Neurologic outcomes at school age in very preterm infants born with severe or mild growth restriction

Pediatrics. 2011 Apr;127(4):e883-91. doi: 10.1542/peds.2010-2442. Epub 2011 Mar 7.


Objective: To determine whether mild and severe growth restriction at birth among preterm infants is associated with neonatal mortality and cerebral palsy and cognitive performance at 5 years of age and school performance at 8 years of age.

Methods: All 2846 live births between 24 and 32 weeks' gestation from 9 regions in France in 1997 were included in a prospective observational study (the EPIPAGE [Étude Epidémiologique sur les Petits Ages Gestationnels] study) and followed until 8 years of age. Infants were classified as "small-for-gestational-age" (SGA) if their birth weight for gestational age was at the <10th centile, "mildly-small-for-gestational-age" (M-SGA) if birth weight was at the ≥ 10th centile and <20th centile, and "appropriate-for-gestational-age" (AGA) if birth weight was at the ≥ 20th centile.

Results: Among the children born between 24 and 28 weeks' gestation, the mortality rate increased from 30% in the AGA group to 42% in the M-SGA group and to 62% in the SGA group (P < .01). Birth weight was not significantly associated with any cognitive, behavioral, or motor outcomes at the age of 5 or any school performance outcomes at 8 years. For the children born between 29 and 32 weeks' gestation, SGA children had a higher risk for mortality (adjusted odds ratio [aOR]: 2.79 [95% confidence interval (CI): 1.50-5.20]), minor cognitive difficulties (aOR: 1.73 [95% CI: 1.12-2.69]), inattention-hyperactivity symptoms (aOR: 1.78 [95% CI: 1.10-2.89]), and school difficulties (aOR: 1.74 [1.07-2.82]) compared with AGA children. Being born M-SGA was associated with an increased risk for minor cognitive difficulties (aOR: 1.87 [95% CI: 1.24-2.82]) and behavioral difficulties (aOR: 1.66 [95% CI: 1.04-2.62]).

Conclusions: In preterm children, growth restriction was associated with mortality, cognitive and behavioral outcomes, as well as school difficulties.

MeSH terms

  • Brain Damage, Chronic / diagnosis*
  • Brain Damage, Chronic / mortality
  • Child
  • Child Behavior Disorders / diagnosis
  • Child Behavior Disorders / mortality
  • Child, Preschool
  • Cognition Disorders / diagnosis
  • Cognition Disorders / mortality
  • Female
  • Fetal Growth Retardation / diagnosis*
  • Gestational Age
  • Humans
  • Infant
  • Infant, Extremely Low Birth Weight*
  • Infant, Newborn
  • Infant, Premature, Diseases / diagnosis*
  • Infant, Premature, Diseases / mortality
  • Infant, Small for Gestational Age*
  • Infant, Very Low Birth Weight*
  • Learning Disabilities / diagnosis
  • Learning Disabilities / mortality
  • Male
  • Neurologic Examination*
  • Neuromuscular Diseases / diagnosis
  • Neuromuscular Diseases / mortality
  • Risk Factors
  • Survival Rate