Axonal loss and cognitive deficits in term infants with normal umbilical artery Doppler born small-for-gestational age

Adults Born Small for Gestational Age at Term Have Thinner Peripapillary Retinal Nerve Fiber Layers Than Controls

PURPOSE

Prenatal growth restriction is associated with impaired neurodevelopment in childhood. This study investigated the effects of being born small for gestational age (SGA) on peripapillary retinal nerve fiber layer (pRNFL) thickness in adults born at term.

METHODS

A retrospective cohort study was conducted with a prospective ophthalmologic examination of participants born at full-term (gestational age ≥37 weeks) between 1969 and 2002. All participants were examined with spectral-domain optical coherence tomography and grouped according to their birth weight in correlation to gestational age as former moderate (birth weight (BW) percentile 3rd to <10th) and severe SGA (<3rd percentile), normal (10th-90th percentile, AGA), and moderately (>90th to 97th percentile) and severely (>97th percentile) large for gestational age (LGA) adults (18 to 52 years).

RESULTS

Overall, 547 eyes of 285 individuals (age 29.9±9.4 years, 151 females) born at term were included. Multivariable regression analyses revealed a strong association between a lower global pRNFL thickness in the severe SGA (B=-8.99 [95%-CI: -12.68; -5.30] µm; p<0.001) and in the moderate SGA groups (B=-6.40 [95%-CI: -10.29; -2.50] µm; p=0.001) compared to the reference AGA group.

CONCLUSION

Our results indicate that restricted fetal growth affects neurologic tissue development of the optic nerve head, particularly in individuals born severely SGA at term. This indicates that fetal growth restriction may exert disturbances in the development of neurologic tissue, which persists in adulthood.

Neurodevelopment of infant with late fetal growth restriction

Late fetal growth restriction has increasingly gain interest. Differently from early fetal growth restriction, the severity of this condition and the impact on perinatal mortality and morbidity is less severe. Nevertheless, there is some evidence to suggest that fetuses exposed to growth restriction late in pregnancy are at increased risk of neurological dysfunction and behavioral impairment. The aim of our review was to discuss the available evidence on the neurodevelopmental outcome in fetuses exposed to growth restriction late in pregnancy. Cerebral blood flow redistribution, a Doppler hallmark of late fetal growth restriction, has been associated with this increased risk, although there are still some controversies. Currently, most of the available studies are heterogeneous and do not distinguish between early and late fetal growth restriction when evaluating the long-term outcome, thus, making the correlation between late fetal growth restriction and neurological dysfunction difficult to interpret. The available evidence suggests that fetuses exposed to late growth restriction are at increased risk of neurological dysfunction and behavioral impairment. The presence of the cerebral blood flow redistribution seems to be associated with adverse neurodevelopmental outcome, however, from the present literature the causality cannot be ascertained.

Association of Birth Weight with Peripapillary Retinal Nerve Fiber Layer Thickness in Adulthood—Results from a Population-Based Study

Purpose

Low birth weight is associated with altered retinal development in childhood, including reduced peripapillary retinal nerve fiber layer (pRNFL) thickness. However, to the best of our knowledge, no population-based study has analyzed the relationship of low birth weight to pRNFL thickness in adulthood. The purpose of this study was to investigate whether birth weight has a long-term effect on pRNFL thickness in adulthood.

Methods

In the German population-based Gutenberg Health Study (GHS), participants were examined with spectral-domain optical coherence tomography using a peripapillary scan and automated measurement of pRNFL thickness as a global parameter and in six sectors. The association between self-reported birth weight and the different pRNFL sectors were analyzed with multivariable linear regression, adjusted for potential confounders including sex, age, axial length, self-reported age-related macular degeneration, and glaucoma.

Results

In 3,028 participants, self-reported birth weight was documented and pRNFL measurements were successfully performed (1632 females, ages 54.9 ± 10.0 years). After adjustment for several confounders in the multivariable model, a positive association was observed between birth weight and pRNFL thickness in the global sector (β = 0.13 µm/100 g; 95% CI, 0.08–0.18; P < 0.001; R² = 0.007) and especially in the inferotemporal sector (β = 0.22 µm/100 g; 95% CI, 0.15–0.29; P < 0.001; R² = 0.008) and inferonasal sector (β = 0.28 µm/100 g; 95% CI, 0.17–0.39; P < 0.001; R² = 0.005).

Conclusions

Our data show that there is a weak relationship between birth weight and pRNFL thickness in adulthood. This weak association is particularly present in the inferior part of the optic nerve head. Therefore, low birth weight may have an impact on optic nerve head development and potentially on ocular disease development.

Face recognition impairment in small for gestational age and preterm children

BACKGROUND

Infants born prematurely or with low birth weight are at increased risk of visual perceptual impairment. Face recognition is a high-order visual ability important for social development, which has been rarely assessed in premature or low birth weight children.

AIMS

To evaluate the influence of prematurity and low birth weight on face recognition skills.

