Neurologic Outcomes at School Age in Very Preterm Infants Born With Severe or Mild Growth Restriction

Abstract

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.