Pathways of neuronal and cognitive development in children born small‐for‐gestational age or late preterm

• Published in: Ultrasound in obstetrics & gynecology 2014-01, Vol.43 (1), p.41-47
• Main Authors: Oros, D., Altermir, I., Elia, N., Tuquet, H., Pablo, L. E., Fabre, E., Pueyo, V.
• Format: Article
• Language: English
• Subjects: Adolescent; Age; Child; Child Development; Cognition Disorders - diagnosis; Cognition Disorders - physiopathology; cognitive outcome; Cross-Sectional Studies; Female; Humans; Infant, Premature; Infant, Small for Gestational Age; late preterm; Male; Odds Ratio; Optic Nerve - physiopathology; optical coherence tomography; Retina - physiopathology; retinal nerve fiber layer; small‐for‐gestational age; Surveys and Questionnaires; Tomography, Optical Coherence; Vision Tests
• ISSN: 0960-7692; 1469-0705
• DOI: 10.1002/uog.12556

ABSTRACT Objective To assess the effects of late small‐for‐gestational‐age (SGA) birth and late prematurity on cognitive outcomes and structural changes in the central nervous system at primary school age, using a novel approach to examine changes in neuronal integrity of the retina. Methods We conducted a cross‐sectional study of 347 children aged 6–13 years, including in the analysis only infants born after 34 weeks' gestation. We recorded all perinatal outcomes through a survey of parents. Neuronal damage was evaluated using optical coherence tomography of the retina. In a subgroup of 112 children aged 6–8 years, visuospatial perception was evaluated with the Children's Bender Visual Motor Gestalt Test. Results The proportions of SGA and late preterm children were 11.8 and 6.3%, respectively. Prematurity and SGA were simultaneously present in five children. When compared with controls, SGA children showed significantly lower than average retinal nerve fiber layer (RNFL) thickness (94.1 vs 98.8 μm; P = 0.007) and an increased percentage of abnormal Bender scores (27.3 vs 6.2%; P = 0.017) (odds ratio 5.6 (95% CI, 1.2–26.8)). These differences increased when late SGA infants with a birth weight below the 3rd percentile were compared with SGA infants with a birth weight between the 3rd and 10th percentiles and with controls, for RNFL thickness (92.5 vs 94.6 and 98.8 μm, respectively; P = 0.021) and abnormal Bender tests (33.3 vs 25.0 and 6.2%, respectively; P = 0.036). However, no differences were found in retinal structure and visuomotor performance between late preterm and term infants. Conclusions These data suggest that late SGA and late prematurity induce a distinct neuronal pattern of structural changes that persist at school age. Late‐onset SGA infants are at increased risk for axonal loss in the retina and present specific visuomotor difficulties. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.