Children Born with Intrauterine Growth Restriction: Neurodevelopmental Outcome
Intrauterine growth restriction (IUGR) is a pathological prenatal process that is characterized by a decrease in fetal growth velocity, resulting in a fetus that did not attain its full growth potential. It has heterogeneous parental, placental, and fetal triggering mechanisms. IUGR rates are increased in multiple rearing conditions where fetal under-nutritional processes are evoked. IUGR is thought to elicit a fetal programming process that has lifelong repercussions. IUGR is often accompanied by increased prenatal, perinatal, and postnatal complications. Processes aimed at conserving vitality take place, but these processes do not suffice to preserve neurodevelopmental integrity. The neurodevelopmental deficits are often mild, comprised of changes in muscle tone, arousal, coordination deficits, visuo-motor and visuospatial organizational deficits, lower verbal skills, lower intellectual competence, attention and executive disorders, and emotion regulation difficulties. Increased risk for learning disabilities is noted as well. Neurodevelopmental outcome is mediated primarily by growth catch-up velocity. Weight and height gain rates are of particular predictive value during early infancy, while head circumference is of added value later on during childhood. Socioeconomical support systems and socioemotional processes may moderate outcome. Intervention with IUGR-related processes requires the attention and care of well-coordinated multidisciplinary medical and paramedical teams. Practical guidelines are presented.
KeywordsHead Circumference Somatic Growth Neurodevelopmental Outcome Neonatal Complication Specific Learning Disability
Intrauterine growth restriction
We would like to extend our gratitude to the Gulton Foundation support, awarded to Prof. Harel and to the Israeli Science Foundation grant awarded to Dr. Ronny Geva. This chapter presents an integrative framework that was initiated and enabled by the IUGR research team at the Child Development Center, Tel Aviv Medical Center and the Psychology Department, Bar-Ilan University, Israel.
- Evensen KA, Steinshamn S, Tjønna AE, Stølen T, Høydal MA, Wisløff U, Brubakk AM, Vik T. Effects of preterm birth and fetal growth retardation on cardiovascular risk factors in young adulthood. Early Hum Dev. 2009;85(4):239–45.Google Scholar
- Fattal-Valevski A, Leitner Y, Kutai M, Tal-Posner E, Tomer A, Lieberman D, Jaffa A, Many A, Harel S. Neurodevelopmental outcome in children with intrauterine growth retardation: a 3-year follow-up. J Child Neurol. 1999;14:724–27.Google Scholar
- Fernández-Carrocera LA, Patino-Felix F, Udaeta-Mora E, Garza Morales S, Ibarra-Reyes MP, Rodriquez-Perez, L. Subependymal/intraventricular hemorrhage in preterm newborn infants. Neurodevelopmental course during the first year of life. Bol Med Hosp Infant Mex. 1993;50(4):241–7.Google Scholar
- Field T, Diego M, Hernandez-Reif M. Prematurity and potential predictors. Int J Neurosci. 2008;118:277–89.Google Scholar
- Geva R, Yosipof R, Eshel R, Leitner Y, Fattal-Valevski A, Harel S. Readiness and adjustments to school for children with intrauterine growth restriction (IUGR): an extreme test case paradigm. Except Child. 2009;75:211–30.Google Scholar
- Harel S, Tomer A, Barak Y, Binderman I, Yavin E. The cephalization index: a screening device for brain maturity and vulnerability in normal intrauterine growth retarded newborns. Brain Dev. 1985;7:580–84.Google Scholar
- Klevanov PK, Brooks-Gunn J, McCormick MC. Classroom behavior of very low birth weight elementary school children. Pediatrics 1994;94:700–8.Google Scholar
- Leitner Y, Bloch AM, Sadeh A, Neuderfer O, Tikotzky L, Harel S. Sleep-wake patterns in children with intrauterine growth retardation. J Child Neurol. 2002;17:872–76.Google Scholar
- Leitner Y, Fattal-Valevski A, Geva R, Eshel R, Toledano-Alhadef H, Rostein R, Bassan H, Radianu B, Bitchonsky O, Jaffa A, Harel S. Neurodevelopmental outcome of children with intrauterine growth retardation (IUGR): a longitudinal, 10-year prospective study. J Child Neurol. 2006;14:724–27.Google Scholar
- Leitner Y, Fattal-Valevski A, Geva R, Eshel R, Toledano-Alhadef H, Rotstein M, Bassan H, Radianu B, Bitchonsky O, Jaffa AJ, Harel S. Neurodevelopmental outcome of children with intrauterine growth retardation: a longitudinal, 10-year prospective study. J Child Neurol. 2007;22:580–7.PubMedCrossRefGoogle Scholar
- Ulman KH. An integrative model of stress management groups for women. Int J Group Psychother. 2000;50:341–62.Google Scholar
- Villar J, Farnot U, Barros F, Victora C, Langer A, Belizan JM. A randomized trial of psychosocial support during high-risk pregnancies. The Latin American network for perinatal and reproductive research. N Engl J Med. 1992;327:1266–71.Google Scholar
- Wilson DA, Cutfield WS, Hofman PL. Pubertal consequences of being born small for gestational age. Contemp Endocrinol. 2007;4:247–66.Google Scholar
- World Health Organization. Fetomaternal nutrition and low birth weight. http://www.who.int/nutrition/topics/feto_maternal/en/index.html (2008).