METHODS

Seventy-seven children were evaluated as part of a prospective cohort study. They were divided into premature and term birth cohorts. Children with a birth weight below the 10th centile were considered small for gestational age. All children underwent a full ophthalmologic assessment and evaluation of face recognition skills using the Facial Memory subtest from the Test of Memory and Learning.

RESULTS

Premature infants scored worse on immediate face recognition compared to term infants. However, after adjusting for birth weight, prematurity was not associated with worse outcomes. Independent of gestational age, outcomes of low birth weight children were worse than those of appropriate birth weight children, for immediate face recognition (odds ratio [OR], 5.14; 95% confidence interval [CI], 1.32-21.74) and for face memory (OR, 4.48; 95% CI, 1.14-16.95).

CONCLUSIONS

Being born small for gestational age is associated with suboptimal face recognition skills, even in children without major neurodevelopmental problems.

Microstructural changes in the retina related to prematurity

PURPOSE

To assess retinal morphology changes in patients born at different stages of prematurity, accounting for the presence or absence of retinopathy of prematurity (ROP) and comorbidity, using spectral-domain optical coherence tomography (SD OCT).

DESIGN

Retrospective cohort study.

METHODS

Preterm and term infants underwent an ophthalmologic assessment (best-corrected visual acuity, stereoacuity, cycloplegic refraction and funduscopy). Retinal layers were imaged, segmented, and measured by SD-OCT. In total 114 full term controls and 60 preterm children, classified as late preterm (32-36 weeks gestational age), early preterm (<32 weeks of gestational age) without ROP, and early preterm with previously treated ROP, were included in the study.

RESULTS

No retinal structure differences were observed in preterm infants with no treated ROP compared to term infants. Early preterm infants with previous treated ROP had decreased retinal nerve fiber layer (RNFL) thickness in the superior and nasal quadrants, increased RNFL in the temporal quadrant, and a thinner ganglion cell and inner plexiform layer complex (GCL-IPL). Low birthweight percentile was associated with increased foveal thickness and ganglion cell damage (RNFL and GCL-IPL) independent of gestational age. Among all the coexisting events, inflammation and hypoxia were correlated with more severe detrimental effects.

CONCLUSIONS

In the absence of treated ROP, prematurity was not associated with disturbed retinal structure. Severe ROP and low birthweight were related to neuronal and axonal damage in the inner retinal layers. Detailed comorbidity should be reviewed when evaluating preterm infants.

A modified prenatal growth assessment score for the evaluation of fetal growth in the third trimester using single and composite biometric parameters

OBJECTIVE

To define modified Prenatal Growth Assessment Scores (mPGAS) for single and composite biometric parameters and determine their reference ranges in normal fetuses.

METHODS

Nine anatomical parameters (ap) were measured and the weight estimated (EWTa, EWTb) in a longitudinal study of 119 fetuses with normal neonatal growth outcomes. Expected third trimester size trajectories, obtained from second trimester Rossavik size models, were used in calculating Percent Deviations (% Dev's) and their age-specific reference ranges in each fetus. The components of individual % Dev's values outside their reference ranges, designated +iapPGAS, -iapPGAS, were averaged to give +apPGAS and -apPGAS values for the 3rd trimester. The +iapPGAS and -iapPGAS values for different combinations of ap (c1a (HC, AC, FDL, ThC, EWTa), c1b (HC, AC, FDL, ThC, EWTb), c2 (ThC, ArmC, AVol, TVol), c3 (HC, AC, FDL, EWTa)) were then averaged to give +icPGAS and -icPGAS values at different time points or at the end of the third trimester (+cPGAS, -cPGAS). Values for iapPGAS, ic1bPGAS, and ic2PGAS were compared to their respective apPGAS or cPGAS reference ranges.

RESULTS

All mPGAS values had one 95% range boundary at 0.0%. Upper boundaries of 1D +apPGAS values ranged from 0.0% (HC) to +0.49% (ThC) and were +0.06%, +2.3% and +1.8% for EWT, AVol and TVol, respectively. Comparable values for -apPGAS were 0.0% (BPD, FDL, HDL), to -0.58% (ArmC), -0.13% (EWT), -0.8% (AVol), and 0.0% (TVol). The +cPGAS, 95% reference range upper boundaries varied from +0.36% (c1b) to +0.89% (c2). Comparable values for -cPGAS lower boundaries were -0.17% (c1b) to -0.43% (c2).

CONCLUSIONS

The original PGAS concept has now been extended to individual biometric parameters and their combinations. With the standards provided, mPGAS values can now be tested to see if detection of different types of third trimester growth problems is improved.

Insights into the pathophysiology of catch-up compared with non-catch-up growth in children born small for gestational age: an integrated analysis of metabolic and transcriptomic data

Small for gestational age (SGA) children exhibiting catch-up (CU) growth have a greater risk of cardiometabolic diseases in later life compared with non-catch-up (NCU) SGA children. The aim of this study was to establish differences in metabolism and gene expression profiles between CU and NCU at age 4-9 years. CU children (n=22) had greater height, weight and body mass index standard deviation scores along with insulin-like growth factor-I (IGF-I) and fasting glucose levels but lower adiponectin values than NCU children (n=11; all P<0.05). Metabolic profiling demonstrated a fourfold decrease of urine myo-inositol in CU compared with NCU (P<0.05). There were 1558 genes differentially expressed in peripheral blood mononuclear cells between the groups (P<0.05). Integrated analysis of data identified myo-inositol related to gene clusters associated with an increase in insulin, growth factor and IGF-I signalling in CU children (P<0.05). Metabolic and transcriptomic profiles in CU SGA children showed changes that may relate to cardiometabolic risk.

