Outcome of very preterm small for gestational age infants: the first nine years of life

Abstract

Objective To determine the influence of intrauterine growth retardation of preterm infants on mortality and cognitive development.Design A nationwide study cohort of very preterm and/or small for gestational age infants (< 32 weeks and/or < 1500 g) born alive in 1983 in the Netherlands. Assessment on neuromotor and cognitive development at five years, and a parental questionnaire on school performance at nine years. Cognitive outcome is defined as handicap for mental and speech-language development, and need for special education.Sample 134 small for gestational age infants (< 10th centile) and 410 appropriate for gestational age infants (between 25th and 75th centile) of all infants between 25 and 32 weeks of gestational age were identified; infants with congenital malformations and not of Caucasian race were excluded.Main outcome measures Neonatal mortality, in-hospital and five years mortality; Cognitive outcome at five years; School performance at nine years. ResultsThe mortality risk for small for gestational age compared with appropriate for gestational age infants was significantly higher, after adjustment for gestational age, sex, multiple pregnancy and mode of delivery (OR 2-56,95% CI I *26-5.26). Small for gestational age infants showed more often gross motor and minor neurological dysfunction, but less cerebral palsy than appropriate for gestational age infants. Cognitive outcome at five years in small for gestational age infants was significantly worse than appropriate for gestational age infants stratified for mode of delivery OR 2.44 (95% CI 1.05-5-55). At nine years of age significantly more small for gestational age infants (1 6.4%) needed special education than appropriate for gestational age infants (1 1.9%). ConclusionIntrauterine growth retardation increases the risk of mortality and of cognitive disorders.

Early Alteration of Structural and Functional Brain Development in Premature Infants Born with Intrauterine Growth Restriction

“…Placental insufficiency, which is the most common cause of IUGR, has further been shown to be associated with a considerable perinatal mortality and long-term morbidity (9,10). Multiple follow-up studies of infants with IUGR have shown that fetal IUGR is associated with significant neurodevelopmental disabilities in fine and gross motor skills, cognitive function, activity, self-regulation, language, abstract reasoning, recognition memory, concentration, attention, mood, and school performance in both preterm and term infants (2,(11)(12)(13)(14)(15)(16)(17). Neurostructural correlations with these observed developmental disabilities in the human, which would help to understand the underlying mechanisms, are missing.…”

Thyroid hormone and central nervous system development

“…IUGR babies contribute significantly to perinatal and neonatal mortality and morbidity. Ten per cent of low birth weight babies suffer some degree of physical handicap (Gaffney 1994) and 5% show neurodevelopmental delay at age 9 (Kok et al 1998). In utero fetal blood sampling has shown that fetuses with severe IUGR have significantly lower levels of circulating free T4, free T3 and a slight elevation in TSH ( Thorpe-Beeston et al 1991b, Kilby et al 1998.…”

Color Doppler Evaluation of Cerebral - Umbilical Pulsatility Ratio and its Usefulness in the Diagnosis of Intrauterine Growth Retardation and Prediction of Adverse Perinatal Outcome

“…Intrauterine growth retardation is associated with an increased risk of perinatal mortality and morbidity and impaired neurodevelopment (Kok et al 1996) 3 . The correct detection of the compromised Intrauterine growth retardation fetus to allow for timely intervention is a main objective of antenatal care.…”