Differential effects of intrauterine and postnatal brain growth failure in infants of very low birth weight
M. Hack, N. Breslau and A. A. Fanaroff
Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland.
We investigated the contribution of brain growth failure to outcome in
infants of very low birth weight (VLBW; less than 1.5 kg) who were
appropriate for gestational age (AGA; n = 379) or small for gestational age
(SGA; n = 102). Growth was assessed at birth, term, and 8 and 20 months'
corrected age and results of a Bayley Mental Developmental Index (MDI) and
neurologic examination were evaluated at 20 months of age. Both groups had
similar 20-month MDI scores (93 vs 90) and similar rates of neurologic
impairment (14% vs 10%). More SGA infants (25%) than AGA infants (14%) had
a subnormal head circumference at 8 months' corrected age, indicating
failure to catch up in head growth. Subnormal head size at 8 months
predicted the 20-month MDI score for both groups. However, multivariate
analysis indicated that, whereas subnormal 8-month head size was directly
associated with the MDI score in AGA children, in SGA children 8-month head
size was not significantly related to the MDI score when neonatal illness,
neurologic impairment, socioeconomic status, and race were controlled for.
We conclude that in AGA VLBW infants, subnormal head size at 8 months
results from major neonatal illness and has adverse later effects. In SGA
infants, subnormal head size at 8 months has many causes, including growth
retardation in utero, which may not have an adverse effect on outcome; if
subnormal head size is superimposed with neonatal illness, a poorer outcome
is likely.
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Carver
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:1550S-1554S.
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Carver et al.
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Six-Year Follow-Up of Children With Intrauterine Growth Retardation: Long-Term, Prospective Study
Leitner et al.
J Child Neurol 2000;15:781-786.
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Neurodevelopmental Outcome in Children With Intrauterine Growth Retardation: A 3-Year Follow-Up
Fattal-Valevski et al.
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Developmental Implications of Head Growth Following Intracranial Hemorrhage
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