BACKGROUND AND OBJECTIVE: Children who experienced intrauterine growth restriction (IUGR) may be at increased risk for adverse developmental outcomes in early childhood. The objective of this study was to carry out a systematic review of neurodevelopmental outcomes from 6 months to 3 years after IUGR.METHODS: PubMed, Embase, PsycINFO, Maternity and Infant Care, and CINAHL databases were searched by using the search terms intrauterine, fetal, growth restriction, child development, neurodevelopment, early childhood, cognitive, motor, speech, language. Studies were eligible for inclusion if participants met specified criteria for growth restriction, follow-up was conducted within 6 months to 3 years, methods were adequately described, non-IUGR comparison groups were included, and full English text of the article was available. A specifically designed data extraction form was used. The methodological quality of included studies was assessed using well-documented quality-appraisal guidelines. RESULTS:Of 731 studies reviewed, 16 were included. Poorer neurodevelopmental outcomes after IUGR were described in 11. Ten found motor, 8 cognitive, and 7 language delays. Other delays included social development, attention, and adaptive behavior. Only 8 included abnormal Doppler parameters in their definitions of IUGR.CONCLUSIONS: Evidence suggests that children are at risk for poorer neurodevelopmental outcomes following IUGR from 6 months to 3 years of age. The heterogeneity of primary outcomes, assessment measures, adjustment for confounding variables, and definitions of IUGR limits synthesis and interpretation. Sample sizes in most studies were small, and some examined preterm IUGR children without including term IUGR or AGA comparison groups, limiting the value of extant studies.

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OBJECTIVE:To determine whether cerebral lactate as measured on fetal MR spectroscopy (MRS) is predictive of cesarean delivery (CD) during labor in pregnancies complicated by complex congenital heart disease (CHD). STUDY DESIGN: We performed an exploratory secondary analysis of a prospective cohort study of term women with singleton gestations who had fetuses with CHD that would require neonatal open-heart surgery. All patients underwent fetal MRI with spectroscopy (MRS) and cerebral lactate was quantified using LCModel. Primary outcome was incidence of unscheduled CD. Secondary outcomes included neonatal resuscitation outcomes. RESULTS: A total of 79 women underwent a fetal MRI at a mean gestation of 32 weeks (range: 20.8-39.0 weeks); 41 (51.9%) of which had positive cerebral lactate in the fetus. Demographic data including maternal age, gestational age at delivery and classification of fetal CHD did not differ between groups. However, fetuses with positive cerebral lactate were studied earlier in gestation in comparison to fetuses without lactate (30.9 AE 4.3 weeks vs 33.2 AE 4.1 weeks, p ¼ 0.02). In the 41 fetuses with lactate, 10 (24.4%) were delivered via CD during labor in comparison to 7 fetuses (18.4%) without fetal lactate, p ¼ 0.52. Fetuses with detectable cerebral lactate delivered via spontaneous vaginal delivery (SVD) with an incidence of 51.2% (21/41) in comparison to 36.8% (14/38) of fetuses without cerebral lactate, p ¼ 0.20. Apgar score at 5 minute was significantly lower in the lactate group 8.0 AE 0.2 vs 9.0 AE 0,2, p <0.001). Initial infant blood gas as well as postnatal lactate were not different between groups. CONCLUSION: In this pilot study of term fetuses with CHD we report that in utero cerebral anaerobic metabolism is commonly detected. The presence of prenatal cerebral lactate at fetal MRI in fetuses with CHD is undoubtedly complex. Further work is needed to determine the cause and consequence of prenatal cerebral lactate on postnatal outcome in CHD fetuses.