Neurodevelopmental outcome in 2-year-old infants who were small-for-gestational age term fetuses with cerebral blood flow redistribution.

Abstract

To assess the neurodevelopmental outcome at 2 years of age of children who had been small-for-gestational-age (SGA) term babies with cerebral blood flow redistribution. Perinatal outcome was assessed in a cohort of 97 term singleton appropriate-for-gestational-age and 125 term singleton SGA fetuses with normal umbilical artery Doppler, stratified according to the presence of cerebral blood flow redistribution. Neurodevelopmental outcome was assessed prospectively at 2 years of age by means of the 24-month Age & Stage Questionnaire (ASQ). Of the 125 SGA fetuses, 25 had redistribution of the cerebral blood flow, and 100 did not. There were no significant differences in perinatal outcome between these two SGA groups. At 2 years of age, children who had been SGA fetuses with middle cerebral artery (MCA) pulsatility index (PI) < 5(th) centile had a higher incidence of suboptimal neurodevelopmental outcome compared with those with normal MCA-PI (52% vs. 31%; P = 0.049) and a lower mean centile in communication (53.1 vs. 67.4; P = 0.006) and problem-solving (39.7 vs. 47.4; P = 0.04) areas. SGA fetuses with cerebral blood flow redistribution have a higher risk of subtle neurodevelopmental deficits at 2 years of age. This challenges the concept that fetal cerebral redistribution is an entirely protective mechanism and suggests MCA-PI as a risk stratifying factor for adverse neurodevelopmental outcome.