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Being Small for Gestational Age: Does it Matter for the Neurodevelopment of Premature Infants? A Cohort Study
Myriam Bickle Graz1, Jean-François Tolsa1, Céline Julie Fischer Fumeaux1
1Clinic of Neonatology and Developmental Unit, Department of Pediatrics and Pediatric Surgery, University Hospital and University of Lausanne, Lausanne, Switzerland.
Insights
Small for gestational age (SGA) in premature infants is linked to hyperactive behavior but not to adverse neurodevelopmental outcomes or cognitive deficits at age five. Birth weight percentile alone is not an independent risk factor for poor neurodevelopment in preterm children.
Area of Science:
- Neonatal Research
- Developmental Pediatrics
- Pediatric Neurology
Background:
- The association between being small for gestational age (SGA) and adverse neurodevelopmental outcomes in premature infants is debated.
- Premature infants face increased risks for developmental challenges.
Purpose of the Study:
- To investigate the impact of SGA on cognitive function, behavior, neurodevelopmental impairment, and therapy needs at five years of age.
- To clarify the role of SGA as an independent risk factor for neurodevelopmental deficits in preterm children.
Main Methods:
- A population-based prospective cohort study of infants born before 32 weeks gestation.
- Cognitive assessment using the Kaufman Assessment Battery for Children (K-ABC) and behavioral assessment with the Strengths and Difficulties Questionnaire (SDQ).
- Primary outcomes included cognitive scores, behavioral scores, and neurodevelopmental impairment; therapy use was a secondary outcome.
Main Results:
- SGA was significantly associated with hyperactivity scores (p < 0.04) but not with cognitive scores or overall neurodevelopmental impairment.
- Factors like gestational age, socioeconomic status, and major brain lesions influenced cognitive outcomes.
- Severe impairment was linked to fetal tobacco exposure, asphyxia, gestational age, and brain lesions.
Conclusions:
- In preterm infants, SGA is associated with hyperactive behavior but not with impaired cognition or neurodevelopmental deficits at age five.
- Birth weight below the 10th percentile alone does not appear to be an independent predictor of adverse neurodevelopmental outcomes in preterm children.
Background:
Whether being small for gestational age (SGA) increases the risk of adverse neurodevelopmental outcome in premature infants remains controversial.
Objective:
to study the impact of SGA (birthweight < percentile 10) on cognition, behavior, neurodevelopmental impairment and use of therapy at 5 years old.
Methods:
This population-based prospective cohort included infants born before 32 weeks of gestation. Cognition was evaluated with the K-ABC, and behavior with the Strengths and Difficulties Questionnaire (SDQ). Primary outcomes were cognitive and behavioral scores, as well as neurodevelopmental impairment (cognitive score < 2SD, hearing loss, blindness, or cerebral palsy). The need of therapy, an indirect indicator of neurodevelopmental impairment, was a secondary outcome. Linear and logistic regression models were used to analyze the association of SGA with neurodevelopment.
Results:
342/515 (76%) premature infants were assessed. SGA was significantly associated with hyperactivity scores of the SDQ (coefficient 0.81, p < 0.04), but not with cognitive scores, neurodevelopmental impairment or the need of therapy. Gestational age, socio-economic status, and major brain lesions were associated with cognitive outcome in the univariate and multivariate model, whereas asphyxia, sepsis and bronchopulmonary dysplasia were associated in the univariate model only. Severe impairment was associated with fetal tobacco exposition, asphyxia, gestational age and major brain lesions. Different neonatal factors were associated with the use of single or multiple therapies: children with one therapy were more likely to have suffered birth asphyxia or necrotizing enterocolitis, whereas the need for several therapies was predicted by major brain lesions.
Discussion:
In this large cohort of premature infants, assessed at 5 years old with a complete panel of tests, SGA was associated with hyperactive behavior, but not with cognition, neurodevelopmental impairment or use of therapy. Birthweight <10th percentile alone does not appear to be an independent risk factor of neurodevelopmental adverse outcome in preterm children.
