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Are small for gestational age infants at higher risk for intracranial lesions?
M E Sims1, C Troy, F J Walther
1Department of Pediatrics, Los Angeles County-University of Southern California Medical Center, University of Southern California School of Medicine.
Insights
Small for gestational age (SGA) infants do not show increased central nervous system (CNS) abnormalities compared to appropriate for gestational age (AGA) neonates. Cranial ultrasounds revealed no significant differences in CNS abnormalities between the two groups.
Area of Science:
- Neonatal Neurology
- Pediatric Radiology
- Fetal Development
Background:
- The relationship between small for gestational age (SGA) and central nervous system (CNS) abnormalities is debated.
- Existing research presents conflicting findings, with some suggesting higher risks and others proposing protective effects of growth retardation.
Purpose of the Study:
- To investigate if intrauterine growth retardation in SGA neonates is associated with a higher incidence of CNS abnormalities detectable by cranial ultrasound.
- To compare cranial ultrasound findings between SGA and appropriate for gestational age (AGA) neonates.
Main Methods:
- A comparative study involving 197 SGA infants and 197 matched AGA neonates.
- Cranial ultrasounds were performed to detect CNS abnormalities.
- Infants with external dysmorphology or TORCH infections were excluded from the analysis.
Main Results:
- No significant difference in the overall incidence of intracranial abnormalities was found between SGA (26%) and AGA (21%) infants.
- Hemorrhagic or ischemic lesions, the most common abnormalities, occurred with similar frequency in both groups (SGA: 22%, AGA: 18%).
- The type and severity of lesions, as well as non-hemorrhagic ventriculomegaly and structural lesions, were comparable between SGA and AGA infants.
Conclusions:
- SGA infants, when free from external dysmorphology and TORCH infections, do not exhibit an elevated risk for CNS abnormalities detectable by cranial ultrasound.
- The findings suggest that growth retardation itself may not predispose neonates to CNS damage detectable by this imaging modality.
Abstract:
The association of small for gestational age (SGA) and central nervous system (CNS) abnormalities is controversial. Some reports suggest that SGA infants are at higher risk, whereas other data indicate that growth retardation may have a protective effect on the CNS. We compared the cranial ultrasound results of 197 SGA infants with 197 appropriate for gestational age (AGA) neonates, matched for gestation and gender, to determine if growth retardation is associated with a difference in ultrasound detectable CNS abnormalities. Infants with external dysmorphology or toxoplasmosis, rubella, cytomegalovirus, herpes simplex (TORCH) infections were excluded. We found 51 (26%) intracranial abnormalities in the SGA infants compared with 41 (21%) in the AGA controls (difference not significant). The most common lesions were hemorrhagic or ischemic, and the incidence was similar for both groups, 43 (22%) for SGA and 35 (18%) for AGA infants. The type and severity of hemorrhagic or ischemic lesions was also the same. Ventriculomegaly, not associated with hemorrhage, and structural lesions were also comparable, nine (5%) in the SGA and six (3%) in the AGA infants. We conclude that SGA infants without external dysmorphology or TORCH infections are not at increased risk for CNS abnormalities detectable by cranial ultrasound.