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Impact of cerebral redistribution on neurodevelopmental outcome in small-for-gestational-age or growth-restricted

S Meher1,2, E Hernandez-Andrade3, S N Basheer4

  • 1Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK.

Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology
|February 17, 2015
PubMed

Insights

Small-for-gestational-age (SGA) fetuses with cerebral redistribution may face increased neurodevelopmental risks. Further research is needed to confirm these findings and re-evaluate delivery timing for SGA fetuses.

Area of Science:

  • Perinatal medicine
  • Fetal development
  • Neurology

Background:

  • Small-for-gestational-age (SGA) and growth-restricted fetuses often exhibit altered blood flow patterns.
  • Cerebral redistribution, indicated by middle cerebral artery (MCA) Doppler indices, is a key indicator of fetal well-being.
  • Understanding the link between cerebral redistribution and neurological outcomes is crucial for optimal fetal management.

Purpose of the Study:

  • To systematically review the evidence on the impact of fetal cerebral redistribution on neurological outcomes in SGA or growth-restricted fetuses.
  • To assess the association between MCA Doppler findings indicative of cerebral redistribution and subsequent neurodevelopmental issues.

Main Methods:

  • A systematic literature search of MEDLINE was conducted for controlled studies from inception to September 2013.
  • Studies reporting neurological outcomes in SGA or growth-restricted fetuses with cerebral redistribution (based on MCA Doppler) were included.
  • Relative risks or odds ratios with 95% confidence intervals were used to analyze the association.

Main Results:

  • Nine studies involving 1198 fetuses were included; definitions and study quality varied.
  • Cerebral redistribution was not linked to an increased risk of intraventricular hemorrhage.
  • In preterm fetuses, it correlated with normal neonatal behavior but abnormal later psychomotor development.
  • In term SGA fetuses, it was associated with increased motor and organizational problems and lower cognitive scores at two years.

Conclusions:

  • SGA fetuses exhibiting cerebral redistribution may be at a higher risk for neurodevelopmental problems.
  • Adequately controlled studies with long-term follow-up are required to draw definitive conclusions.
  • Findings suggest a potential need to re-evaluate delivery timing in SGA management when cerebral redistribution is detected, especially at term gestation.
Abstract

Keywords:
MCAbrain sparingcerebral redistributioncerebroplacental ratiomiddle cerebral arteryneurodevelopmentneurological outcome

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