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Early childhood neurodevelopment after intrauterine growth restriction: a systematic review
Terri A Levine1, Ruth E Grunau2, Fionnuala M McAuliffe3
1School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland; f.a.alderdice@qub.ac.uk.
Insights
Children born with intrauterine growth restriction (IUGR) face higher risks for developmental delays. This review highlights motor, cognitive, and language deficits in early childhood following IUGR.
Area of Science:
- Pediatric Neurology
- Developmental Psychology
- Neonatology
Background:
- Intrauterine growth restriction (IUGR) is linked to potential adverse developmental outcomes in early childhood.
- Understanding neurodevelopmental trajectories post-IUGR is crucial for early intervention.
Purpose of the Study:
- To systematically review neurodevelopmental outcomes in children from 6 months to 3 years of age following IUGR.
Main Methods:
- Comprehensive literature search across major databases (PubMed, Embase, PsycINFO, etc.) using relevant keywords.
- Inclusion criteria focused on studies with defined IUGR, 6-month to 3-year follow-up, comparison groups, and English full text.
- Methodological quality appraisal and data extraction using standardized forms.
Main Results:
- 16 studies were included, with 11 reporting poorer neurodevelopmental outcomes in IUGR children.
- Common delays observed included motor (10 studies), cognitive (8 studies), and language (7 studies).
- Other reported delays encompassed social development, attention, and adaptive behaviors; few studies defined IUGR using Doppler parameters.
Conclusions:
- Children with IUGR show an increased risk for poorer neurodevelopmental outcomes between 6 months and 3 years.
- Heterogeneity in outcome measures, definitions of IUGR, and small sample sizes limit current evidence synthesis.
- Further research with standardized methodologies and larger sample sizes is needed, particularly for term IUGR infants.
Background And Objective:
Children who experienced intrauterine growth restriction (IUGR) may be at increased risk for adverse developmental outcomes in early childhood. The objective of this study was to carry out a systematic review of neurodevelopmental outcomes from 6 months to 3 years after IUGR.
Methods:
PubMed, Embase, PsycINFO, Maternity and Infant Care, and CINAHL databases were searched by using the search terms intrauterine, fetal, growth restriction, child development, neurodevelopment, early childhood, cognitive, motor, speech, language. Studies were eligible for inclusion if participants met specified criteria for growth restriction, follow-up was conducted within 6 months to 3 years, methods were adequately described, non-IUGR comparison groups were included, and full English text of the article was available. A specifically designed data extraction form was used. The methodological quality of included studies was assessed using well-documented quality-appraisal guidelines.
Results:
Of 731 studies reviewed, 16 were included. Poorer neurodevelopmental outcomes after IUGR were described in 11. Ten found motor, 8 cognitive, and 7 language delays. Other delays included social development, attention, and adaptive behavior. Only 8 included abnormal Doppler parameters in their definitions of IUGR.
Conclusions:
Evidence suggests that children are at risk for poorer neurodevelopmental outcomes following IUGR from 6 months to 3 years of age. The heterogeneity of primary outcomes, assessment measures, adjustment for confounding variables, and definitions of IUGR limits synthesis and interpretation. Sample sizes in most studies were small, and some examined preterm IUGR children without including term IUGR or AGA comparison groups, limiting the value of extant studies.
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