Abstract
In addition to small for gestational age (SGA) and low birth weight at term (LBWT), critically ill cases of SGA/LBWT are significant events from outcomes and economic perspectives that require further understanding of risk factors. We aimed to assess the spatiotemporal distribution of locations where there were consistently higher numbers of critically ill SGA/LBWT (hot spots) in comparison with all SGA/LBWT and all births. We focused on Edmonton (2008-2010) and Calgary (2006-2010), Alberta, and used a geographical information system to apply emerging hot spot analysis, as a new approach for understanding SGA, LBWT, and the critically ill counterparts (ciSGA or ciLBWT). We also compared the resulting aggregated categorical patterns with proportions of land use and socioeconomic status (SES) using Spearman correlation and logistic regression. There was an overall increasing trend in all space-time clusters. Whole period emerging hot spot patterns among births and SGA generally coincided, but SGA with ciSGA and LBWT with ciLBWT did not. Regression coefficients were highest for low SES with SGA and LBWT, but not with ciSGA and ciLBWT. Open areas and industrial land use were most associated with ciLBWT but not with ciSGA, SGA, or LBWT. Differences in the space-time hot spot patterns and the associations with ciSGA and ciLBWT indicate further need to research the interplay of maternal and environmental influences. We demonstrated the novel application of emerging hot spot analysis for small newborns and spatially related them to the surrounding environment.