Two-year neurological outcome of very-low-birth-weight children with prenatal absent or reversed end-diastolic flow velocity in the umbilical artery

Chen, Chen‐Yu; Wang, Kuo-Gon; Wang, Shwu-Meei

doi:10.1016/j.tjog.2012.04.039

Cited by 6 publications

(5 citation statements)

References 27 publications

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“…In total, 89 samples from 60 studies including 52 822 children compared preterm and term-born children who had IUGR and were SGA with children with AGA with respect to cognitive outcomes. A total of 48 studies reported results for mean cognitive scores, and 24 studies reported the percentages of group-specific children with BII …”

Section: Resultsmentioning

confidence: 99%

Association of Intrauterine Growth Restriction and Small for Gestational Age Status With Childhood Cognitive Outcomes

et al. 2020

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The magnitude of the association of intrauterine growth restriction (IUGR) and small for gestational age (SGA) status with cognitive outcomes in preterm and term-born children has not been established.OBJECTIVE To examine cognitive outcomes of preterm and term-born children who had IUGR and were SGA compared with children who were appropriate for gestational age (AGA) during the first 12 years of life.DATA SOURCES For this systematic review and meta-analysis, the Scopus, PubMed, Web of Science, Science Direct, PsycInfo, and ERIC databases were searched for English-language, peer-reviewed literature published between January 1, 2000, and February 20, 2020. The following Medical Subject Heading terms for IUGR and SGA and cognitive outcomes were used: intrauterine growth restriction, intrauterine growth retardation, small for gestational age AND neurodevelopment, neurodevelopmental outcome, developmental outcomes, and cognitive development.STUDY SELECTION Inclusion criteria were assessment of cognitive outcomes (full-scale IQ or a cognitive subscale), inclusion of an AGA group as comparison group, and inclusion of gestational age at birth and completion of cognitive assessment up to 12 years of age. DATA EXTRACTION AND SYNTHESISThe Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines were followed. Data were double screened for full-text articles, and a subset were independently coded by 2 authors. Standardized mean differences (SMDs) and odd ratios from individual studies were pooled by applying random-effects models. MAIN OUTCOMES AND MEASURESCognitive outcomes, defined as mental, cognitive, or IQ scores, estimated with standardized practitioner-based cognitive tests or as borderline intellectual impairment (BII), defined as mental, cognitive, or IQ scores at least 1 SD below the mean cognitive score. RESULTSIn this study of 89 samples from 60 studies including 52 822 children, children who had IUGR and were SGA had significantly poorer cognitive outcomes (eg, cognitive scores and BII) than children with AGA in childhood. For cognitive scores, associations are consistent for preterm (SMD, −0.27; 95% CI, −0.38 to −0.17) and term-born children (SMD, −0.39; 95% CI, −0.50 to −0.28), with higher effect sizes reported for term-born IUGR and AGA group comparisons (SMD, -0.58; 95% CI, -0.82 to -0.35). Analyses on BII revealed a significantly increased risk in the preterm children who had IUGR and were SGA (odds ratio, 1.57; 95% CI, 1.40-1.77) compared with the children with AGA.CONCLUSIONS AND RELEVANCE Growth vulnerabilities assessed antenatally (IUGR) and at the time of birth (SGA) are significantly associated with lower childhood cognitive outcomes in preterm and term-born children compared with children with AGA. These findings highlight the need to develop interventions that boost cognitive functions in these high-risk groups.

