title: Being Small for Gestational Age: Does it Matter for the Neurodevelopment of Premature Infants? A Cohort Study.
abstract: BACKGROUND
  Whether being small for gestational age (SGA) increases the risk of adverse neurodevelopmental outcome in premature infants remains controversial.
  
  
  OBJECTIVE
  to study the impact of SGA (birthweight < percentile 10) on cognition, behavior, neurodevelopmental impairment and use of therapy at 5 years old.
  
  
  METHODS
  This population-based prospective cohort included infants born before 32 weeks of gestation. Cognition was evaluated with the K-ABC, and behavior with the Strengths and Difficulties Questionnaire (SDQ). Primary outcomes were cognitive and behavioral scores, as well as neurodevelopmental impairment (cognitive score < 2SD, hearing loss, blindness, or cerebral palsy). The need of therapy, an indirect indicator of neurodevelopmental impairment, was a secondary outcome. Linear and logistic regression models were used to analyze the association of SGA with neurodevelopment.
  
  
  RESULTS
  342/515 (76%) premature infants were assessed. SGA was significantly associated with hyperactivity scores of the SDQ (coefficient 0.81, p < 0.04), but not with cognitive scores, neurodevelopmental impairment or the need of therapy. Gestational age, socio-economic status, and major brain lesions were associated with cognitive outcome in the univariate and multivariate model, whereas asphyxia, sepsis and bronchopulmonary dysplasia were associated in the univariate model only. Severe impairment was associated with fetal tobacco exposition, asphyxia, gestational age and major brain lesions. Different neonatal factors were associated with the use of single or multiple therapies: children with one therapy were more likely to have suffered birth asphyxia or necrotizing enterocolitis, whereas the need for several therapies was predicted by major brain lesions.
  
  
  CONCLUSIONS
  In this large cohort of premature infants, assessed at 5 years old with a complete panel of tests, SGA was associated with hyperactive behavior, but not with cognition, neurodevelopmental impairment or use of therapy. Birthweight <10th percentile alone does not appear to be an independent risk factor of neurodevelopmental adverse outcome in preterm children.
authors.affiliation: Clinic of Neonatology and Developmental Unit, Department of Pediatrics and Pediatric Surgery, University Hospital and University of Lausanne, Lausanne, Switzerland.
authors.forename: Myriam
authors.initials: M
authors.lastname: Bickle Graz
authors.affiliation: Clinic of Neonatology and Developmental Unit, Department of Pediatrics and Pediatric Surgery, University Hospital and University of Lausanne, Lausanne, Switzerland.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Tolsa
authors.affiliation: Clinic of Neonatology and Developmental Unit, Department of Pediatrics and Pediatric Surgery, University Hospital and University of Lausanne, Lausanne, Switzerland.
authors.forename: Céline Julie
authors.initials: CJ
authors.lastname: Fischer Fumeaux
mesh_terms: D002657:Child Development; D003071:Cognition; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000254:growth & development*; D007236:Infant, Small for Gestational Age / Q000254:growth & development*; D008297:Male; D065886:Neurodevelopmental Disorders / Q000453:epidemiology*