Neurological follow-up of small-for-gestational age newborn infants: a study of risk factors related to prognosis at one year of age

Evolução neurológica do recém-nascido pequeno para a idade gestacional: estudo de fatores de risco relacionados ao prognóstico com 1 ano de vida

José Luiz D. Gherpelli Helvetia Ferreira Helenice P.F. Costa About the authors

Abstracts

To examine the relative importance of some risk factors and neurological prognosis in the first year of life, 37 small-for-gestational age newborns were followed prospectively to 1 year of conceptional age. An abnormal neurological examination was found in 51.3% of the newborns and, at 12 months, 32.5% were still considered abnormal. Only 8.1% of the group had severe neurological sequelae at 1 year of corrected age. The developmental tests showed little changes during the first year, with abnormality rates varying from 16.1 to 25%. The following risk factors were analyzed concerning their relation to neurological and developmental abnormalities: high-risk pregnancy, maternal hypertension, social class, pre-term birth, neonatal asphyxia and weight and height less than 2.5 percentile at the age of 1 year. The statistical analysis showed a high correlation between subnormal weight gain and neurological (p=0.000l) and developmental (p=0.001) abnormalities at 1 year. None of the other risk factors were statistically related to neurological prognosis at 1 year.

small-for-gestational newborn infants; neurological follow-up; prognosis; risk factors


Para estudarmos a importância relativa de alguns fatores de risco sobre o prognóstico neurológico, no primeiro ano de vida, 37 recém-nascidos (RN) pequenos para a idade gestacional (PIG) foram seguidos, prospectivamente, até 1 ano de idade concepcional. O exame neurológico neonatal foi anormal em 51,3% das crianças e, aos 12 meses, 32,3% ainda apresentavam anormalidades neurológicas. Entretanto, somente 8,1% das crianças apresentavam anormalidades neurológicas severas, com 1 ano de idade. Os testes de desenvolvimento apresentaram taxas de anormalidades que variaram de 16 a 25%, nas várias faixas etárias. Os seguintes fatores de risco foram analisados em relação à sua interferência com o prognóstico neurológico: gestação de alto risco, hipertensão arterial materna, nivel sócio-econômico materno, prematuridade, asfixia neonatal e peso e estatura abaixo do percentil 2,5, na idade de 1 ano. A análise estatística demonstrou correlação altamente significativa entre presença de anormalidades neurológicas (p=0,000l) e no teste de desenvolvimento (p=0,001) e peso abaixo do percentil 2,5, na idade de 1 ano. Nenhum dos outros fatores de risco apresentou correlação significativa com o prognóstico neurológico, na idade de 1 ano.

recém-nascido pequeno para a idade gestacional; evolução neurológica; prognóstico; fatores de risco


Neurological follow-up of small-for-gestational age newborn infants: a study of risk factors related to prognosis at one year of age

Evolução neurológica do recém-nascido pequeno para a idade gestacional: estudo de fatores de risco relacionados ao prognóstico com 1 ano de vida

José Luiz D. GherpelliI; Helvetia FerreiraII; Helenice P.F. CostaIII

IMaternity-School Hospital of Vila Nova Cachoeirinha, São Paulo. Child Neurologist

IIMaternity-School Hospital of Vila Nova Cachoeirinha, São Paulo. Neonatologist

IIIMaternity-School Hospital of Vila Nova Cachoeirinha, São Paulo. Head of Neonatal Unit

SUMMARY

To examine the relative importance of some risk factors and neurological prognosis in the first year of life, 37 small-for-gestational age newborns were followed prospectively to 1 year of conceptional age. An abnormal neurological examination was found in 51.3% of the newborns and, at 12 months, 32.5% were still considered abnormal. Only 8.1% of the group had severe neurological sequelae at 1 year of corrected age. The developmental tests showed little changes during the first year, with abnormality rates varying from 16.1 to 25%. The following risk factors were analyzed concerning their relation to neurological and developmental abnormalities: high-risk pregnancy, maternal hypertension, social class, pre-term birth, neonatal asphyxia and weight and height less than 2.5 percentile at the age of 1 year. The statistical analysis showed a high correlation between subnormal weight gain and neurological (p=0.000l) and developmental (p=0.001) abnormalities at 1 year. None of the other risk factors were statistically related to neurological prognosis at 1 year.

Key words: small-for-gestational newborn infants, neurological follow-up, prognosis, risk factors.

