1. HEAD GROWTH AND NEURODEVELOPMENTAL OUTCOME AT 1 YEAR FOLLOWING FETAL GROWTH RESTRICTION
M. Boyle1,3,4, R.Pinnamaneni 2,3,4, F. Malone 2,4, J. Unterscheider 2,4, N. McCallion 2,3,4, A.Foran 2,3,4
Rosie Hospital, Cambridge University Hospitals NHS Foundation trust, UK
Rotunda Hospital, Dublin, Ireland
Children’s University Hospital, Temple Street, Dublin, Ireland
Royal College of Surgeons of Ireland
Introduction
Intrauterine growth restriction (IUGR) infants can be defined as babies whose birth weights lie below the 10th percentile for that gestational age, and affects up to 10% of all pregnancies.
Approximately 5 to 10% of pregnancies complicated by IUGR will result in either stillbirth or neonatal death 1,2.
The effects of IUGR continue beyond the neonatal period and may have a profound impact on child growth and development.
With the advent of more detailed antenatal monitoring of growth restriction, Doppler measurement of umbilical artery (UA) flow has been used to identify those at risk for adverse perinatal and longer-term neurodevelopmental outcome.*
Absence of abnormal UA blood flow on Doppler measurement does not necessarily translate to normal developmental outcome.
Studies have shown that near term IUGR and SGA with normal Doppler measurements also have increased rates of adverse neurodevelopmental outcome.*
In one study of 1116 fetuses ( PORTO study), abnormal Doppler was significantly associated with adverse obstetric and neonatal outcomes, regardless of estimated fetal weight*.
Results
74 infants were recruited, 63 had an EFW <10th centile (IUGR) and 11 infants were term infants (controls) whose weight was appropriate for their gestational age (AGA).
Of the 63 SGA infants, 34 had had abnormal ultrasound Dopplers and 29 had normal Dopplers.
The mean age at completion of the ASQ and measurement of OFC was 12 and months respectively.
Successful 1-year follow up was achieved in 60/73 (82%) infants for ASQ, 61/73 (84%) for OFC with a combined follow up rate of 59/73 (81%).
The results of the 12-month ASQ-3 did not show a statistically significant difference between the groups for total score.
Differences were statistically significant in the domains of communication and personal- social between the group with abnormal dopplers and controls.
There were no significant differences identified between normal and abnormal Doppler groups (See table 1).
Table 1. Comparison of ASQ-3 Scores (12 months) between the groups. Individual scores reported as median value and total score as mean value. ANOVA test was used for group differences for total score and personal-social and the Kruskal-Wallis test was used for all other analysis.
Head circumference and growth trajectory over the first year was measured. The difference between groups OFC was statistically significant at delivery (p<0.0001), but not at 1 year (p=0.8074) which implies that the groups start off different and normalise to similar levels at one year of age. (Fig.1)
Fig.1 OFC trends from delivery to year 1 in the 3 groups
Participants were recruited from the PORTO (Prospective Observational Trial to Optimize paediatric health in IUGR infants) study. From this cohort, 74 infants were recruited into the StOOPS (Short- term surrogate Outcome Of infants in the PORTO) study.
Informed consent was obtained; background data and birth anthropometry measurements were recorded.
All 74 infants had a detailed 3T MRI brain at term corrected gestational age ( weeks). At 1 year corrected age participant parents were asked to complete a 12 month Ages and Stages Questionnaire (ASQ-3) .An Occipito-frontal circumference (OFC) was measured by the General Practitioner or health visitor.
Materials and Methods
IUGR babies had lower OFC’s compared to AGA infants at delivery, however by 1 year this difference normalized.
IUGR infants scored lower than controls in communication and personal-social component of the ASQ-3; this difference was not significant between the normal and abnormal Doppler groups.
References