{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T01:47:18Z","timestamp":1782265638822,"version":"3.54.5"},"reference-count":20,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T00:00:00Z","timestamp":1781913600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Preterm (&lt;37 weeks) and very preterm (&lt;32 weeks) infants face considerably higher mortality and morbidity rates than full-term infants. We compared clinical outcomes between small-for-gestational-age (SGA) and appropriate-for-gestational-age (AGA) preterm infants. Methods: This retrospective cohort study used a prospectively collected database, obtained from 2014 to 2025. Propensity score matching (PSM), multivariate regression, and subgroup analyses of very preterm infants were performed to minimize confounding. Results: Among the 5890 neonatal admissions, 2331 preterm infants met the inclusion criteria. After PSM, 298 SGA and 298 AGA preterm infants were analyzed. Multivariate analysis showed that SGA preterm infants had significantly higher risks of the composite outcome of mortality or major morbidity (adjusted risk ratio [aRR], 1.89; 95% confidence interval [CI], 1.18\u20133.02), mortality (aRR, 3.53; 95% CI, 1.57\u20137.95), and mortality or moderate-to-severe bronchopulmonary dysplasia (aRR, 2.13; 95% CI, 1.30\u20133.48). In the subgroup analysis after PSM, 190 very preterm infants showed similar results, with SGA infants having increased risks of the composite outcome of mortality or major morbidity (aRR, 1.81; 95% CI, 1.02\u20133.23), mortality (aRR, 3.23; 95% CI, 1.09\u20139.62), mortality or moderate-to-severe bronchopulmonary dysplasia (aRR, 2.03; 95% CI, 1.10\u20133.72), and mortality or treated retinopathy of prematurity (aRR, 2.62; 95% CI, 1.03\u20136.65). Conclusions: SGA status is associated with a higher risk of mortality and major morbidity in preterm and very preterm infants. In resource-limited settings, the focused management of SGA infants is critical to improving short- and long-term outcomes.<\/jats:p>","DOI":"10.3390\/jcm15124798","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T01:03:23Z","timestamp":1782263003000},"page":"4798","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Small-for-Gestational-Age Status and Adverse Clinical Outcomes in Preterm and Very Preterm Infants: A Propensity Score-Matched Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9176-7383","authenticated-orcid":false,"given":"Manapat","family":"Praditaukrit","sequence":"first","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2363-6362","authenticated-orcid":false,"given":"Anucha","family":"Thatrimontrichai","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1978-3610","authenticated-orcid":false,"given":"Praew","family":"Chareesri","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2437-8577","authenticated-orcid":false,"given":"Pattima","family":"Pakhathirathien","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6332-3216","authenticated-orcid":false,"given":"Gunlawadee","family":"Maneenil","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Supaporn","family":"Dissaneevate","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1001\/jamapediatrics.2026.0533","article-title":"Cognitive and Educational Outcomes After Preterm Birth or Low Birth Weight: An Umbrella Review and Meta-Analysis","volume":"180","author":"Hu","year":"2026","journal-title":"JAMA Pediatr."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Fenton, T.R., and Kim, J.H. (2013). A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr., 13.","DOI":"10.1186\/1471-2431-13-59"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1007\/s12098-021-03878-3","article-title":"Propensity-matched comparison of very preterm small- and appropriate-for-gestational-age neonates","volume":"89","author":"Anne","year":"2022","journal-title":"Indian J. Pediatr."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e000740","DOI":"10.1136\/bmjpo-2020-000740","article-title":"Comparison of neonatal outcomes of small for gestational age and appropriate for gestational age preterm infants born at 28-36 weeks of gestation: A multicentre study in Ethiopia","volume":"4","author":"Gidi","year":"2020","journal-title":"BMJ Paediatr. Open"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1055\/s-0031-1295647","article-title":"Neonatal outcomes of small for gestational age preterm infants in Canada","volume":"29","author":"Qiu","year":"2012","journal-title":"Am. J. Perinatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"F192","DOI":"10.1136\/archdischild-2017-314171","article-title":"Adverse effects of small for gestational age differ by gestational week among very preterm infants","volume":"104","author":"Jensen","year":"2019","journal-title":"Arch. Dis. Child. Fetal Neonatal Ed."