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Very low birth weight and growth to age 8 years. II: Head dimensions and intelligence
W H Kitchen1, L W Doyle, G W Ford
1Department of Obstetrics and Gynecology, University of Melbourne, Australia.
Insights
Occipitofrontal circumference (OFC) in children born with very low birth weight is often below the 10th percentile. However, OFC is the best head measurement correlated with Full Scale IQ, even with dolichocephaly.
Area of Science:
- Pediatric Neurology
- Developmental Pediatrics
- Neonatology
Background:
- Head circumference measurements are crucial for monitoring child development and identifying potential neurological issues.
- Previous studies have highlighted variations in head growth among preterm infants, necessitating further investigation into normative data.
- Understanding the relationship between head size and cognitive outcomes in children born with low birth weight is essential for early intervention.
Purpose of the Study:
- To compare occipitofrontal circumference (OFC) measurements in children with varying birth weights against established reference data.
- To determine the correlation between OFC and Full Scale IQ (FSIQ) in a cohort of children without severe cerebral palsy.
- To assess the clinical significance of dolichocephaly, a common head shape variation in very-low-birth-weight infants, on cognitive development.
Main Methods:
- Longitudinal measurement of occipitofrontal circumference (OFC) at ages 2, 5, and 8 years in three birth weight groups (500-999g, 1000-1499g, >2500g).
- Comparison of OFC data against National Center for Health Statistics (NCHS) and Nellhaus reference values.
- Correlation analysis between OFC and Full Scale IQ (FSIQ) using the Wechsler Intelligence Scale for Children-Revised (WISC-R).
Main Results:
- A significant proportion of children, particularly those with very low birth weight, exhibited OFC below the 10th percentile, especially at age 2.
- National Center for Health Statistics (NCHS) data identified more children with low OFC compared to Nellhaus data.
- Occipitofrontal circumference (OFC) demonstrated the strongest correlation with Full Scale IQ (FSIQ); dolichocephaly did not significantly impact IQ, and its correction was rarely clinically relevant.
Conclusions:
- Children born with very low birth weight often have smaller occipitofrontal circumferences (OFCs) compared to normative data.
- Occipitofrontal circumference (OFC) is a reliable indicator of cognitive potential, correlating well with Full Scale IQ (FSIQ).
- The presence of dolichocephaly in very-low-birth-weight children does not appear to negatively affect IQ, suggesting limited clinical impact.
Abstract:
The occipitofrontal circumference was measured in all available children in the following cohorts at ages 2, 5, and 8 years: group 1, consisting of 79 children with birth weight between 500 and 999 g; group 2, with 111 children with birth weight between 1000 and 1499 g; and group 3 with 56 children with birth weight greater than 2500 g; all were white with no signs of moderate or severe cerebral palsy. National Center for Health Statistics reference values indicated substantially more children with an occipitofrontal circumference lower than the 10th percentile, particularly at age 2 years, compared with Nellhaus reference data. Occipitofrontal circumference was the head measurement best correlated with the Full Scale IQ on the Wechsler Intelligence Scale for Children-Revised. Dolichocephaly, often seen in very-low-birth-weight children was unrelated to IQ, and correction of occipitofrontal circumference for dolichocephaly was rarely of clinical importance.