Pathways of neuronal and cognitive development in children born small-for-gestational age or late preterm

OBJECTIVE

To assess the effects of late small-for-gestational-age (SGA) birth and late prematurity on cognitive outcomes and structural changes in the central nervous system at primary school age, using a novel approach to examine changes in neuronal integrity of the retina.

METHODS

We conducted a cross-sectional study of 347 children aged 6-13 years, including in the analysis only infants born after 34 weeks' gestation. We recorded all perinatal outcomes through a survey of parents. Neuronal damage was evaluated using optical coherence tomography of the retina. In a subgroup of 112 children aged 6-8 years, visuospatial perception was evaluated with the Children's Bender Visual Motor Gestalt Test.

RESULTS

The proportions of SGA and late preterm children were 11.8 and 6.3%, respectively. Prematurity and SGA were simultaneously present in five children. When compared with controls, SGA children showed significantly lower than average retinal nerve fiber layer (RNFL) thickness (94.1 vs 98.8 μm; P = 0.007) and an increased percentage of abnormal Bender scores (27.3 vs 6.2%; P = 0.017) (odds ratio 5.6 (95% CI, 1.2-26.8)). These differences increased when late SGA infants with a birth weight below the 3(rd) percentile were compared with SGA infants with a birth weight between the 3(rd) and 10(th) percentiles and with controls, for RNFL thickness (92.5 vs 94.6 and 98.8 μm, respectively; P = 0.021) and abnormal Bender tests (33.3 vs 25.0 and 6.2%, respectively; P = 0.036). However, no differences were found in retinal structure and visuomotor performance between late preterm and term infants.

CONCLUSIONS

These data suggest that late SGA and late prematurity induce a distinct neuronal pattern of structural changes that persist at school age. Late-onset SGA infants are at increased risk for axonal loss in the retina and present specific visuomotor difficulties.

Differences in cortical development assessed by fetal MRI in late-onset intrauterine growth restriction

OBJECTIVE

The objective of the study was to evaluate cortical development parameters by magnetic resonance imaging (MRI) in late-onset intrauterine growth-restricted (IUGR) fetuses and normally grown fetuses.

STUDY DESIGN

A total of 52 IUGR and 50 control fetuses were imaged using a 3T MRI scanner at 37 weeks of gestational age. T2 half-Fourier acquisition single-shot turbo spin-echo anatomical acquisitions were obtained in 3 planes. Cortical sulcation (fissures depth corrected by biparietal diameter), brain volumetry, and asymmetry indices were assessed by means of manual delineation and compared between cases and controls.

RESULTS

Late-onset IUGR fetuses had significantly deeper measurements in the left insula (late-onset IUGR: 0.293 vs control: 0.267; P = .02) and right insula (0.379 vs 0.318; P < .01) and the left cingulate fissure (0.096 vs 0.087; P = .03) and significantly lower intracranial (441.25 cm(3) vs 515.82 cm(3); P < .01), brain (276.47 cm(3) vs 312.07 cm(3); P < .01), and left opercular volumes (2.52 cm(3) vs 3.02 cm(3); P < .01). IUGR fetuses showed significantly higher right insular asymmetry indices.

CONCLUSION

Late-onset IUGR fetuses had a different pattern of cortical development assessed by MRI, supporting the existence of in utero brain reorganization. Cortical development could be useful to define fetal brain imaging-phenotypes characteristic of IUGR.

Automatic quantitative MRI texture analysis in small-for-gestational-age fetuses discriminates abnormal neonatal neurobehavior

Background

We tested the hypothesis whether texture analysis (TA) from MR images could identify patterns associated with an abnormal neurobehavior in small for gestational age (SGA) neonates.

Methods

Ultrasound and MRI were performed on 91 SGA fetuses at 37 weeks of GA. Frontal lobe, basal ganglia, mesencephalon and cerebellum were delineated from fetal MRIs. SGA neonates underwent NBAS test and were classified as abnormal if ≥1 area was <5^th centile and as normal if all areas were >5^th centile. Textural features associated with neurodevelopment were selected and machine learning was used to model a predictive algorithm.

Results

Of the 91 SGA neonates, 49 were classified as normal and 42 as abnormal. The accuracies to predict an abnormal neurobehavior based on TA were 95.12% for frontal lobe, 95.56% for basal ganglia, 93.18% for mesencephalon and 83.33% for cerebellum.

Conclusions

Fetal brain MRI textural patterns were associated with neonatal neurodevelopment. Brain MRI TA could be a useful tool to predict abnormal neurodevelopment in SGA.