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Preterm or small-for-gestational-age infants. Neurological and behavioural development at the age of 6 years
M Hadders-Algra1, H J Huisjes, B C Touwen
1Department of Developmental Neurology, University Hospital, Groningen, The Netherlands.
Insights
Low birth weight infants, particularly preterm small-for-gestational-age (PT-SGA) babies, show higher rates of neurological abnormalities. Risk factors include prematurity, growth restriction, and neonatal condition, with timing influencing outcomes.
Area of Science:
- Pediatric Neurology
- Developmental Pediatrics
- Neonatology
Background:
- Low birth weight and prematurity are associated with adverse neurodevelopmental outcomes.
- Understanding risk factors and timing of insults is crucial for early intervention.
Purpose of the Study:
- To assess neurological abnormalities, behavior, and school achievement at age 6 in infants with different birth weights and gestational ages.
- To identify risk factors associated with major and minor neurological abnormalities.
Main Methods:
- Neurological examination at 6 years in 453 infants: FT-SGA, PT-AGA, PT-SGA, and FT-AGA.
- Data collection on behavior and school achievement.
- Multivariate analysis to determine risk factors for neurological abnormalities.
Main Results:
- Major and minor neurological abnormalities were more frequent in low birth weight groups, especially PT-SGA.
- Risk factors included prematurity, growth retardation, neonatal neurological status, social class, and neonatal course.
- Harmful factors had temporal differences: early pregnancy for handicap, later gestation/early life for minor neurological dysfunction (MND).
- Behavioral differences were minimal; school achievement linked to neurological condition and social class.
Conclusions:
- Prematurity and growth restriction significantly increase the risk of neurological abnormalities.
- Specific risk factors and their timing influence the type and severity of neurological dysfunction.
- Neurological condition and social class are key determinants of school achievement in early childhood.
Abstract:
In 166 full term, small-for-gestational-age (FT-SGA), 53 preterm, appropriate-for-gestational-age (PT-AGA), 27 PT-SGA and 206 FT-AGA infants a neurological examination at the age of 6 years was carried out. Data were collected on behaviour and school achievement. Major and minor neurological abnormalities were more frequent in the three low birth weight groups, especially in the PT-SGA group. Multivariate analysis showed that the development of major and minor neurological abnormalities was explained by a varying set of risk factors, in which besides prematurity and growth retardation, neonatal neurological condition, social class, neonatal course and interval complications were preponderant. The results suggest a temporal difference in potentially harmful factors: for neurological handicap early in pregnancy, for minor neurological dysfunction (MND) the second half of gestation and the first 2 years of life. No striking behavioural differences were found between the three low birth weight groups and the FT-AGA group; behaviour was related to neonatal and follow-up neurological condition, sex, gestational age and birth weight to a limited extent only. Three (4%) of the preterms entered a special school (already at the age of 6). School achievement was mainly related to the present neurological condition and social class, which underlines the importance of the latter.