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Published on: August 25, 2014
Behavioural problems at the age of eleven years in preterm-born children with or without fetal brain sparing: a
Antonia J M van den Broek1, Joke H Kok, Bregje A Houtzager
1Department of Pediatrics, Diaconessenhuis Leiden, Leiden, The Netherlands. ajmvandenbroek@diac-leiden.nl
Insights
Fetal brain sparing, a sign of placental insufficiency in premature infants, did not significantly correlate with behavioral problems at age eleven. Other factors like oxygen dependency and IQ were more predictive of later behavioral issues.
Area of Science:
- Neonatalogy
- Developmental Pediatrics
- Perinatal Medicine
Background:
- Severe intrauterine growth restriction (IUGR) involves fetal brain sparing, a hemodynamic adaptation to placental insufficiency.
- Brain sparing is identified by an increased umbilical to cerebral artery pulsatility index (U/C ratio) via Doppler ultrasound.
- IUGR is linked to adverse neurodevelopmental outcomes.
Purpose of the Study:
- To evaluate the long-term impact of fetal brain sparing on behavioral problems in children born prematurely.
- To determine if antenatal indicators of brain sparing predict later behavioral issues at eleven years of age.
Main Methods:
- A prospective cohort study included premature infants born between 26 and 33 weeks gestational age.
- Fetal brain sparing was defined as a U/C ratio greater than 0.72.
- Behavioral problems were assessed using the Child Behaviour Check List (CBCL) and Teacher's Report Form (TRF), with abnormal scores above 60.
Main Results:
- Of 116 survivors, 98 were assessed; 31 had antenatal brain sparing.
- Behavioral problem rates were similar between brain sparing (23.3% CBCL, 21.4% TRF) and non-brain sparing groups (22.8% CBCL, 20.0% TRF).
- Logistic regression identified oxygen dependency, low IQ, cranial ultrasound abnormalities, poor fetal growth, low Apgar scores, and low birth weight as significant predictors of behavioral problems, not brain sparing.
Conclusions:
- Antenatal fetal brain sparing was not significantly associated with behavioral problems at eleven years of age in this cohort of premature children.
- Factors such as prematurity complications and early developmental indicators appear more influential on long-term behavioral outcomes than brain sparing alone.
Background:
In severe intrauterine growth restriction (IUGR) due to placental insufficiency a haemodynamic adaptation occurs, resulting in preferential blood flow to the fetal brain (brain sparing). With Doppler ultrasound an increased ratio between the umbilical and the cerebral artery pulsatility index (U/C ratio) can be demonstrated. IUGR is associated with impaired neurodevelopmental outcome.
Objective:
Evaluation of the effect of fetal brain sparing on behavioural problems at eleven years in premature born children.
Methods:
Prospective cohort study in premature children born in 1989, with a gestational age of 26 0/7 to 33 0/7 weeks. An U/C ratio>0.72 was defined as brain sparing. Behavioural problems were assessed with the parent-reported Child Behaviour Check List (CBCL) and the Teacher's Report Form (TRF). T scores >60 for total problem score and subscales of internalizing and externalizing behaviour, were considered abnormal.
Results:
Ninety-eight of the 116 survivors were assessed, of which 31 with antenatally established fetal brain sparing. According to the CBCL-total problem score 23.3% of the premature born babies in the brain sparing group had behavioural problems compared with 22.8% of those without brain sparing. According to the TRF-total problem score the percentages were 21.4% and 20.0%, respectively. Logistic regression analysis failed to show a significant association of U/C ratio with behavioural problems. In this model oxygen dependency at 28 days, IQ<85 at five years, cranial ultrasound abnormalities, fetal growth ratio<0.80, Apgar scores<7 after 5 min and birth weight
Conclusion:
In this cohort brain sparing itself has no significant association with behavioural problems at eleven years.