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Section: Resultsmentioning

confidence: 99%

Association of Intrauterine Growth Restriction and Small for Gestational Age Status With Childhood Cognitive Outcomes

et al. 2020

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“…We found that UA blood flow was better in NWMAA. Pathological UA blood flow relates to adverse outcome and neurological sequels [ 28 ]. Normal UA blood flow is almost never connected with adverse outcomes.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Tests in the Prediction of Neonatal Outcome in Early Placental Fetal Growth Restriction

et al. 2023

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Background and Objectives: Monitoring pregnancies with fetal growth restriction (FGR) presents a challenge, especially concerning the time of delivery in cases of early preterm pregnancies below 32 weeks. The aim of our study was to compare different diagnostic parameters in growth-restricted preterm neonates with and without morbidity/mortality and to determine sensitivity and specificity of diagnostic parameters for monitoring preterm pregnancies with early preterm fetal growth restriction below 32 weeks. Materials and Methods: Our clinical study evaluated 120 cases of early preterm deliveries, with gestational age ≤ 32 + 0 weeks, with prenatally diagnosed placental FGR. All the patients were divided into three groups of 40 cases each based on neonatal condition,: I—Neonates with morbidity/mortality (NMM); II—Neonates without morbidity with acidosis/asphyxia (NAA); III—Neonates without neonatal morbidity/acidosis/asphyxia (NWMAA). Results: Amniotic fluid index (AFI) was lower in NMM, while NWMAA had higher biophysical profile scores (BPS). UA PI was lower in NWMAA. NWMAA had higher MCA PI and CPR and fewer cases with CPR <5th percentile. NMM had higher DV PI, and more often had ductus venosus (DV) PI > 95th‰ or absent/reversed A wave, and pulsatile blood flow in umbilical vein (UV). The incidence of pathological fetal heart rate monitoring (FHRM) was higher in NMM and NAA, although the difference was not statistically significant. ROC calculated by defining a bad outcome as NMM and a good outcome as NAA and NWMAA showed the best sensitivity in DV PIi. ROC calculated by defined bad outcome in NMM and NAA and good outcome in NWMAA showed the best sensitivity in MCA PI. Conclusions: In early fetal growth restriction normal cerebral blood flow strongly predicts good outcomes, while pathological venous blood flow is associated with bad outcomes. In fetal growth restriction before 32 weeks, individualized expectant management remains the best option for the optimal timing of delivery.

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“…Other studies on pathological antenatal Doppler flow used less robust matching criteria with an increased UA resistance index >95 percentile instead of UA AREDF (8; 33) or smaller sample sizes with UA AREDF30 34 35 or included no control group,33 but showed also that pathological antenatal Doppler flow is associated with unfavourable cognitive outcome, but not with motor development in former VLBW infants at 2 years of age 33 34. Another study that compared only 16 very preterm infants with UA AREDF to GA-matched eutrophic controls found higher rates of mental delay and a tendency to more frequent motor problems at age 2 years, which was not surprising 35.…”

Section: Discussionmentioning

confidence: 99%

Neurodevelopmental outcome in very low birthweight infants with pathological umbilical artery flow

Brütsch

Burkhardt

Kurmanavičius

et al. 2015

Arch Dis Child Fetal Neonatal Ed

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VLBW infants with UA AREDF have a higher risk of poorer mental development during toddlerhood than controls matched for gestational age, birth weight, sex and year of birth. UA AREDF may be considered a prenatal predictor of poorer mental development in this population. Long-term follow-up studies with larger cohorts are needed to better evaluate the impact of this prenatal factor on later neurodevelopment.

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Two-year neurological outcome of very-low-birth-weight children with prenatal absent or reversed end-diastolic flow velocity in the umbilical artery

Abstract: VLBW children delivered earlier than 29 gestational weeks with abnormal umbilical blood flow velocity prenatally have greater mental developmental delay at 2 years of age.

Cited by 6 publications

References 27 publications

Association of Intrauterine Growth Restriction and Small for Gestational Age Status With Childhood Cognitive Outcomes

Association of Intrauterine Growth Restriction and Small for Gestational Age Status With Childhood Cognitive Outcomes

Diagnostic Tests in the Prediction of Neonatal Outcome in Early Placental Fetal Growth Restriction

Neurodevelopmental outcome in very low birthweight infants with pathological umbilical artery flow

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