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PEDIATRICS Vol. 105 No. 2 February 2000, pp. 385-391

The Discrepancy Between Maturation of Visual-Evoked Potentials and Cognitive Outcome at Five Years in Very Preterm Infants With and Without Hemodynamic Signs of Fetal Brain-Sparing

Received Sep 14, 1998; accepted May 4, 1999.

Sicco Scherjon*, Dagger , Judy Briët§, Hans Oostingparallel , and Joke Kok§

From the * Graduate School Neurosciences Amsterdam; the Dagger  Department of Obstetrics and Gynaecology; the § Department of Neonatology, and the parallel  Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, The Netherlands.

Objective.  After intrauterine growth restriction we found at the age of 6 months an acceleration of neurophysiologic maturation. However, at later ages impaired cognitive outcome has been reported. Therefore, we investigated in children with and without fetal hemodynamic adaptation to intrauterine growth restriction whether the accelerated neurophysiologic maturation in infancy might be associated with impaired cognitive outcome at preschool age.

Design.  At 5 years of age cognitive function was assessed using the Revision of the Amsterdam Children's Intelligence Test in 73 preterm infants (26-33 weeks) who were prospectively followed from the antenatal period up to the age of 5 years. Maternal educational level was used as a background variable to estimate the confounding effects of socioeconomic status on cognitive function. Fetal Doppler studies were performed and the umbilical artery pulsatility index (PI) divided by the middle cerebral artery PI ratio (U/C ratio) was calculated. A U/C ratio >0.725 was considered as an indication of fetal cerebral hemodynamic adaptation to a compromised placental perfusion, ie, fetal brain-sparing. Visual-evoked potentials (VEPs) were recorded at 6 months and 1 year of age. In addition, data on neurologic status at 3 years were available.

Results.  Mean IQ score was significantly lower for children born with a raised U/C ratio (87 ± 16) compared with children with a normal U/C ratio (96 ± 17). VEP latencies decreased significantly in infants with a normal U/C ratio, whereas no decrease was found in infants with a raised U/C ratio. Variables contributing significantly to the variance of cognitive function were: U/C group, VEP latency maturation, level of maternal education, and neurodevelopmental outcome at 3 years. The linear regression model explained 33% of the variance in cognitive function.

Conclusions.  Both being born with a raised U/C ratio and an acceleration of VEP latencies are negatively associated with cognitive outcome at 5 years of age. Fetal brain-sparing, although a seemingly beneficial adaptive mechanism for intact neurologic survival, is, however, later associated with a poorer cognitive outcome.  Key words:  fetal growth restriction, cognitive outcome, brain-sparing, visual-evoked potentials, brain maturation.




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