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Published online October 26, 2009
PEDIATRICS Vol. 124 No. 5 November 2009, pp. e934-e941 (doi:10.1542/peds.2008-3346)
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ARTICLE

Neurobehavior in Term, Small-for-Gestational Age Infants With Normal Placental Function

Francesc Figueras, MDa,b,c, Daniel Oros, MDb, Rogelio Cruz-Martinez, MDb, Nelly Padilla, MDb, Edgar Hernandez-Andrade, MDb, Francesc Botet, MDb,c,d, Carme Costas-Moragas, PhDe, Eduard Gratacos, PhDa,b,c

a Maternal-Fetal Medicine
d Neonatology Departments, Hospital Clinic
c CIBER-ER, University of Barcelona, Barcelona, Spain
b Fetal and Perinatal Research Group, August Pi i Sunyer Institute for Biomedical Research, Barcelona, Spain
e Department of Clinical and Health Psychology, Autonomous University of Barcelona, Barcelona, Spain

OBJECTIVE: The goal was to evaluate the neurobehavioral outcomes of term, small-for-gestational age (SGA) newborns with normal placental function.

METHODS: A cohort of consecutive term SGA newborns with normal prenatal umbilical artery Doppler ultrasound findings was created and compared with a group of term infants with size appropriate for gestational age, who were sampled from our general neonatal population. Neonatal behavior was evaluated at corrected age of 40 ± 1 weeks with the Neonatal Behavioral Assessment Scale. The effect of the study group on each Neonatal Behavioral Assessment Scale area was adjusted, through multivariate analysis of covariance, for smoking during pregnancy, maternal BMI, socioeconomic level, onset of labor, mode of delivery, use of epidural anesthetic medication, gestational age at delivery, postnatal age (in days) at evaluation, and gender.

RESULTS: A total of 202 newborns (102 SGA and 100 appropriate for gestational age) were included. All of the neurobehavioral areas studied were poorer in the SGA group, with significance for attention, habituation, motor, social-interactive, and regulation of state. The average mean differences in scores between the study groups were 0.77 (95% confidence interval: 0.38–1. 14) for attention, 0.64 (95% confidence interval: 0.13–1.14) for habituation, 0.52 (95% confidence interval: 0.31–0.74) for motor, 0.95 (95% confidence interval: 0.54–1.37) for social-interactive, and 0.68 (95% confidence interval: 0.23–1.13) for regulation of state. These differences remained significant after adjustment for potential confounders.

CONCLUSION: Term SGA newborns with no signs of placental insufficiency had poorer neurobehavioral competencies, which suggests delayed neurologic maturation.

Key Words: small for gestational age • intrauterine growth restriction • neurobehavioral outcome • Doppler ultrasonography

Abbreviations: SGA—small for gestational age • AGA—appropriate for gestational age • IUGR—intrauterine growth restriction • NBAS—Neonatal Behavioral Assessment Scale

Accepted Jun 4, 2009.


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