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Neurodevelopmental delay in small babies at term: a systematic review
T Arcangeli1, B Thilaganathan, R Hooper
1Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology, St George's University of London, London, UK.
Insights
Term infants who are small for gestational age (SGA) have lower neurodevelopmental scores compared to appropriate for gestational age (AGA) infants. Further research is needed to explore interventions for improving outcomes in these infants.
Area of Science:
- Perinatal Medicine
- Neurodevelopmental Pediatrics
- Growth Restriction
Background:
- Small for gestational age (SGA) and fetal growth restriction (FGR) are associated with potential neurodevelopmental deficits.
- Understanding the magnitude of these deficits in term infants is crucial for clinical management and intervention strategies.
Purpose of the Study:
- To systematically review and quantify the neurodevelopmental outcomes in term infants identified as SGA or FGR.
- To compare neurodevelopmental scores of SGA/FGR infants with those of appropriate for gestational age (AGA) controls.
Main Methods:
- Systematic literature search of scientific databases for studies on neurodevelopment in SGA/FGR infants.
- Inclusion criteria: term births, defined neurodevelopmental scores. Exclusion criteria: preterm births, undefined outcome measures.
- Calculation of effect size using standardized mean difference between SGA/FGR children and controls.
Main Results:
- Analysis of 28 studies involving 7861 SGA and 91,619 AGA infants revealed significantly lower neurodevelopmental scores in SGA infants (0.32 SD below controls).
- Significant heterogeneity was observed among the SGA studies (I² = 68.3%).
- Insufficient data were available to draw conclusions for FGR infants.
Conclusions:
- Term infants born SGA exhibit reduced neurodevelopmental scores compared to their AGA counterparts.
- There is an urgent need for clinical trials investigating interventions to improve neurodevelopmental outcomes in term infants with fetal growth restriction.
Objective:
Being small for gestational age (SGA) or having fetal growth restriction (FGR) may be associated with poorer neurodevelopmental outcomes compared to being appropriate for gestational age (AGA). The aim of this paper was to evaluate the existence and magnitude of decrease in neurodevelopmental scores in SGA and FGR infants born at term from a systematic review of the existing literature.
Methods:
Studies of neurodevelopment in SGA/FGR babies were identified from a search of the internet scientific databases. Studies that included preterm births and those that did not define absolute indices of standardized cognitive outcome were excluded. SGA was defined as birth weight below the 10(th) centile for gestation and FGR as the same birth-weight standard with abnormal umbilical artery Doppler ultrasound or evidence of abnormal placentation on pathology specimen studies. Effect size was calculated as the standardized mean difference between neurodevelopment scores of controls and SGA/FGR children.
Results:
There were 28 studies of SGA, with a total of 7861 SGA and 91 619 control AGA babies, and three studies of FGR, with a total of 119 FGR and 49 control AGA babies. Data synthesis showed that standardized neurodevelopmental scores in SGA babies were 0.32 SD (95% CI, 0.25-0.38) below those for normal controls, though with heterogeneity between studies (I(2) = 68.3%). Insufficient data were available for FGR babies.
Conclusion:
The findings of the study demonstrate that among babies born at term, being SGA is associated with lower scores on neurodevelopmental outcomes compared to AGA controls. A trial designed to evaluate the effects of intervention in small fetuses born at term in order to improve the neurodevelopmental outcome is urgently needed.
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