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Background <p>Small for gestational age (SGA) is common among very preterm infants, but its independent impact on healthcare resource utilization remains controversial. This study aimed to evaluate the independent effect of SGA on length of hospital stay (LOS) and hospitalization costs in very preterm infants.</p> Methods <p>This single-center retrospective cohort study included preterm infants born at &lt; 32 weeks of gestation and admitted to the NICU of Zhangzhou Affiliated Hospital of Fujian Medical University between January 2024 and February 2026. Infants were classified as SGA (birth weight &lt; 10th percentile for gestational age and sex according to the Fenton 2013 growth chart) or non-SGA. The primary outcome was LOS; secondary outcomes included hospitalization costs, duration of respiratory support, and discharge anthropometrics. Multivariable generalized linear models with Gamma distribution and log link function were used to assess the independent association between SGA status and outcomes, adjusting for gestational age, mode of delivery, invasive mechanical ventilation duration, and bronchopulmonary dysplasia.</p> Results <p>A total of 270 very preterm infants were included, of whom 17 (6.3%) were classified as SGA. The SGA group had significantly longer LOS (median: 68.0 vs. 48.0 days, <i>P</i> = 0.022) and higher hospitalization costs (median: 96,219 vs. 71,361 RMB, <i>P</i> = 0.044) compared with the non-SGA group. After adjusting for gestational age, cesarean delivery, invasive mechanical ventilation duration, and bronchopulmonary dysplasia, SGA remained independently associated with prolonged LOS (approximately 40% longer; Exp(B) = 1.401, 95% CI: 1.239–1.582, <i>P</i> &lt; 0.001) and increased hospitalization costs (approximately 34% higher; Exp(B) = 1.339, 95% CI: 1.112–1.614, <i>P</i> = 0.002).</p> Conclusions <p>SGA is an independent risk factor for prolonged LOS (approximately 40% increase) and increased hospitalization costs (approximately 34% increase) in very preterm infants, after adjusting for illness severity. These findings provide quantitative evidence for healthcare resource planning and targeted management of this high-risk population.</p>

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Impact of small for gestational age on length of hospital stay and hospitalization costs in very preterm infants: a single-center retrospective cohort study

  • 期刊论文

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  • 发表日期：

    2026年7月15日

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  • Zhihong Wang,
  • Xiaoyun Chen,
  • Licong Lin

摘要

Background

Small for gestational age (SGA) is common among very preterm infants, but its independent impact on healthcare resource utilization remains controversial. This study aimed to evaluate the independent effect of SGA on length of hospital stay (LOS) and hospitalization costs in very preterm infants.

Methods

This single-center retrospective cohort study included preterm infants born at < 32 weeks of gestation and admitted to the NICU of Zhangzhou Affiliated Hospital of Fujian Medical University between January 2024 and February 2026. Infants were classified as SGA (birth weight < 10th percentile for gestational age and sex according to the Fenton 2013 growth chart) or non-SGA. The primary outcome was LOS; secondary outcomes included hospitalization costs, duration of respiratory support, and discharge anthropometrics. Multivariable generalized linear models with Gamma distribution and log link function were used to assess the independent association between SGA status and outcomes, adjusting for gestational age, mode of delivery, invasive mechanical ventilation duration, and bronchopulmonary dysplasia.

Results

A total of 270 very preterm infants were included, of whom 17 (6.3%) were classified as SGA. The SGA group had significantly longer LOS (median: 68.0 vs. 48.0 days, P = 0.022) and higher hospitalization costs (median: 96,219 vs. 71,361 RMB, P = 0.044) compared with the non-SGA group. After adjusting for gestational age, cesarean delivery, invasive mechanical ventilation duration, and bronchopulmonary dysplasia, SGA remained independently associated with prolonged LOS (approximately 40% longer; Exp(B) = 1.401, 95% CI: 1.239–1.582, P < 0.001) and increased hospitalization costs (approximately 34% higher; Exp(B) = 1.339, 95% CI: 1.112–1.614, P = 0.002).

Conclusions

SGA is an independent risk factor for prolonged LOS (approximately 40% increase) and increased hospitalization costs (approximately 34% increase) in very preterm infants, after adjusting for illness severity. These findings provide quantitative evidence for healthcare resource planning and targeted management of this high-risk population.