Does fetal growth restriction lead to increased brain injury as detected by neonatal cranial ultrasound in premature infants?
OBJECTIVE
Intra-uterine growth restriction (IUGR) is an important cause for prematurity as well as a significant risk factor for neurodevelopmental deficits. In this study, we aimed to examine the association between IUGR and early brain injury on neonatal cranial ultrasound in preterm infants.


METHODS
This retrospective cohort study examined the relationship between IUGR and neonatal cranial ultrasound findings in preterm infants <32 weeks gestation with IUGR, compared with gestation and year of birth-matched appropriately grown infants, in a tertiary level neonatal unit. Primary outcome was incidence and severity of intraventricular haemorrhage (IVH), periventricular leucomalacia (PVL) and hydrocephalus detected by cranial ultrasound in the neonatal period.


RESULTS
A total of 153 IUGR and 306 non-IUGR preterm infants <32 weeks were included. The rates of IVH (21.6% vs. 23.9%), severe IVH (3.9% vs. 4.6%), PVL (8.4% vs. 9.4%), cystic PVL (2.6% vs. 0%) and hydrocephalus (0.7% vs. 0.3%) were similar in the two groups. Composite outcome of death and severe brain injury (severe IVH, cystic PVL and hydrocephalus) was greater (20.2% vs. 9.1%, P = 0.001) in IUGR infants.


CONCLUSIONS
IUGR did not lead to increased neonatal brain injury on cranial ultrasound but was associated with increased mortality. Advanced neonatal neuroimaging techniques may be necessary to estimate risk and to provide prognostic information of adverse neurological outcomes in this vulnerable population.
Monash Newborn, Monash Children's Hospital, Melbourne, Victoria, Australia.|The Ritchie Centre, MIMR-PHI Institute, Melbourne, Victoria, Australia.|Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.
Atul
A
Malhotra
Monash Newborn, Monash Children's Hospital, Melbourne, Victoria, Australia.
Zamir
Z
Yahya
Monash Newborn, Monash Children's Hospital, Melbourne, Victoria, Australia.
Arun
A
Sasi
The Ritchie Centre, MIMR-PHI Institute, Melbourne, Victoria, Australia.|Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.
Graham
G
Jenkin
Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.|Diagnostic Imaging, Monash Health, Melbourne, Victoria, Australia.
Michael
M
Ditchfield
The Ritchie Centre, MIMR-PHI Institute, Melbourne, Victoria, Australia.|Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.
Graeme R
GR
Polglase
The Ritchie Centre, MIMR-PHI Institute, Melbourne, Victoria, Australia.|Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.
Suzanne L
SL
Miller
D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000453:epidemiology*; D015331:Cohort Studies; D004453:Echoencephalography / Q000379:methods*; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging / Q000453:epidemiology*; D005865:Gestational Age; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging / Q000453:epidemiology*; D015994:Incidence; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology*; D007969:Leukomalacia, Periventricular / Q000000981:diagnostic imaging / Q000453:epidemiology*; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors
IUGR; neonate; neuroimaging; outcome