Intrauterine Growth Restriction, Head Size at Birth, and Outcome in Very Preterm Infants

Isabelle Guellec (1, 2, 3) , Stéphane Marret (4, 5) , Olivier Baud (6) , Gilles Cambonie (7, 8) , Alexandre Lapillonne (2, 9) , Jean-Christophe Roze (10) , Jeanne Fresson (11, 12) , Cyril Flamant (10) , Marie-Laure Charkaluk (11) , Catherine Arnaud (13) , Pierre-Yves Ancel (11, 14)

1 CRESS - U1153 - Equipe 1 : EPOPé - Épidémiologie Obstétricale, Périnatale et Pédiatrique
2 AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP)
3 CHU Trousseau [APHP]
4 NU - Normandie Université
5 IFRMP 23 - Institut Fédératif de Recherches Multidisciplinaires sur les Peptides
6 PROTECT - Neuroprotection du Cerveau en Développement / Promoting Research Oriented Towards Early Cns Therapies
7 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
8 UM - Université de Montpellier
9 Hôpital Necker - Enfants Malades [AP-HP]
10 CIC Plurithématique de Nantes
11 CRESS (U1153 / UMR_A_1125 / UMR_S_1153) - Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité
12 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
13 LEASP - Epidémiologie et analyses en santé publique : risques, maladies chroniques et handicaps
14 UPD5 - Université Paris Descartes - Paris 5

OBJECTIVES: To determine whether small head circumference (HC) or birth weight (BW) or both are associated with neonatal and long-term neurologic outcome in very preterm infants. STUDY DESIGN: All 2442 live births from the 1997 Epipage study between 26 and 32 weeks of gestational age in 9 regions of France were analyzed. A total of 1395 were tested at age 5 years for cognitive performance and 1315 with school performance reports at age 8 years. Symmetric growth restriction (SGR) was defined by HC and BW <20th percentile and in the same percentile range, and asymmetric growth restriction by at least 1 of HC and BW <20th percentile and the other in a higher decile range. There were 2 forms of asymmetric growth restriction: head growth restriction (HGR) and weight growth restriction (WGR). Appropriate for gestational age was defined by both BW and HC >20th percentile. RESULTS: Compared with appropriate for gestational age, SGR was significantly associated with neonatal mortality (aOR 2.99, 95% CI 1.78-5.03), moderate and severe cognitive deficiency (aOR 1.65, 95% CI 1.01-2.71 and aOR 2.61, 95% CI 1.46-4.68, respectively), and poor school performance (aOR 1.79; 95% CI 1.13-2.83). HGR was significantly associated with severe cognitive deficiency (aOR 2.07, 95% CI 1.15-3.74). WGR was not significantly associated with cognitive or school performance despite higher rates of neonatal morbidity. CONCLUSIONS: SGR in preterm infants was associated with neonatal mortality and impaired cognitive and school performance. The outcome of asymmetric growth restriction differed according to HC. HGR was associated with impaired cognitive function; WGR was not.

Domaines: Pédiatrie

Isabelle Guellec, Stéphane Marret, Olivier Baud, Gilles Cambonie, Alexandre Lapillonne, et al.. Intrauterine Growth Restriction, Head Size at Birth, and Outcome in Very Preterm Infants. The Journal of Pediatrics, 2015, 167 (5), pp.975-981.e2. ⟨10.1016/j.jpeds.2015.08.025⟩. ⟨hal-01949438⟩