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Infant neurodevelopment following fetal growth restriction: relationship with antepartum surveillance parameters
A A Baschat1, R M Viscardi, B Hussey-Gardner
1Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland, Baltimore, MD 21201-1703, USA. aabaschat@hotmail.com
Insights
Reversed end-diastolic velocity in the umbilical artery (UA-REDV) is linked to neurodevelopmental delay in growth-restricted infants. However, gestational age and birth weight are the primary predictors of poor neurodevelopment outcomes.
Area of Science:
- Perinatal medicine
- Fetal medicine
- Neonatology
Background:
- Intrauterine growth restriction (IUGR) poses significant risks to fetal development and long-term neurodevelopmental outcomes.
- Fetal Doppler parameters and biophysical profile scores (BPP) are used to assess fetal well-being in IUGR pregnancies.
- Neurodevelopmental delay is a critical concern for infants born with IUGR.
Purpose of the Study:
- To investigate the association between fetal Doppler parameters, BPP, and neurodevelopmental delay at two years corrected age in infants with IUGR.
- To identify key predictors of neurodevelopmental outcomes in growth-restricted neonates.
Main Methods:
- Prospective observational study of 113 pregnancies with IUGR.
- Evaluation of umbilical artery (UA), middle cerebral artery, and ductus venosus (DV) Doppler features.
- Assessment of BPP, birth acidemia, gestational age at delivery, birth weight, and neonatal morbidity.
- Neurodevelopmental assessment at 2 years corrected age using standardized tools (BSID, etc.).
Main Results:
- 52.8% of infants experienced neurodevelopmental delay, with abnormal tone and speech delay being common.
- Reversed end-diastolic velocity (REDV) in the UA was associated with global delay (r2=0.31, P=0.006).
- Gestational age at delivery and birth weight were strongly associated with neurodevelopmental delay (r2=0.52 and r2=0.54, respectively).
Conclusions:
- UA-REDV independently contributes to poor neurodevelopment in IUGR infants.
- Abnormal venous Doppler findings or BPP did not show a significant effect on neurodevelopment.
- Gestational age at delivery and birth weight remain the most critical factors influencing neurodevelopmental outcomes in growth-restricted infants.
Objectives:
To evaluate the relationship between fetal Doppler parameters, biophysical profile score (BPP) and neurodevelopmental delay at 2 years of corrected age in infants who had been growth-restricted in utero.
Methods:
This was a prospective observational study including 113 pregnancies complicated by intrauterine growth restriction (IUGR) (abdominal circumference<5th percentile and elevated umbilical artery (UA) pulsatility index). The relationships of UA, middle cerebral artery and ductus venosus (DV) Doppler features, BPP, birth acidemia (artery pH<7.0+/or base deficit>12), gestational age at delivery, birth weight and neonatal morbidity (i.e. bronchopulmonary dysplasia, >Grade 2 intraventricular hemorrhage, or necrotizing enterocolitis) with a 2-year neurodevelopmental delay were evaluated. Best Beginnings Developmental Screen, Bayley Scale of Infant Development II (BSID) and Clinical Adaptive/Clinical Linguistic Auditory Milestone Stage were used. BSID<70, cerebral palsy, abnormal tone, hearing loss and/or blindness defined neurodevelopmental delay.
Results:
Seventy-two of the 113 pregnancies completed assessment; there were 10 stillbirths, 19 neonatal deaths, three infant deaths and nine pregnancies with no follow-up. Twenty fetuses (27.8%) had UA reversed end-diastolic velocity (REDV), 34 (47.2%) abnormal DV Doppler features and 31 (43.1%) an abnormal BPP. Median gestational age at delivery and birth weight were 30.4 weeks and 933 g, respectively. Twelve infants had acidemia and 28 neonatal morbidity. There were 38 (52.8%) infants with neurodevelopmental delay, including 37 (51.4%) with abnormal tone, 20 (27.8%) with speech delay, 23 (31.9%) with an abnormal neurological examination, eight (11.1%) with a hearing deficit and six (8.3%) with cerebral palsy. Gestational age at delivery was associated with cerebral palsy (r2=0.52, P<0.0001; 92% sensitivity and 83% specificity for delivery at <27 weeks). UA-REDV was associated with global delay (r2=0.31, P=0.006) and birth weight with neurodevelopmental delay (r2=0.54, P<0.0001; 82% sensitivity and 64% specificity for BW<922 g).
Conclusions:
Although UA-REDV is an independent contributor to poor neurodevelopment in IUGR no such effect could be demonstrated for abnormal venous Doppler findings or BPP. Gestational age and birth weight remain the predominant factors for poor neurodevelopment in growth-restricted infants.
