REGULAR ARTICLE Twelve-month neurodevelopmental outcome in preterm infants with and without intrauterine growth restriction Nelly Padilla (fpadilla@clinic.ub.es) 1,2,3 , Josep Perapoch 3 , Antonio Carrascosa 2,4 , Ruthy Acosta-Rojas 1,2 , Francesc Botet 5 , Eduard Gratacós 1,2,3 1.Department of Maternal-Fetal Medicine, ICGON, Hospital Clinic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain 2.Center for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain 3.Department of Obstetrics and Neonatology, Hospital Vall d’Hebron, Universidad Auto ´ noma de Barcelona, Barcelona, Spain 4.Department of Pediatrics, Hospital Vall d’Hebron, Universidad Auto ´ noma de Barcelona, Barcelona, Spain 5.Department of Neonatology, ICGON, Hospital Clinic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain Keywords Developmental outcome, Intrauterine growth restriction, Neurological examination Correspondence Nelly Padilla, Fetal Medicine Research Group – Department of Maternal Fetal medicine, ICGON, Hospital Clı ´nic. Sabino de Arana 1, 08028 Barcelona, Spain. Tel: +34 93 227 9333 | Fax: +34 93 227 9336 | Email: fpadilla@clinic.ub.es Received 24 December 2009; revised 5 March 2010; accepted 23 April 2010. DOI:10.1111/j.1651-2227.2010.01848.x ABSTRACT Aim: To evaluate the neurodevelopmental outcome at 12 months’ corrected age in preterm infants with and without severe intrauterine growth restriction. Methods: This prospective follow-up study included 37 infants with severe intrauter- ine growth restriction and 36 appropriate-for-gestational-age infants born between 26 and 34 weeks. Neonatal and infant data were prospectively recorded. Infants were assessed at 12 ± 2 months’ corrected age with the Hammersmith Infant Neurological Examination and the Bayley Scale for Infant Development version-II. Results: Both groups were similar in demographic characteristics and perinatal sta- tus. No significant differences in neurodevelopmental performance were found. The men- tal development index was 98.8 (SD 9.0) vs 98.4 (SD 13.1) (p = 0.9) and the psychomotor development index was 91.7 (SD 9.9) vs 95.5 (SD 13.4) (p = 0.2) for the study and reference groups respectively. Neurological assessment showed no significant differences between the two groups. Conclusion: Although the study group showed a non-significant trend towards a lower score in the psychomotor development index than the reference group, significant differences at 12 months could not be demonstrated. IUGR infants continued to have significantly lower weight, length and head circumference at 1 year. INTRODUCTION Preterm newborns are at high risk for brain damage. Approximately 5–7% of preterm neonates are born with intrauterine growth restriction (IUGR), which poses an increased risk for an adverse neurodevelopmental outcome (1,2). Recent long-term postnatal studies in children with IUGR have described a higher prevalence of developmental deficits specifically related to cognitive functions involving poor academic performance, memory, visuomotor and lan- guage difficulties and executive function problems (3,4). Recent advanced magnetic resonance imaging studies have shown that IUGR is associated with structural differences that can be identified very early in life. Studies in preterm newborns with IUGR evaluated at term-corrected age have found reductions in the cerebral cortical grey mat- ter (5), hippocampal volume (6) and sulcation index (7), which were accompanied by less mature behavioural scores. These macrostructural alterations have been associated with microstructural and metabolic changes assessed by dif- fusion tensor imaging and spectroscopy (8), which could underlie the increased risk of neurodevelopmental deficits. In addition, correlations between growth patterns and neurocognitive development in IUGR infants have been demonstrated (9). Neurodevelopmental problems in preterm IUGR infants should ideally be identified as early in life as possible to establish early intervention strategies. However, diagnosis of neurodevelopmental deficits very early in life remains elusive. The results of developmental studies in the first few years of life using either Griffith’s scale (10) or the Bayley Scale of Infant Development version II (BSID-II) (6,11) have failed to show clear differences in comparison with preterm children with normal birth weight. Among the rea- sons proposed to explain the absence of differences are the Abbreviations AGA, appropriate for gestational age; BSID-II, Bayley Scale for Infant Development version II; CI, cephalization index; CRIB, Clinical Risk Index for Babies; GA, gestational age; HC, head cir- cumference; HINE, Hammersmith Infant Neurologic Examina- tion; IUGR, intrauterine growth restriction; MDI, Mental Developmental Index; NICU, neonatal intensive care unit; PDI, Psychomotor Developmental Index. Acta Pædiatrica ISSN 0803–5253 1498 ª2010 The Author(s)/Journal Compilation ª2010 Foundation Acta Pædiatrica/Acta Pædiatrica 2010 99, pp. 1498–1503