title: Impact of cerebral redistribution on neurodevelopmental outcome in small-for-gestational-age or growth-restricted babies: a systematic review.
abstract: OBJECTIVE
  To review systematically the evidence on impact of cerebral redistribution, as assessed by fetal middle cerebral artery (MCA) Doppler, on neurological outcomes in small-for-gestational-age (SGA) or growth-restricted fetuses.
  
  
  METHODS
  For this systematic review, MEDLINE was searched for all controlled studies reporting neurological outcomes in SGA or growth-restricted babies with cerebral redistribution based on MCA Doppler indices, from inception to September 2013. We used relative risk or odds ratios, with 95% CI, to identify the association of cerebral redistribution with neurological outcomes.
  
  
  RESULTS
  The search yielded 1180 possible citations, of which nine studies were included in the review, with a total of 1198 fetuses. Definitions of SGA and cerebral redistribution were variable, as was study quality. Data could not be synthesized in meta-analyses because of heterogeneity in outcome reporting. Cerebral redistribution was not associated with increased risk of intraventricular hemorrhage in neonates (five studies; n = 806). When present in preterm fetuses, cerebral redistribution was associated with normal Neonatal Behavioral Assessment Scale (NBAS) scores at 40 weeks (one study; n = 62) but abnormal psychomotor development at 1 year of age on the Bayley scale (one study; n = 172). When present in term SGA fetuses, cerebral redistribution was associated with increased risk of motor and state organizational problems on NBAS (two studies; n = 158), and lower mean percentile scores in communication and problem solving at 2 years of age on the Ages and Stages Questionnaire (one study; n = 125).
  
  
  CONCLUSIONS
  SGA fetuses with cerebral redistribution may be at higher risk of neurodevelopmental problems. More data are needed from adequately controlled studies with long-term follow-up before conclusions can be drawn. If these findings are true, there is a need to re-evaluate timing of delivery in the management of SGA fetuses, particularly when cerebral redistribution is found at term gestation.
authors: Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK.|Department of Women's and Children's Health, University of Liverpool, Liverpool, UK.
authors: S
authors: S
authors: Meher
authors: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Wayne State University, Detroit, MI, USA.
authors: E
authors: E
authors: Hernandez-Andrade
authors: Department of Paediatric Neurology and Neonatal Medicine, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.
authors: S N
authors: SN
authors: Basheer
authors: Institute of Reproductive and Developmental Biology, Department of Surgery and Cancer, Imperial College London, London, UK.|Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
authors: C
authors: C
authors: Lees
mesh_terms: D001921:Brain / Q000098:blood supply* / Q000196:embryology*; D016022:Case-Control Studies; D002560:Cerebrovascular Circulation / Q000502:physiology; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age / Q000502:physiology*; D008297:Male; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging; D065886:Neurodevelopmental Disorders / Q000503:physiopathology*; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D016032:Randomized Controlled Trials as Topic; D018608:Ultrasonography, Doppler / Q000379:methods; D016216:Ultrasonography, Prenatal / Q000379:methods; D014469:Umbilical Arteries / Q000000981:diagnostic imaging
keywords: MCA; brain sparing; cerebral redistribution; cerebroplacental ratio; middle cerebral artery; neurodevelopment; neurological outcome