Isabelle Guellec1, Stephane Marret2, Olivier Baud3, Gilles Cambonie4, Alexandre Lapillonne5, Jean-Christophe Roze6, Jeanne Fresson7, Cyril Flamant6, Marie-Laure Charkaluk8, Catherine Arnaud9, Pierre-Yves Ancel10. 1. Institut National de la Santé et de la Recherche Médicale (INSERM), UMR 1153, Equipe de recherche en Epidémiologie Obstétricale, Périnatale et Pédiatrique, Paris, France; Assistance Publique - Hôpitaux de Paris, Department of Neonatology and Intensive Care, A. Trousseau Hospital, Paris, France. Electronic address: isabelle.guellec@trs.aphp.fr. 2. Rouen University Hospital, Neonatal Medicine, Rouen, France; Institute of Biomedical Research, University, Inserm Avenir Research Group, IFR 23, Rouen, France. 3. INSERM UMR 1141, Paris, France; Assistance Publique - Hôpitaux de Paris, Department of Neonatology, R. Debré Hospital, Paris, France. 4. Montpellier University Hospital Center, Neonatal and Pediatric Intensive Care Unit, Montpellier, France. 5. Assistance Publique - Hôpitaux de Paris, Department of Neonatology, Necker Hospital, Paris, France. 6. Nantes University, Department of Neonatology, Maternite Regionale, Clinical Epidemiology and Biostatistics Department France, Nantes University, INSERM CIC004, Nantes, France. 7. Institut National de la Santé et de la Recherche Médicale (INSERM), UMR 1153, Equipe de recherche en Epidémiologie Obstétricale, Périnatale et Pédiatrique, Paris, France; Clinical Epidemiology and Biostatistics Department, CHRU Nancy, France. 8. Institut National de la Santé et de la Recherche Médicale (INSERM), UMR 1153, Equipe de recherche en Epidémiologie Obstétricale, Périnatale et Pédiatrique, Paris, France. 9. Clinical Epidemiology and Biostatistics Department, CHRU Nancy, France. 10. Institut National de la Santé et de la Recherche Médicale (INSERM), UMR 1153, Equipe de recherche en Epidémiologie Obstétricale, Périnatale et Pédiatrique, Paris, France; Centre de Recherche Epidémiologie et Statistique Sorbonne Paris Cité DHU Risques et grossesse Université Paris Descartes, Paris, France.
Abstract
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.
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.
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