Neurodevelopmental outcome of full‐term small‐for‐gestational‐age infants with normal placental function

Savchev, S.; Sanz‐Cortes, M.; Cruz‐Martínez, R.; Arranz, A.; Botet, Francesc; Gratacós, Eduard; Figueras, F.

doi:10.1002/uog.12391

Cited by 123 publications

(104 citation statements)

References 48 publications

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“…On the other end, there will always be a proportion of ‘constitutionally small' fetuses, among those diagnosed as FGR, although current evidence suggests though that this number is small. Indeed, poorer perinatal outcomes [19,40,42,43], long-term neurologic [44,45,46] and cardiovascular [47,48] development, and placental abnormalities are present in a large fraction of fetuses with EFW <10th percentile.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of an Optimal Gestational Age Cut-Off for the Definition of Early- and Late-Onset Fetal Growth Restriction

et al. 2013

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Objective: The terms early- and late-onset fetal growth restriction (FGR) are commonly used to distinguish two phenotypes characterized by differences in onset, fetoplacental Doppler, association with preeclampsia (PE) and severity. We evaluated the optimal gestational age (GA) cut-off maximizing differences among these two forms. Patients and Methods: A cohort of 656 consecutive singleton pregnancies with FGR was created. We used the decision tree analysis to evaluate the GA cut-off that best discriminated perinatal mortality, association with PE and adverse perinatal outcome (fetal demise, early neonatal death, neonatal acidosis at birth, and 5-min Apgar score <7). Results: We identified 32 weeks at diagnosis as the optimal cut-off, resulting in two groups with 7.1 and 0%, p < 0.001 perinatal mortality, 35.1 and 12.1%, p < 0.001 association with PE, and 13.4 and 4.6%, p < 0.001 composite adverse perinatal outcome. Abnormal versus normal umbilical artery (UA) Doppler classified two groups with 10.6 and 0.2%, p < 0.001 perinatal mortality, 50.0 and 11.8%, p < 0.001 association with PE, and 18.2 and 4.2%, p < 0.001 composite adverse perinatal outcome. Conclusions: UA Doppler discriminated better the two forms of FGR with average early- and late-onset presentation, higher association with PE and poorer outcome. In the absence of UA information, a GA cut-off of 32 weeks at diagnosis maximizes differences between early- and late-onset FGR.

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Section: Discussionmentioning

confidence: 99%

Evaluation of an Optimal Gestational Age Cut-Off for the Definition of Early- and Late-Onset Fetal Growth Restriction

et al. 2013

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“…From a clinical perspective, given the high prevalence of late-onset small fetuses and its impact on neurodevelopment [1,2,5,7], early detection of those small fetuses at higher risk for a suboptimal neurodevelopment is a critical goal in order to trigger strategies such as delivery planning, breast-feeding promotion and early educational interventions, which have shown to improve the neurodevelopmental outcome in similar populations at risk [44,45]. Ultrasonographic assessment of the CC can be obtained with low inter-observer variation in experienced hands [18,19].…”

Section: Discussionmentioning

confidence: 99%

“…At this stage of pregnancy, to make a distinction between IUGR associated with placental insufficiency from other forms of fetal smallness, normally termed small for gestational age (SGA), can be challenging [6]. Abnormal neurodevelopment is among the most relevant consequences associated with fetal smallness [7,8,9]. Several studies have described brain reorganizational changes and neurodevelopment deficits [10,11,12].…”

Section: Introductionmentioning

confidence: 99%

Neurosonographic Assessment of the Corpus Callosum as Imaging Biomarker of Abnormal Neurodevelopment in Late-Onset Fetal Growth Restriction

Egaña-Ugrinovic¹,

Savchev²,

Bazán‐Arcos³

et al. 2015

Fetal Diagn Ther

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Objective: To explore corpus callosum (CC) developmental differences by ultrasound in late-onset small fetuses compared with adequate for gestational age (AGA) controls. Study Design: Ninety four small (estimated fetal weight <10th centile) and 71 AGA fetuses were included. Small fetuses were further subdivided into fetal growth restriction (IUGR, n = 64) and small for gestational age (SGA, n = 30) based on poor perinatal outcome factors, that is, birth weight <3rd centile and/or abnormal cerebroplacental ratio and/or uterine artery Doppler. The entire cohort was scanned to assess CC by transvaginal neurosonography obtaining axial, coronal and midsagittal images. CC length, thickness, total area and the areas after a subdivision in 7 portions were evaluated by semiautomatic software. Furthermore, the weekly average growth of the CC in each study group was calculated and compared. Results: Small fetuses showed significantly shorter (small fetuses: 0.49 vs. AGA: 0.52; p < 0.01) and smaller CC (1.83 vs. 2.03; p < 0.01) with smaller splenium (0.47 vs. 0.55; p < 0.01) compared to controls. The CC growth rate was also reduced when compared to controls. Changes were more prominent in small fetuses with abnormal cerebroplacental Doppler suggesting fetal growth restriction. Conclusions: Neurosonographic assessment of CC showed significantly altered callosal development, suggesting in-utero brain reorganization in small fetuses. This data support the potential value of CC assessment by US to monitor brain development in fetuses at risk.

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“…Recent observational studies indicate that neither UA status nor cerebral Doppler studies stratified the risk for cognitive development in term FGA pregnancies [72,73]. In the DIGITAT trial, randomization of delivery timing with safety criteria to intervene for fetal indications did not produce any significant differences in early infant development either [74].…”

Section: Fetal Deterioration Before Deliverymentioning

confidence: 99%

Neurodevelopment after Fetal Growth Restriction

2013

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Fetal growth restriction (FGR) can emerge as a complication of placental dysfunction and increases the risk for neurodevelopmental delay. Marked elevations of umbilical artery (UA) Doppler resistance that set the stage for cardiovascular and biophysical deterioration with subsequent preterm birth characterize early-onset FGR. Minimal, or absent UA Doppler abnormalities and isolated cerebral Doppler changes with subtle deterioration and a high risk for unanticipated term stillbirth are characteristic for late-onset FGR. Nutritional deficiency manifested in lagging head growth is the most powerful predictor of developmental delay in all forms of FGR. Extremes of blood flow resistance and cardiovascular deterioration, prematurity and intracranial hemorrhage increase the risks for psychomotor delay and cerebral palsy. In late-onset FGR, regional cerebral vascular redistribution correlates with abnormal behavioral domains. Irrespective of the phenotype of FGR, prenatal tests that provide precise and independent stratification of risks for adverse neurodevelopment have yet to be determined.

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Neurodevelopmental outcome of full‐term small‐for‐gestational‐age infants with normal placental function

Abstract: Objective To evaluate the 2-year neurodevelopmental outcome of full-term, small-for-gestational-age

Cited by 123 publications

References 48 publications

Evaluation of an Optimal Gestational Age Cut-Off for the Definition of Early- and Late-Onset Fetal Growth Restriction

Evaluation of an Optimal Gestational Age Cut-Off for the Definition of Early- and Late-Onset Fetal Growth Restriction

Neurosonographic Assessment of the Corpus Callosum as Imaging Biomarker of Abnormal Neurodevelopment in Late-Onset Fetal Growth Restriction

Neurodevelopment after Fetal Growth Restriction

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