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Updated: Jun 3, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Neurologic outcomes at school age in very preterm infants born with severe or mild growth restriction
Isabelle Guellec1, Alexandre Lapillonne, Sylvain Renolleau
1INSERM, UMR 953, Epidemiological Research in Perinatal Health and Women's and Children Health, Bâtiment de recherche, Hôpital Tenon, Paris, France. isaguellec@hotmail.com
Insights
Growth restriction in preterm infants is linked to increased neonatal mortality and later developmental challenges. Severe growth restriction significantly elevates risks for mortality and cognitive issues in premature babies.
Area of Science:
- Neonatalogy
- Developmental Pediatrics
- Perinatal Epidemiology
Background:
- Preterm birth is a major concern in neonatal care.
- Growth restriction at birth may impact long-term neurodevelopmental outcomes.
Purpose of the Study:
- To investigate the association between mild and severe growth restriction in preterm infants and neonatal mortality.
- To assess the impact of growth restriction on cerebral palsy, cognitive, and school performance at 5 and 8 years of age.
Main Methods:
- Prospective observational study of 2846 live births between 24-32 weeks gestation in France (EPIPAGE study).
- Infants classified as small-for-gestational-age (SGA), mildly-small-for-gestational-age (M-SGA), or appropriate-for-gestational-age (AGA) based on birth weight percentiles.
- Follow-up until 8 years of age to assess mortality and neurodevelopmental outcomes.
Main Results:
- For infants born 24-28 weeks gestation, mortality increased with growth restriction severity (AGA: 30%, M-SGA: 42%, SGA: 62%).
- Among infants born 29-32 weeks gestation, SGA was associated with higher mortality, cognitive difficulties, inattention-hyperactivity symptoms, and school difficulties.
- Mild growth restriction (M-SGA) was linked to increased risks of minor cognitive and behavioral difficulties in infants born 29-32 weeks gestation.
Conclusions:
- Growth restriction in preterm infants is associated with increased neonatal mortality.
- Mild and severe growth restriction can negatively impact cognitive and behavioral outcomes, as well as school performance in later childhood.
Objective:
To determine whether mild and severe growth restriction at birth among preterm infants is associated with neonatal mortality and cerebral palsy and cognitive performance at 5 years of age and school performance at 8 years of age.
Methods:
All 2846 live births between 24 and 32 weeks' gestation from 9 regions in France in 1997 were included in a prospective observational study (the EPIPAGE [Étude Epidémiologique sur les Petits Ages Gestationnels] study) and followed until 8 years of age. Infants were classified as "small-for-gestational-age" (SGA) if their birth weight for gestational age was at the <10th centile, "mildly-small-for-gestational-age" (M-SGA) if birth weight was at the ≥ 10th centile and <20th centile, and "appropriate-for-gestational-age" (AGA) if birth weight was at the ≥ 20th centile.
Results:
Among the children born between 24 and 28 weeks' gestation, the mortality rate increased from 30% in the AGA group to 42% in the M-SGA group and to 62% in the SGA group (P < .01). Birth weight was not significantly associated with any cognitive, behavioral, or motor outcomes at the age of 5 or any school performance outcomes at 8 years. For the children born between 29 and 32 weeks' gestation, SGA children had a higher risk for mortality (adjusted odds ratio [aOR]: 2.79 [95% confidence interval (CI): 1.50-5.20]), minor cognitive difficulties (aOR: 1.73 [95% CI: 1.12-2.69]), inattention-hyperactivity symptoms (aOR: 1.78 [95% CI: 1.10-2.89]), and school difficulties (aOR: 1.74 [1.07-2.82]) compared with AGA children. Being born M-SGA was associated with an increased risk for minor cognitive difficulties (aOR: 1.87 [95% CI: 1.24-2.82]) and behavioral difficulties (aOR: 1.66 [95% CI: 1.04-2.62]).
Conclusions:
In preterm children, growth restriction was associated with mortality, cognitive and behavioral outcomes, as well as school difficulties.