RESUMO

Para estudarmos a importância relativa de alguns fatores de risco sobre o prognóstico neurológico, no primeiro ano de vida, 37 recém-nascidos (RN) pequenos para a idade gestacional (PIG) foram seguidos, prospectivamente, até 1 ano de idade concepcional. O exame neurológico neonatal foi anormal em 51,3% das crianças e, aos 12 meses, 32,3% ainda apresentavam anormalidades neurológicas. Entretanto, somente 8,1% das crianças apresentavam anormalidades neurológicas severas, com 1 ano de idade. Os testes de desenvolvimento apresentaram taxas de anormalidades que variaram de 16 a 25%, nas várias faixas etárias. Os seguintes fatores de risco foram analisados em relação à sua interferência com o prognóstico neurológico: gestação de alto risco, hipertensão arterial materna, nivel sócio-econômico materno, prematuridade, asfixia neonatal e peso e estatura abaixo do percentil 2,5, na idade de 1 ano. A análise estatística demonstrou correlação altamente significativa entre presença de anormalidades neurológicas (p=0,000l) e no teste de desenvolvimento (p=0,001) e peso abaixo do percentil 2,5, na idade de 1 ano. Nenhum dos outros fatores de risco apresentou correlação significativa com o prognóstico neurológico, na idade de 1 ano.

Palavras-chave: recém-nascido pequeno para a idade gestacional, evolução neurológica, prognóstico, fatores de risco.

Full text available only in PDF format.

Texto completo disponível apenas em PDF.

Aceite: 27-julho-1992.

Dr. José Luiz Gherpelli — Serviço de Neurologia Infantil, Divisão de Neurologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo — Caixa Postal 8091 — 01065-970 São Paulo SP — Brasil.

  • 1. Bourre JM, Morand O, Chanez C, Dumont O, Flexor MA. Influence of intrauterine malnutrition on brain development: alterations of myelination. Biol Neonate 1981, 39:96-99.
  • 2. Capurro H, Konichezky S, Fonseca D, Caldeyro-Barcia R. A simplified method for diagnosis of gestational age in the newborn infant. J Pediatr 1978, 93:120-122.
  • 3. Commey JO, Fitzhardinge PM. Handicap in the preterm small-for-gestational age infant. J Pediatr 1979, 779-786.
  • 4. Cravioto J, de Lacardie ER. Neurointegrative development and intelligence in children rehabilited from severe malnutrition. In Prescott JW, Read MS, Coursin DB (eds): Brain function and malnutrition. New York: John Wiley, 1975, p 53-72.
  • 5. Dobbing J. Undernutrition and the developing brain. Am J Dis Child 1970, 120:411-415.
  • 6. Dobbing J. Infant nutrition and later achievement. Nutr Rev 1984, 42:1-7.
  • 7. Dobbing J, Sands J. Vulnerability of developing brain not explained by cell number/ cell size hypothesis. Early Hum Dev 1981, 5:227-231.
  • 8. Dobbing J, Sands J. Cell size and cell number in tissue growth and development. Arch Fr Pediatr 1985, 42:199-203.
  • 9. Drillien CM. Abnormal neurologic signs in the first year of life in low-birthweight infants: possible prognostic significance. Dev Med Child Neurol 1972, 14:575-584.
  • 10. Drillien CM, Thomson AJM, Burgoyne K. Low-birthweight children at early school age: a longitudinal study. Dev Med Child Neurol 1980, 22:26-47.
  • 11. Dubowitz LMS, Dubowitz V, Goldberg C. A comparison of neurological function in growth retarded and appropriate sized full-term newborn infants in two ethnic groups. S Afr Med J 1982, 61:1003-1007.
  • 12. Dunn HG, Robertson AM, Crichton JU. Clinical outcome: neurological sequelae and their evolution. In Dunn, HG (ed): Sequelae of low-birthweight: the Vancouver study. Clinics in Developmental Medicine 95/6. Oxford: MacKeith Press, Blackwell, 1986, p 68-96.
  • 13. Dunn HG, Robertson AM, Schultzer M. Neurological correlations and predictions. In Dunn HG (ed): Sequelae of low-birthweight: the Vancouver study. Clinics in Developmental Medicine 95/6. Oxford: MacKeith Press, Blackwell, 1986, p 238-248.
  • 14. Eaves LC, Nuttall JC, Klonoff H, Dunn HG. Developmental and psychological test scores in children of low birth weight. Pediatrics 1970, 45:9-20.
  • 15. Ellenberg JH, Nelson KB. Early recognition of infants at risk for cerebral palsy: examination at age four months. Dev Med Child Neurol 1981, 23:705-716.
  • 16. Fitzhardinge PM, Steven EM. The small-for-date infant: II. Neurological and intellectual sequelae. Pediatrics 1972, 49:50-57.
  • 17. Granthan-McGregor S, Steward ME, Schofield WN. Effect of long-term psychosocial stimulation on mental development of severely malnourished children. Lancet 1980,2:785-789.
  • 18. Hack M, Merkatz IR, Gordon D, Jones PK, Fanaroff AA. The prognostic significance of postnatal growth in very low-birth-weight infants. Am J Obstet Gynecol 1982, 143:693-699.
  • 19. Hack M, Merkatz IR, McGrath SK, Jones PK, Fanaroff AA, Catch-up growth in very low-birth-weight infants. Am J Dis Child 1984, 138:370-375.
  • 20. Harvey D, Prince J, Bunton J, Parkinson C, Campbell S. Abilities of children who were small-for-gestational age babies. Pediatrics 1982, 69:296-300.
  • 21. Holmqvist P, Ingemarsson E, Ingemarsson I. Intra-uterine growth retardation and gestational age. Acta Obstet Gynecol Scand 1986, 65:633-638.
  • 22. Jungens van der Zee AD, Bierman-van Eendenbuirg MEC, Fidler VJ, Olinga AA, Visch JH, Touwen BCL. Pre-term birth, growth retardation and acidemia in relation to neurological abnormality in the newborn. Early Hum Dev 1979, 3:141-154.
  • 23. Kitchen WH, Ryan MM, Rickards A, McDougall AB, Billson FA, Keir ER, Naylor FD. A longitudinal study of very-low-birthweight infants: IV. An overview of performance at eight years of age. Dev Med Child Neurol 1980, 22:172-188.
  • 24. Kurtzberg D, Vaughan HG, Daum C, Grellong BA, Albin S, Rotkin L. Neurobehavioural performance of low-birthweight infants at 40 weeks conceptional age: comparison with normal full-term infants. Dev Med Child Neurol 1979, 21:590-607.
  • 25. Leathwood P. Influence of early undernutrition on behavioral development and learning in rodents. In Gottlieb G (ed): Studies on the development of behavior and the nervous system: early influences. New York: Academic Press, 1978, p 187-209.
  • 26. Leijon I, Billstrom G, Lind I. A 18 month follow-up study of growth retarded neonates. Early Hum Dev 1980, 4:271-285.
  • 27. Lipper E, Lee KS, Gartner LM, Grellong B. Determinants of neurobehavioural outcome in low-birth-weight infants. Pediatrics 1981, 67:502-505.
  • 28. Low JA, Golbraith RS, Muir D, Killen H, Karchmar J, Campbe D II. Intrauterine growth retardation: a preliminary report of long-term morbidity. Am J Obstet Gynecol 1978, 130:534-545.
  • 29. Marcondes E. Normas para o diagnóstico e a classificação dos distúrbios de crescimento e nutrição: última versão. Pediatria (São Paulo) 1982, 4:307-326.
  • 30. Matile P-A, Calame A, Plancherel B. Valeur pronostique du status neuro-développe-mental durant La première année de vie chez les infants à risque perinatal élevé. Helv Pediatr Acta 1984, 39:449-462.
  • 31. Matteis F, Lellis M, Búfalo C, Tobia U, D'Addezio N. Studio longitudinale de alcuni parametri neuropsicologici ed auxometria su un campione di piccoli per etá gestazio-nale, Boll Soc It Biol Sper 1978, 54:167-172.
  • 32. McBurney AK, Eaves LC. Evolution of developmental and psychological test scores. In Dunn HG (ed): Sequelae of low-birthweight: the Vancouver study. Clinics in Developmental Medicine 95/6. Oxford: McKeith Press, Blackwell, 1986, p 54-67.
  • 33. Michaelis R, Schulte FJ, Noite R. Motor behavior of small-for-gestational age newborn infants. J Pediatr 1970, 76:208-213.
  • 34. Monckeberg F. The effect of malnutrition on physical growth and brain development. In Prescott JW, Read MS, Coursin DB (eds): Brain function and malnutrition. New York: John Wiley, 1975, p 15-40.
  • 35 Neligan GA, Kolvin I, McScott D, Garside RF. Born too soon or born too small. Clinics in Developmental Medicine 61. London: SIMP, William Heinemann, 1976.
  • 36. Ounsted M, Moar V, Scott A. Small-for-dates babies at the age of four years: health, handicap and developmental status. Early Hum Dev 1982, 7:347-356.
  • 37. Ounsted M, Moar V, Scott R. Children of deviant birthweight at the age of seven years: health, handicap, size and developmental status. Early Hum Dev 1984, 9:323-340.
  • 38. Ounsted M, Taylor ME. The postnatal growth of children who were small-for-dates or large-for-dates at birth. Dev Med Child Neurol 1971, 13:421-428.
  • 39. Paine PA, Pasquali L. Effects of intrauterine growth and gestational age upon infants' early psychomotor development in Brazil. Percept Mot Skills 1982, 55:871-880.
  • 40. Paine PA, Pasquali L. Crianças nascidas pequenas pana a idade gestational: crescimento pós-natal, desenvolvimento psicomotor e ambiente social. J Ped 1982, 52:413-417.
  • 41. Parkinson CE, Wallis S, Harvey D. School achievement and behavior of children who were small-for-diates at birth. Dev Med Child Neurol 1981, 23:41-50.
  • 42. Prechtl HFR. The neurological examination of the full-term newborn infant. Ed 2. Clinics in Developmental Medicine, 63. London: SIMP, William Heinemann, 1977.
  • 43. Pryor G. Malnutrition and the «critical period>> hypothesis. In Prescott JW, Read MS, Coursin DB (eds): Brain function and malnutrition. New York: John Wiley, 1975, p 103-112.
  • 44. Rantakallio P, von Wendt L, Mtakinen H. Influence of social background on psychomotor development in the first year of life and its correlation with later intellectual capacity: a prospective study. Early Hum Dev 1985, 11:141-148.
  • 45. Schausiel-Zipf U, Hamm W, Mandl-Kramer S, Gladtke E, Bolte A. Nachuntersuchungsergebnisse ehemaliger pranatal dystropher Neugeborener um Alter von 6-12 Jahren. Monatsschr Kinderheilkd 1985, 133:93-98.
  • 46. Schulte FJ, Michaelis R, Noite R, Motor nerve conduction velocity in term, preterm and small-for-dates infants. Pediatrics 1968, 42:17-26.
  • 47. Schulte FJ, Schrempf G, Hinze G. Maternal toxemia, fetal malnutrition and motor behavior of the newborn. Pediatrics 1971, 48:871-882.
  • 48. Villar J, Smeriglio V, Martorell R, Brown CH, Klein RE. Heterogeneous growth and mental development of intrauterine growth-retarded infants during the first 3 years of life. Pediatrics 1984, 74:783-791.
  • 49. Vohr BR, Coll CTG. Neurodevelopmental school performance of very low-birthweight infants: a seven year longitudinal study. Pediatrics 1985, 76:345-350.
  • 50. Vohr BR, Oh W. Growth and development in preterm infants small-for-gestational age. J Pediatr 1983, 103:941-945.
  • 51. Watt J. Interaction and development in the first year: II. The effects of intrauterine growth retardation. Early Hum Dev 1986, 13:211-223.
  • 52. Watt J, Strongman KT. Mother-infant interaction at 1 and 3 months in preterm small--for-gestational age and fufll-term infants. Early Hum Dev 1985, 11:231-246.
  • 53. Westwood M, Kramer MS, Munz D, Lovett JM, Watters GV. Growth and development of full-term non-asphyxiated small-for-gestational age newborns: follow-up through adolescence. Pediatrics 1983, 71:376-382.
  • 54. Wilcox AJ. Intrauterine growth retardation: beyond birthweight criteria. Early Hum Dev 1983, 8:189-193.
  • 55. Winick M. Malnutrition and brain development. Pediatrics 1969, 74:667-679.
  • 56. Winick M, Rosso P. Malnutrition and central nervous system development. In Prescott JW, Read MS, Coursin DB (eds): Brain function and malnutrition. New York: John Wiley, 1975, p 41-52.

Publication Dates

  • Publication in this collection
    19 Jan 2011
  • Date of issue
    Mar 1993
Academia Brasileira de Neurologia - ABNEURO R. Vergueiro, 1353 sl.1404 - Ed. Top Towers Offices Torre Norte, 04101-000 São Paulo SP Brazil, Tel.: +55 11 5084-9463 | +55 11 5083-3876 - São Paulo - SP - Brazil
E-mail: revista.arquivos@abneuro.org