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Impact of fetal growth restriction on neurodevelopmental outcome at 2 years for extremely preterm infants: a single
Mayass El Ayoubi1,2, Juliana Patkai2, Cécile Bordarier2
1INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.
Insights
Fetal growth restriction in extremely preterm infants is linked to lower developmental quotients at two years, particularly in fine motor and social skills. However, it does not increase the risk of cerebral palsy.
Area of Science:
- Neonatalogy
- Developmental Pediatrics
- Perinatal Medicine
Background:
- Extremely preterm infants (<27 weeks gestational age) face significant neurodevelopmental challenges.
- Fetal growth restriction (FGR) is a common complication in preterm births, but its specific impact on neurodevelopment is not fully understood.
- Understanding FGR's long-term effects is crucial for targeted interventions.
Purpose of the Study:
- To investigate the association between fetal growth restriction and neurodevelopmental outcomes at two years corrected age in infants born before 27 weeks gestational age.
- To determine if FGR impacts the risk of cerebral palsy (CP) or cognitive development in this vulnerable population.
Main Methods:
- A cohort of 463 infants born before 27 weeks gestational age between 1999-2008 was analyzed.
- Infants were categorized based on birthweight relative to intrauterine reference curves (below 10th centile vs. at least 10th centile).
- Neurodevelopmental outcomes, including cerebral palsy and cognitive development (Brunet-Lézine assessment), were assessed at two years corrected age, with adjustments for perinatal and social factors.
Main Results:
- Fetal growth restriction was not significantly associated with an increased risk of cerebral palsy.
- Infants with birthweight below the 10th centile exhibited a 4.7-point lower global developmental quotient compared to peers (p<0.001).
- The most pronounced deficits were observed in fine motor skills (-4.7, p=0.053) and social interaction skills (-7.3, p<0.001).
Conclusions:
- Fetal growth restriction is associated with poorer neurodevelopmental outcomes in extremely preterm children at two years corrected age.
- While FGR does not elevate the risk of cerebral palsy, it significantly impacts cognitive and motor development.
- These findings highlight the need for early neurodevelopmental monitoring and support for preterm infants affected by FGR.
Aim:
We evaluated the impact of fetal growth restriction on neurodevelopmental outcomes at 2 years corrected age for infants born before 27 weeks gestational age.
Method:
Data on infants born before 27 weeks gestational age between 1999 and 2008 (n=463), admitted to a tertiary neonatal unit in Paris, were used to compare neurological outcomes at 2 years for infants with birthweight lower than the 10th centile and birthweight of at least the 10th centile, using intrauterine reference curves. Outcomes were cerebral palsy (CP) and the Brunet-Lézine assessment of cognitive development, which provides age-corrected overall and domain-specific (global and fine motor skills, language and social interaction) developmental quotients. Models were adjusted for perinatal and social factors.
Results:
Seventy-two percent of infants were discharged alive. Eighty-three percent (n=268) were evaluated at 2 years. Six percent had CP. Fetal growth restriction was not associated with the risk of CP. After adjustment, children with a birthweight lower than the 10th centile had a global developmental quotient 4.7 points lower than those with birthweight of at least the 10th centile (p<0.001); differences were greatest for fine motor and social skills (-4.7, p=0.053 and -7.3, p<0.001 respectively).
Interpretation:
In extremely preterm children, fetal growth restriction was associated with poorer neurodevelopmental outcomes at 2 years, but not with CP.
