Birth weight- and fetal weight-growth restriction: impact on neurodevelopment
Iris G Streimish1, Richard A Ehrenkranz, Elizabeth N Allred
1Newborn Medicine, Newton-Wellesley Hospital, Newton, MA, USA.
Insights
Severe prenatal growth restriction in female infants, but not males, is linked to neurodevelopmental impairment. Neurosensory limitations can mask these effects in preterm infants.
Area of Science:
- Neonatal development
- Perinatal outcomes
- Neurodevelopmental disorders
Background:
- Distinguishing small for gestational age (SGA) infants prenatally versus postnatally is crucial.
- Infants identified as SGA based on fetal weight curves but appropriate for gestational age (AGA) at birth present a unique classification challenge.
Purpose of the Study:
- To compare neurodevelopmental outcomes at 24 months corrected age among infants identified as SGA based on birth weight curves (B-SGA), SGA based on fetal weight curves only (F-SGA), and AGA.
- To investigate sex-based differences in the impact of growth restriction.
- To assess the influence of neurosensory limitations on observed outcomes.
Main Methods:
- Observational cohort study of preterm infants (born before 28 weeks gestation).
- Neurodevelopmental assessment using the Bayley Scales of Infant Development II, including Mental Development Index (MDI) and Psychomotor Development Index (PDI).
Main Results:
- Female infants classified as B-SGA showed an increased risk of low Psychomotor Development Index (PDI < 70) compared to AGA girls (OR=2.8).
- No increased risk of low developmental indices was observed for B-SGA or F-SGA boys compared to AGA boys.
- Neurosensory limitations reduced the apparent association between growth restriction and neurodevelopmental outcomes in both sexes.
Conclusions:
- Only girls experiencing the most severe growth restriction demonstrated a significantly increased risk of neurodevelopmental impairment at 24 months corrected age.
- Neurosensory limitations complicate the assessment of growth restriction effects in preterm infants, affecting both boys and girls.
Background:
The newborn classified as growth-restricted on fetal weight curves, but not on birth weight curves, is classified prenatally as small for gestational age (SGA), but postnatally as appropriate for gestational age (AGA).
Aims:
To see (1) to what extent the neurodevelopmental outcomes at 24 months corrected age differed among three groups of infants (those identified as SGA based on birth weight curves (B-SGA), those identified as SGA based on fetal weight curves only (F-SGA), and the referent group of infants considered AGA, (2) if girls and boys were equally affected by growth restriction, and (3) to what extent neurosensory limitations influenced what we found.
Study Design:
Observational cohort of births before the 28th week of gestation.
Outcome Measures:
Mental Development Index (MDI) and Psychomotor Development Index (PDI) of the Bayley Scales of Infant Development II.
Results:
B-SGA, but not F-SGA girls were at an increased risk of a PDI<70 (OR=2.8; 95% CI: 1.5, 5.3) compared to AGA girls. B-SGA and F-SGA boys were not at greater risk of low developmental indices than AGA boys. Neurosensory limitations diminished associations among girls of B-SGA with low MDI, and among boys B-SGA and F-SGA with PDI<70.
Conclusions:
Only girls with the most severe growth restriction were at increased risk of neurodevelopmental impairment at 24 months corrected age in the total sample. Neurosensory limitations appear to interfere with assessing growth restriction effects in both girls and boys born preterm.
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