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Thin-for-gestational age infants are at increased risk of neurodevelopmental delay at 2 years
Sinéad M O'Neill1, Geraldine Hannon2, Ali S Khashan1,3
1Irish Centre for Fetal and Neonatal Translational Research, Cork University Maternity Hospital, University College Cork, Cork, Ireland.
Insights
Infants with low birth weight or low body fat percentage are at higher risk for developmental delays. Thin-for-gestational age (TGA) infants, especially those who are also small-for-gestational age (STGA), showed poorer cognitive outcomes at two years.
Area of Science:
- Neonatal development
- Pediatric health
- Developmental pediatrics
Background:
- Infants born small-for-gestational age (SGA) face increased risks of developmental difficulties, making early identification crucial.
- Neonatal body composition and customized birthweight centiles are key factors influencing infant development.
- This study investigates the impact of these factors on neurocognitive and behavioral outcomes at age two.
Purpose of the Study:
- To determine the effect of neonatal body composition and customized birthweight centiles on neurocognitive and behavioral outcomes at age two.
- To identify specific risk factors for developmental delay in infants.
- To compare outcomes between SGA, thin-for-gestational age (TGA), small- and thin-for-gestational age (STGA), and appropriate-for-gestational age (AGA) infants.
Main Methods:
- A prospective cohort study involving term infants from the Cork BASELINE Birth Cohort Study.
- Infants were categorized into SGA (<10th customized birthweight centile), TGA (<10th body fat percentage centile), STGA (both SGA and TGA), and AGA (reference) groups.
- Neurocognitive and behavioral outcomes were assessed at 24 months using the Bayley Scales of Infant Development III and the Child Behaviour Checklist.
Main Results:
- Infants born thin-for-gestational age (TGA) exhibited significantly lower scores in language, cognitive, and motor domains compared to AGA infants.
- Small- and thin-for-gestational age (STGA) infants showed poorer cognitive outcomes, with a higher adjusted odds ratio for developmental delay at two years.
- Outcomes for SGA infants did not significantly differ from the AGA reference group.
Conclusions:
- Thin-for-gestational age (TGA) infants, particularly those also born small-for-gestational age (STGA), face an elevated risk of developmental delay at two years.
- Neonatal body composition is a critical predictor of developmental outcomes.
- Early identification of TGA and STGA infants is essential for timely intervention and support.
Background:
Infants born small-for-gestational age (SGA) are at increased risk of developmental difficulties. Identifying those most at risk is challenging. We examined the effect of neonatal body composition and customised birthweight centiles on neurocognitive and behavioural outcomes at age 2.
Study Design:
Prospective cohort study of term infants from the Cork BASELINE Birth Cohort Study classified into the following exposure groups: a birth weight <10th customised centile (SGA, n=51); body fat percentage at birth <10th centile (thin-for-gestational age (TGA, n=51)) or both SGA and TGA infants (small- and thin-for-gestational age (STGA), n=13). The SGA, TGA and STGA groups were compared with a reference (unexposed) group of appropriate-for-gestational age (AGA, n=189) infants. Outcome was assessed at 24 months using the Bayley Scales of Infant Development Version III and the Child Behaviour Checklist.
Results:
Outcomes in the SGA infants did not differ significantly from the AGA group. TGA infants had significantly lower scores across all three domains, with a 0.35, 0.38 and 0.41 SD reduction in language, cognitive and motor scale scores, respectively. STGA infants had poorer cognitive outcome with a median cognitive scale score of 90 (IQR 85-95) compared with 95 (IQR 90-100) in the AGA reference group, p=0.005. The adjusted OR of developmental delay at 2 years was 5.00 (95% CI 1.46 to 17.13, p=0.010) in the STGA group.
Conclusion:
TGA infants, in particular those born STGA, are at increased risk of developmental delay at 2 years compared with the AGA infants.