title: Neurodevelopmental outcomes of near-term small-for-gestational-age infants with and without signs of placental underperfusion.
abstract: OBJECTIVE
  To evaluate 2-year neurodevelopmental outcomes of near-term, small-for-gestational-age (SGA) newborns segregated by presence or absence of histopathology reflecting placental underperfusion (PUP).
  
  
  METHODS
  A cohort of consecutive near-term (≥ 34.0 weeks) SGA newborns with normal prenatal umbilical artery Doppler studies was selected. All placentas were inspected for evidence of underperfusion and classified in accordance with established histologic criteria. Neurodevelopmental outcomes at 24 months (age-corrected) were then evaluated, applying the Bayley Scale for Infant and Toddler Development, Third Edition (Bayley-III) to assess cognitive, language, and motor competencies. The impact of PUP on each domain was measured via analysis of covariance, logistic and ordinal regression, with adjustment for smoking, socioeconomic status, gestational age at birth, gender, and breastfeeding.
  
  
  RESULTS
  A total of 83 near-term SGA deliveries were studied, 46 (55.4%) of which showed signs of PUP. At 2 years, adjusted neurodevelopmental outcomes were significantly poorer in births involving PUP (relative to SGA infants without PUP) for all three domains of the Bayley scale: cognitive (105.5 vs 96.3, adjusted-p = 0.03), language (98.6 vs 87.8, adjusted-p<0.001), and motor (102.7 vs 94.5, adjusted-p = 0.007). Similarly, the adjusted likelihood of abnormal cognitive, language, and motor competencies in instances of underperfusion was 9.3-, 17.5-, and 1.44-fold higher, respectively, differing significantly for the former two domains.
  
  
  CONCLUSIONS
  In a substantial fraction of near-term SGA babies without Doppler evidence of placental insufficiency, histologic changes compatible with PUP are still identifiable. These infants are at greater risk of abnormal neurodevelopmental outcomes at 2 years.
authors: Department of Maternal-Fetal Medicine, Institute Clínic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic-IDIBAPS, University of Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain; Maternal - Fetal Unit, CEDIFETAL, Centro de Diagnóstico de Ultrasonido e Imágenes, CEDIUL, Clínica General del Norte, Barranquilla, Colombia.
authors: Miguel
authors: M
authors: Parra-Saavedra
authors: Department of Maternal-Fetal Medicine, Institute Clínic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic-IDIBAPS, University of Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain; Fondazione Cà Granda, Ospedale Maggiore Policlinico, Dipartimento Ostetricia e Ginecologia, Università degli Studi di Milano, Milan, Italy.
authors: Francesca
authors: F
authors: Crovetto
authors: Department of Maternal-Fetal Medicine, Institute Clínic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic-IDIBAPS, University of Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain; Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy.
authors: Stefania
authors: S
authors: Triunfo
authors: Department of Maternal-Fetal Medicine, Institute Clínic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic-IDIBAPS, University of Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
authors: Stefan
authors: S
authors: Savchev
authors: Department of Maternal-Fetal Medicine, Institute Clínic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic-IDIBAPS, University of Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
authors: Anna
authors: A
authors: Peguero
authors: Department of Pathology, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
authors: Alfons
authors: A
authors: Nadal
authors: Maternal - Fetal Unit, CEDIFETAL, Centro de Diagnóstico de Ultrasonido e Imágenes, CEDIUL, Clínica General del Norte, Barranquilla, Colombia.
authors: Guido
authors: G
authors: Parra
authors: Department of Maternal-Fetal Medicine, Institute Clínic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic-IDIBAPS, University of Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
authors: Eduard
authors: E
authors: Gratacos
authors: Department of Maternal-Fetal Medicine, Institute Clínic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic-IDIBAPS, University of Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
authors: Francesc
authors: F
authors: Figueras
mesh_terms: D000328:Adult; D002657:Child Development; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007236:Infant, Small for Gestational Age / Q000254:growth & development*; D008297:Male; D009420:Nervous System / Q000254:growth & development*; D021041:Placental Circulation; D010927:Placental Insufficiency / Q000503:physiopathology*; D011247:Pregnancy
keywords: Doppler; Intrauterine growth restriction; Neurodevelopmental outcomes; Placental underperfusion lesions; Small for gestational age