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The preterm small-for-gestational age infant: a two-year follow-up study
Insights
Preterm infants small for gestational age (SGA) weighing under 1,500 grams showed favorable neurologic and developmental outcomes. These findings support clinical decisions for managing intrauterine growth restriction.
Area of Science:
- Neonatal neurology
- Developmental pediatrics
- Perinatal medicine
Background:
- Small-for-gestational age (SGA) infants born preterm (<30 weeks gestation) or at term have historically shown poor neurologic and developmental outcomes.
- Obstetric decisions for SGA fetuses often occur between 30 and 38 weeks gestation, making the outcomes of these survivors clinically relevant.
Purpose of the Study:
- To evaluate the neurologic and developmental outcomes of preterm small-for-gestational age (SGA) infants weighing less than 1,500 grams during the first two years of life.
- To compare the growth and neurodevelopmental trajectories of SGA infants with those of appropriate-for-gestation (AGA) infants.
Main Methods:
- A cohort of 28 surviving preterm SGA infants (birth weight <1,500g) were followed for two years.
- SGA infants were pair-matched with appropriate-for-gestation (AGA) infants based on birth weight.
- Evaluations included physical growth measurements (weight, length, head circumference), quarterly neurologic examinations, and quarterly Bayley Scales of Infant Development scores.
Main Results:
- SGA infants' weight, length, and head circumference reached the tenth percentile by 6-8 months, comparable to AGA infants.
- Neurologic examinations revealed similar findings between SGA and AGA groups during the first year.
- While SGA infants had lower Bayley scores initially, both groups showed similar scores by 24 months; two SGA infants had diplegia, and one AGA infant had hemiplegia at 2 years.
Conclusions:
- Preterm small-for-gestational age (SGA) infants weighing less than 1,500 grams demonstrate favorable neurologic and developmental outcomes.
- These findings provide valuable information for clinical management of mothers with suspected intrauterine growth restriction, particularly regarding delivery timing.
Abstract:
Previous investigators have reported unfavorable neurologic and developmental outcome of small-for-gestational age (SGA) infants (birth weight less than 1,500 grams born at term or at less than 30 weeks. of gestation. Since obstetrical considerations for the delivery of a SGA fetus often arise between 30 and 38 weeks, the outcome of these survivors becomes a relevant issue. In 1975 and 1976, twenty-eight of 47 such infants survived and 21 were followed sequentially during the first two years. Their birth weight was 1,220 +/- 195 grams (mean +/- S.D.) and the gestation 33.4 +/- 2 weeks. Each SGA infant was paired with a birth weight-matched appropriate-for-gestation (AGA) infant whose birth weight was 1,195 +/- 190 grams and gestation 29 +/- 2 weeks. The weight, length, and head circumference of the SGA infants attained the tenth percentile by 6 to 8 months and were similar to the AGA group. Quarterly neurologic examinations showed similar findings during the first year in the two groups. At 2 years, two SGA (diplegia) and one AGA (hemiplegia) infants were abnormal. The quarterly Bayley scores of the SGA infants were lower during the first 18 months but at 24 months, the two groups had similar scores. The favorable outcome in preterm SGA infants weighing less than 1,500 grams may serve as useful information in making clinical decisions for the management of mothers with suspected intrauterine growth retardation.