Six-Year Follow-Up of Children With Intrauterine Growth Retardation: Long-Term,Prospective Study

Abstract

This prospective study was designed to characterize the neurodevelopmental and cognitive difficulties specific to children with intrauterine growth retardation and to detect early clinical predictors of these difficulties. Eighty-one children with intrauterine growth retardation were monitored up to 6 to 7 years of age using biometric parameters, perinatal risk questionnaires, and detailed neurodevelopmental and cognitive assessments. Forty-one children served as age-matched, appropriate for gestational age controls. A significant difference in growth parameters (P < .001), neurodevelopmental score (P < .05), and IQ (P < .05) was found between the children with intrauterine growth retardation and controls. A specific profile of difficulties in coordination, lateralization, spatial and graphomotor skills, and abundance of associated movements is typical of the children with intrauterine growth retardation and hints at possible later learning disabilities. The clinical parameters best predicting neurodevelopmental outcome were the neonatal risk score (P < .05) and the weight and height at 6 years of age (P < .05). The children with intrauterine growth retardation with neonatal complications had lower neurodevelopmental scores than the controls but no difference in IQ. Intrauterine growth retardation children diagnosed prenatally had the same neurodevelopmental and IQ scores as those diagnosed at birth, probably due to the careful perinatal and obstetric care provided. Children with intrauterine growth retardation demonstrate a specific profile of neurodevelopmental disabilities at preschool age. Early diagnosis and intervention could probably reduce these difficulties to a minimum. (J Child Neurol 2000;15:781-786).

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References

Pryor JE : The identification and long-term effects of fetal growth restriction. Br J Obstet Gynaecol 1996; 103:1116-1122.

Leeson S. , Aziz N. : Customized fetal growth assessment. Br J Obstet Gynaecol 1997;104:648-651.

Harel S. , Tal-Posener E. , Kutai M. , et al: Intrauterine growth retardation and brain development: Parts I and II. Neurodevelopmental outcome. Int Pediatr 1991;6:114-120.

Kok JH , Den-Ouden AL , Verloove-Vanhorick SP , Brand R. : Outcome of very preterm small for gestational age infants: the first nine years of life. Br J Obstet Gynaecol 1998;105:162-168.

Hadders-Algra M. , Huisjes HJ , Touwen Bcl : Preterm or small-for-gestational-age infants: Neurological and behavioural development at the age of 6 years. Eur J Pediatr 1988;147:460-467.

Barker Djp : Intrauterine programming of coronary heart disease and stroke. Acta Paediatr 1997;423:178-182.

Hadders-Algra M. , Touwen BC : Body measurements, neurological and behavioural development in six-year-old children born preterm and/or small-for-gestational-age . Early Hum Dev 1990;22:1-13.

Harvey D. , Prince J. , Bunton J. , et al: Abilities of children who were small-for-gestational-age babies . Pediatrics 1982;69:296-300.

Low JA , Handley-Derry MH , Burke SO , et al: Association of intrauterine fetal growth retardation and learning deficits at age 9 to 11 years. Am J Obstet Gynecol 1992;167:1499-1505.

10.

Robertson Cmt , Etches PC , Kyle JM : Eight-year school performance and growth of preterm small-for-gestational-age infants: A comparative study with subjects matched for birth weight or for gestational age. J Pediatr 1990;116:19-26.

11.

Hawdon JM , Hey E. , Kolvin I. , Fundudis T. : Born too small — is outcome still affected? Dev Med Child Neurol 1990;32:943-953.

12.

Sung IK , Vohr B. , Oh W. : Growth and neurodevelopmental outcome of very low birth weight infants with intrauterine growth retardation: Comparison with control subjects matched by birth weight and gestational age. J Pediatr 1993;123:618-624.

13.

Goldenberg R. , Hack M. , Grantham-McGregor, Schurch B: Report of the IDECG/IUNS Working Group on IUGR effects on neurological, sensory, cognitive and behavioral function. Eur J Clin Nutr 1998 ;52:S1.

14.

Leibermann JR , Fraser D. , Weitzman S. , Glezerman M. : Birthweight curves in southern Israel populations . Isr J Med Sci 1993;29: 198-203.

15.

Neerhof MG : Causes of intrauterine growth restriction. Clin Perinatol 1995;22:375-385.

16.

Lapillonne A. , Peretti N. , Ho PS , Salle BL : Aetiology, morphology and body composition of infants born small-for-gestational-age. Acta Paediatr 1997;423:173-176.

17.

Spinillo A. , Capuzzo E. , Egbe TO , et al: Pregnancies complicated by idiopathic intrauterine growth retardation: Severity of growth failure, neonatal morbidity and two-year infant neurodevelopmental outcome. J Reprod Med 1995;40:209-215.

18.

Hack M. , Breslau N. , Fanaroff AA : Differential effects of intrauterine and postnatal brain growth value in infants of very low birth weight. Am J Dis Child 1989 ;143:63-68.

19.

Harel S. , Tomer A. , Barak Y. , et al: The cephalization index: A screening device for brain maturity and vulnerability in normal and intrauterine growth retarded newborns. Brain Dev 1985;7:580-584.

20.

Prechtl Hfr : Assessment methods for newborn infant: A critical evaluation, in Stratton P (ed): Psychology of the Human Newborn . New York, John Wiley & Sons , 21.

21.

Wechsler D. : WPPSI — Wechsler Preschool and Primary Scale of Intelligence. WPPSI Manual. New York, The Psychological Corporation, 1967.

22.

Fattal-Valevski A. , Leitner Y. , Kutai M. , et al: Neurodevelopmental outcome in children with intrauterine growth retardation: A 3-year follow-up. J Child Neurol 1999; 14:724-727.