Neurodevelopmental outcome at three years of age after fetal 'brain-sparing'.
Intrauterine growth restriction (IUGR), occurring preterm, may be related to impaired neurodevelopmental outcome. We measured neurodevelopmental outcome (Hempel examination) at the age of three years in a cohort of infants born between 26 and 33 weeks in 1989. Fetuses were studied haemodynamically, using Doppler ultrasound. The ratio between the umbilical and the cerebral artery Pulsatility Index (U/C ratio) was calculated. This is a measure of redistribution of fetal blood preferentially to the brain and this may be a marker of fetal adaptation to placental insufficiency. Impaired fetal growth was also measured by the fetal growth ratio. Neonatal cranial ultrasound was performed to document intracranial haemorrhages and/or ischaemia. From the original cohort of 106 infants, 96 (91%) infants were examined at three years. After adjustment for obstetric variables, adverse Hempel outcome was related to neonatal cranial ultrasound abnormality and low head circumference at three years. Neither the U/C ratio nor fetal growth were independently associated with Hempel outcome. Fetal 'brain-sparing' in IUGR appears to be a benign adaptive mechanism preventing severe brain damage.
Department of Obstetrics, University of Amsterdam, Academic Medical Centre, The Netherlands.
S A
SA
Scherjon
H
H
Oosting
H
H
Smolders-DeHaas
H A
HA
Zondervan
J H
JH
Kok
D001921:Brain / Q000502:physiology*; D002543:Cerebral Hemorrhage / Q000151:congenital / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D002675:Child, Preschool; D005317:Fetal Growth Retardation / Q000097:blood / Q000503:physiopathology*; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018608:Ultrasonography, Doppler