Background and aims Small for gestational age (SGA) very premature infants are at increased risk of neonatal morbidities, but the data about long-term neurodevelopmental outcome are conflicting. We aimed to study the impact of SGA, defined with a birthweight below the 10th percentile, on neurodevelopment and use of therapy at 5 years old.
Methods Retrospective analysis of a cohort of 515 patients, evaluated at 5 years of age with a cognitive test, a behavioural questionnaire, the presence of neurodevelopmental impairment (cerebral palsy, blindness, deafness), and use of therapy. The association of SGA with cognitive and behavioural scores, neurodevelopmental impairment and use of therapy was explored with linear and logistic regression models.
Results SGA had a positive association (p = 0.03) with behaviour, but no association with cognitive scores, risk of impairment or use of therapy. Neonatal factors associated with cognitive scores in the multivariable model were gestational age, socio-economic status, and major brain lesions. Neurodevelopmental impairment was associated with tobacco consumption (OR 2.05, p = 0.04, CI95%. 89–4.72), sepsis, asphyxia (pH < 7.0 and encephalopathy) (OR 4.28, p = 0.02, CI95% 1.24–14.8), gestational age and major brain lesions. The use of one therapy was associated with asphyxia, necrotizing enterocolitis, and marginally bronchopulmonary dysplasia, whereas the need for several therapies was predicted by major brain lesions (RR 5.9, p < 0.005).
Discussion SGA was associated with behaviour at 5 years old, and with no other neurodevelopmental outcome. In order to better clarify the impact of SGA in premature infants, further studies, allowing differentiating growth restricted from constitutionally small infants, are needed.