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The neurodevelopmental outcome of term infants with different intrauterine growth characteristics
1Department of Paediatrics, University College London Medical School, UK. sroth@glenrosa.demon.co.uk
Insights
Neurodevelopmental outcomes in term infants did not differ between small-for-gestational-age (SGA) and intrauterine growth retardation (IUGR) groups. Despite optimal care, many infants experienced minor neurological damage.
Area of Science:
- Neonatalogy
- Developmental Pediatrics
- Obstetrics
Background:
- Small-for-gestational-age (SGA) infants are at risk for adverse neurodevelopmental outcomes.
- Third-trimester growth patterns may influence neurodevelopmental trajectories in SGA infants.
Purpose of the Study:
- To investigate if third-trimester growth characteristics differentiate neurodevelopmental outcomes in term SGA infants.
- To compare neurodevelopmental outcomes between intrauterine growth retardation (IUGR) and SGA groups.
Main Methods:
- Prospective cohort study of 76 term infants with estimated fetal weight below the 10th percentile.
- Categorization into IUGR (n=23) and SGA (n=53) groups based on third-trimester abdominal circumference growth velocity.
- Neurological and developmental assessments at birth and 1 year of age.
Main Results:
- At birth, neurological impairments were observed in 51% of SGA and 57% of IUGR infants.
- At 1 year, 37% of SGA and 33% of IUGR infants showed impairments, with some experiencing disability.
- No significant difference in neurodevelopmental outcome was found between the IUGR and SGA groups at 1 year.
Conclusions:
- Third-trimester growth patterns do not appear to affect 1-year neurodevelopmental outcomes in term infants with estimated birth weight below the 10th percentile.
- A significant proportion of term SGA and IUGR infants experience neurological damage, even with optimal obstetric management.
Abstract:
The objective of this study was to test the hypothesis that neurodevelopmental outcome would differ between two groups of small-for-gestational age infants born at term showing different in utero growth characteristics during the third trimester. The design was a prospective cohort study done at a tertiary referral centre. The 76 subjects who fulfilled the inclusion criteria had an estimated fetal weight below the 10th centile for their gestation. Subsequent to enrolment, repeat ultrasound scans were performed weekly to determine growth velocity. Twenty-three infants whose change in fetal abdominal circumference between first and last scan was greater than -1.5 standard deviation scores (SDS) were assigned to the intrauterine growth retardation group (IUGR) while 53 infants whose fetal abdominal circumference changed less than 1.5 SDS were assigned to the small-for-gestational-age (SGA) group. Ten infants with normal intrauterine growth were enrolled as controls. Following delivery all infants had a neurological examination and a cranial ultrasound scan. At 1 year, 75 infants (87%) were traced and reassessed (49 SGA, 18 IUGR and eight controls) with a neurological examination and a developmental assessment. At birth, impairments were found in 27 (51%) of the SGA, 13 (57%) of the IUGR groups and one (10%) of the controls. At 1 year, 18 (37%) of the SGA subjects, six (33%) of the IUGR subjects and one (13%) of the control infant were impaired, including three (6%) of the SGA subjects and one (6%) of the IUGR subjects who were disabled. We conclude that in term fetuses with an estimated birthweight below the 10th centile for their gestation, the pattern of growth in the third trimester does not affect outcome at 1 year. In spite of optimum obstetric management, nearly one-third of the combined SGA and IUGR term fetuses had suffered some, albeit minor, neurological damage.