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Neurodevelopment at Age 10 Years of Children Born <28 Weeks With Fetal Growth Restriction
Steven J Korzeniewski1,2, Elizabeth N Allred3,4, Robert M Joseph5
1Department of Obstetrics and Gynecology, School of Medicine, Wayne State University, Detroit, Michigan; skorzeni@med.wayne.edu.
Insights
Severe fetal growth restriction (FGR) in extremely preterm infants is linked to poorer cognitive and academic outcomes by age 10. These children also face higher risks for social, behavioral, and psychiatric challenges.
Area of Science:
- Neonatal development
- Neurodevelopmental disorders
- Pediatric neurology
Background:
- Fetal growth restriction (FGR) affects neurodevelopmental trajectories.
- Extremely preterm infants are a vulnerable population.
- Understanding long-term outcomes of FGR is crucial.
Purpose of the Study:
- To examine the association between FGR severity and cognitive, academic, and behavioral outcomes at age 10.
- To compare outcomes in infants with severe and less severe FGR.
Main Methods:
- Longitudinal cohort study of 889 extremely preterm infants (<28 weeks gestation).
- Cognitive, academic, and behavioral assessments at age 10.
- FGR defined by birth weight z-scores (<-2 severe, -2 to -1 less severe).
Main Results:
- Greater FGR severity correlated with lower cognitive and academic performance.
- FGR infants showed increased social-communicative impairments and autism spectrum disorder diagnoses.
- Higher rates of phobias, obsessions, and compulsions were reported by teachers.
Conclusions:
- Severe FGR in extremely preterm infants is associated with significant cognitive and neurobehavioral deficits.
- Intrauterine growth factors may impact broader neurodevelopmental trajectories.
- Early identification and intervention are vital for affected children.
Objectives:
We sought to evaluate the relationships between fetal growth restriction (FGR) (both severe and less severe) and assessments of cognitive, academic, and adaptive behavior brain function at age 10 years.
Methods:
At age 10 years, the Extremely Low Gestational Age Newborns Cohort Study assessed the cognitive function, academic achievement, social-communicative function, psychiatric symptoms, and overall quality of life of 889 children born before 28 weeks' gestation. A pediatric epileptologist also interviewed parents as part of a seizure evaluation. The 52 children whose birth weight z scores were <-2 were classified as having severe FGR, and the 113 whose birth weight z scores were between -2 and -1 were considered to have less severe FGR.
Results:
The more severe the growth restriction in utero, the lower the level of function on multiple cognitive and academic achievement assessments performed at age 10 years. Growth-restricted children were also more likely than their extremely preterm peers to have social awareness impairments, autistic mannerisms, autism spectrum diagnoses, difficulty with semantics and speech coherence, and diminished social and psychosocial functioning. They also more frequently had phobias, obsessions, and compulsions (according to teacher, but not parent, report).
Conclusions:
Among children born extremely preterm, those with severe FGR appear to be at increased risk of multiple cognitive and behavioral dysfunctions at age 10 years, raising the possibility that whatever adversely affected their intrauterine growth also adversely affected multiple domains of cognitive and neurobehavioral development.