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"eAO6781","DOI":"10.31744\/einstein_journal\/2022AO6781","article-title":"In-hospital outcomes in preterm and small-for-gestational-age newborns: A cohort study","volume":"20","author":"Costa","year":"2022","journal-title":"Einstein"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"E4","DOI":"10.1542\/peds.100.2.e4","article-title":"Outcome of small-for-gestational age and appropriate-for-gestational age infants born before 27 weeks of gestation","volume":"100","author":"Bardin","year":"1997","journal-title":"Pediatrics"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1016\/S0022-3476(05)80965-5","article-title":"Growth and neurodevelopmental outcome of very low birth weight infants with intrauterine growth retardation: Comparison with control subjects matched by birth weight and gestational age","volume":"123","author":"Sung","year":"1993","journal-title":"J. Pediatr."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1007\/s13312-020-1779-9","article-title":"Growth and neurodevelopmental outcomes at 12 to 18 months of corrected age in preterm infants born small for gestational age","volume":"57","author":"Murki","year":"2020","journal-title":"Indian Pediatr."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Lin, C.Y., Chang, H.Y., Chang, J.H., Hsu, C.H., Jim, W.T., Peng, C.C., and Chen, C.H. (2023). The impact of small-for-gestational-age Status on the outcomes in very-Low-birth-weight (VLBW) premature infants: A prospective cohort study in Taiwan. Front. Pediatr., 11.","DOI":"10.3389\/fped.2023.1209765"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Committee on Fetus Newborn, Barfield, W.D., Papile, L.-A., Baley, J.E., Benitz, W., Cummings, J., Carlo, W.A., Kumar, P., Polin, R.A., and Tan, R.C. (2012). Levels of neonatal care. Pediatrics, 130, 587\u2013597.","DOI":"10.1542\/peds.2012-1999"},{"key":"ref_13","unstructured":"Vermont Oxford Network (2013, January 01). Manuals and Forms. Available online: https:\/\/vtoxford.zendesk.com\/hc\/en-us\/categories\/360000861394-Manuals-and-Forms."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1542\/peds.2012-0541","article-title":"Management of neonates with suspected or proven early-onset bacterial sepsis","volume":"129","author":"Polin","year":"2012","journal-title":"Pediatrics"},{"key":"ref_15","unstructured":"The Centers for Disease Control and Prevention (CDC) and National Healthcare Safety Network (NHSN) (2025, January 31). Bloodstream Infection Event (Central Line-Associated Bloodstream Infection and Non-Central Line Associated Bloodstream Infection), Available online: https:\/\/www.cdc.gov\/nhsn\/pdfs\/pscmanual\/4psc_clabscurrent.pdf."},{"key":"ref_16","unstructured":"The Centers for Disease Control and Prevention (CDC) and National Healthcare Safety Network (NHSN) (2025, January 31). Pneumonia (Ventilator-Associated [VAP] and Non-Ventilator-Associated Pneumonia [PNEU]) Event, Available online: http:\/\/www.cdc.gov\/nhsn\/pdfs\/pscmanual\/6pscvapcurrent.pdf."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/00000658-197801000-00001","article-title":"Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging","volume":"187","author":"Bell","year":"1978","journal-title":"Ann. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1723","DOI":"10.1164\/ajrccm.163.7.2011060","article-title":"Bronchopulmonary dysplasia","volume":"163","author":"Jobe","year":"2001","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1379","DOI":"10.1055\/a-2016-7568","article-title":"Risk factors for mortality or major morbidities of very preterm infants: A study from Thailand","volume":"41","author":"Thatrimontrichai","year":"2024","journal-title":"Am. J. Perinatol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Toth, I.H., Pantea, M.M., Enatescu, I., Filimon, A.T., Kali, F.Y., and Belei, O. (2026). Umbilical cord biomarkers of nutritional and metabolic status in neonates with intrauterine growth restriction. J. Clin. Med., 15.","DOI":"10.3390\/jcm15031043"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/12\/4798\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T01:25:24Z","timestamp":1782264324000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/12\/4798"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,20]]},"references-count":20,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["jcm15124798"],"URL":"https:\/\/doi.org\/10.3390\/jcm15124798","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,20]]}}}