 95% CI: 0.39, 0.96; P = 0.032) than did the IFA group. The other group differences were not significant. The effect of intervention was modified by mother’s parity, age, height, baseline hemoglobin, household food insecurity, and child sex, with parity being the most consistent modifier. Among primiparous women (IFA = 131; MMN = 110; LNS = 128), the LNS group had greater mean birth length (+0.91 cm; P = 0.001), LAZ (+0.47; P = 0.001), weight (+237 g; P &lt; 0.001), WAZ (+0.56; P &lt; 0.001), BMIZ (+0.52; P &lt; 0.001), head circumference (0.50 cm; P = 0.017), and head circumference-for-age z score (+0.40; P = 0.022) than did the IFA group; similar differences were found when comparing the LNS and MMN groups among primiparous women, and no group differences were found among multiparous women. Conclusion: Prenatal LNS supplementation can improve fetal growth among vulnerable women in Ghana, particularly primiparous women. This trial was registered at clinicaltrials.gov as NCT00970866.

7 Efficacy of Pharmacologic Therapy for Patent Ductus Arteriosus Closure in Preterm Newborns According to Their Gestational Age-Specific Z-Score for Birth Weight

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e4-e5
Author(s):  
Ankur Srivastava ◽  
Amuchou Soraisham ◽  
Prashanth Murthy ◽  
Sharandeep Kaur ◽  
Majeeda Kamaluddeen ◽  
...  
Keyword(s):  
Birth Weight ◽  
Preterm Infants ◽  
Ductus Arteriosus ◽  
Multivariate Logistic Regression Analysis ◽  
Pharmacologic Therapy ◽  
Z Score ◽  
Multivariate Logistic Regression ◽  
Pda Ligation ◽  
Z Scores ◽  
Patent Ductus

Abstract Primary Subject area Neonatal-Perinatal Medicine Background Preterm infants who are also intrauterine growth restricted (IUGR) experience more frequent and earlier hemodynamic consequences of patent ductus arteriosus (PDA). This may be related to altered levels of prostaglandins or altered number or sensitivity of their receptors in IGUR infants. Few studies have examined the efficacy of pharmacologic therapy (non-steroidal anti-inflammatory drugs [NSAIDs]: indomethacin, ibuprofen, or acetaminophen) for PDA closure among preterm infants based on their degree of IUGR with differing results. Objectives Primary: To determine if the degree of IUGR [defined by birth weight (BW) z-score] affects the efficacy of pharmacologic PDA closure and rate of surgical PDA ligation in preterm infants. Secondary: To compare the side effects of NSAIDs and neonatal outcomes based on the severity of IUGR. Design/Methods This retrospective cohort study included infants of &lt; 30 weeks’ GA, admitted to a tertiary neonatal intensive care unit (NICU) between 2010 and 2018, with hemodynamically significant PDA and treated with NSAIDs. Infants with major congenital anomalies, those who received prophylactic Indomethacin and those who died in the first 48 hours were excluded. Birth weight (BW) z-scores were calculated using Olsen nomograms and classified into 3 categories: z-score &gt; −0.5 (normal), z-score −0.5 to −2.0 (mild to moderate growth restriction), z-score &lt;−2 (severe IUGR). We compared responses to NSAID treatment and PDA ligation. Multivariate logistic regression analysis was done to examine the association of BW z-score and response to pharmacological therapy and subsequent surgical PDA ligation. Results Of the 1511 eligible infants, 769 (51%) had a diagnosis of PDA. Of 517 included infants, 323 (62.5%) had BW z-score &gt;− 0.5, while 154 (29.8%) had z-scores − 0.5 to −2.0 and 40 (7.7%) had z-score &lt; −2. Table 1 shows their demographic characteristics. Efficacy of first course of NSAIDs was not different among these birth weight groups (Table 2). There was no difference in the side effects and neonatal morbidities amongst the three groups (Table 2). Multivariate logistic regression analysis after controlling for GA, gender, antenatal steroids, C-section, and SNAP II showed that the odds of PDA ligation was significantly higher among infants with BW z-score &lt; −2 (aOR 2.68, 95% CI 1.13- 6.36) but not among infants with z-score −0.5 to−2.0 (aOR 1.41, 95% CI 0.84, 2.39) as compared to z-score &gt;-0.5. Conclusion Preterm severe IUGR infants with z-score &lt; −2 have an associated increased risk of PDA ligation following pharmacologic treatment as compared to normally grown infants.

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