The Influence of Fetal Growth Reference Standards on Assessment of Cognitive and?Academic Outcomes of Very Preterm Children

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• 作者：Marie-Laure Charkaluk ; MD ; PhD¹ ; ² ; ³ ; ^{charkaluk.marie-laure@ghicl.net} ; Laetitia Marchand-Martin¹ ; ² ; Anne Ego ; MD ; PhD¹ ; ⁴ ; Jennifer Zeitlin ; DSc¹ ; ² ; Catherine Arnaud ; MD⁵ ; ⁶ ; Antoine Burguet ; MD ; PhD¹ ; ⁷ ; Sté ; phane Marret ; MD ; PhD⁸ ; ⁹ ; Jean-Christophe Rozé ; MD ; PhD¹⁰ ; Rachel Vieux ; MD ; PhD¹¹ ; Monique Kaminski¹ ; ² ; Pierre-Yves Ancel ; MD ; PhD¹ ; ² ; Vé ; ronique Pierrat ; MD ; PhD¹ ; ² ; ¹² ; Epipage Study Group &lowast
• 关键词：AGA ; Appropriate for gestational age ; bw ; Birth weight classification ; (cust) ; Customized classification ; CP ; Cerebral palsy ; FGR ; Fetal growth restriction ; GA ; Gestational age ; (intraut) ; Intrauterine classification ; K-ABC ; Kaufman Assessment Battery for
• 刊名：The Journal of Pediatrics
• 出版年：2012
• 出版时间：December, 2012
• 年：2012
• 卷：161
• 期：6
• 页码：1053-1058.e1
• 全文大小：191 K

文摘

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Objective

To compare 3 methods of identifying small-for-gestational-age (SGA) status in very preterm children as related to cognitive function and academic outcome.

Study design

There were 1038 singletons in the Epipage Study, born before 33 weeks in 1997 without severe neurosensory impairment, who were classified as SGA when birth weight was below the 10th percentile according to: (1) birth weight (bw) reference: SGA(bw)/appropriate for gestational age (AGA)(bw); (2) intrauterine (intraut) reference: SGA(intraut)/AGA(intraut); and (3) intrauterine reference customized (cust) according to individual characteristics: SGA(cust)/AGA(cust). Cognitive function was assessed by the mental processing composite (MPC) score of the Kaufman Assessment Battery for Children at age 5 and academic achievement by a parental questionnaire at age?8.

Results

Of the children, 15 % were SGA(bw), 38 % were SGA(intraut), and 39 % were SGA(cust). All children SGA(bw) were also SGA(intraut) and SGA(cust). MPC was <85 in 32 % of children and 27 % had low academic achievement. AGA(bw)/SGA(intraut) children had a significantly increased risk of MPC <85 (adjusted OR 1.74, 95 % CI 1.22-2.28) or low academic achievement (adjusted OR 1.64, 95 % CI 1.05-2.55) compared with AGA(bw)/AGA(intraut) children. The SGA(cust) group was only slightly different from the SGA(intraut) group.

Conclusions

An intrauterine reference identified very preterm infants at risk of poor cognitive or academic outcomes better than a birth weight reference. Customization resulted in only slight modifications of the SGA group.