Introduction: Term newborns Small for Gestational Age (SGA) have an increased risk for minor neurological impairment at pre- and school age. The general movements (GMs) assessment, in particular at Fidgety (F+) age, has been increasingly used to predict neurological dysfunctions. Aim of our study was to evaluate, in a population of term newborn SGA (gestational age >37 weeks) the growth recovery, the presence of F+ at 3 months of age, and the neurological outcome at 2 years, compared to term AGA newborns.
Methods: Prospective evaluation of SGA newborns (birth weight and/or length <3° percentile according to national growth charts) and AGA controls. At 3 months we evaluate: the auxological parameters (AP) (weight, length, head circumference) and the assessment of spontaneous motility according to the Prechtls evaluation of GMs method, the neurological examination (NE) according to Amiel-Tyson. At 6-12-24 months we evaluate AP + NE + neurodevelopment assessment by the Griffiths mental development scales.
Results: We enrolled 38 SGA and 20 AGA controls. At three months, 13% of SGA presented at least one auxological parameter <3° percentile, despite a significant catch up growth both for weight and length (P<0.001; P<0.001, respectively). 100% of AGA newborns presented F+ at three months, while in SGA children 23.7% (4M, 5F) did not show F+ (P<0.001). No substantial differences were recorded in weight (P=0.53), length (P=0.32) and cranial circumference (P=0.24) at birth and at 3 months (respectively P=0.49, P=0.84, P=0.84) between SGA F+ and SGA F-. Cranial circumference at birth was noticed to be a positive predictive factor for F+ (P=0.039). At 2 years of age, a difference statistically significant between SGA and AGA was detected in each item of the Griffiths mental development scales.
Conclusion: Independently from the growth recovery, at three months of age, about 1/4 of SGA newborns do not show Fidgety movements. At 2 years of age the neurodevelopmental assessment reveal differences in each domain of evaluation between SGA and AGA children, although within the normal ranges. We may assume that intrauterine growth restriction and the reduction of cranial circumference could have a negative effect on neuropsychological development and that SGA children may need an attentive neurological follow-up.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology