JURNALUL PEDIATRULUI – Year XX, Vol. XX, Nr. 79-80, july-december 2017 18 NEONATAL NEUROLOGICAL OUTCOME OF SMALL FOR GESTATIONAL AGE VERSUS PREMATURE INFANTS Teofana Bizerea 1,2 , Ramona Stroescu 1,2 , Constantin Ilie 1,3 , Claudiu Angelescu 1,3 , Ştefana-Gheorghina Dezsi 4,5 , Otilia Mărginean 1,2 Abstract Introduction Neonates born prematurely or small for gestational age (SGA) as a consequence of intrauterine growth restriction (IUGR) have a higher risk of neurological injury due to fetal hypoxia. Hypoxic ischemic encephalopathy (HIE) and intraventricular hemorrhage (IVH) are the main clinical forms of brain injury. The patterns and underlying mechanisms of neurological injury are interrelated. Aim of the study The purpose of the study was to evaluate the neurological outcome of SGA newborns versus neonates born preterm. Materials and methods A 3 year randomized case – control study was conducted between the 1 st of January 2014 and the 31 th of December 2016, at the Emergency County Hospital, Timisoara. 170 SGA newborns and 170 AGA newborns matched 1:1 for gestational age and birth month were included in the study. Patients were divided in 4 subgroups according to gestational age: 101 SGA newborns born at term (SGA- Term) and 69 SGA newborns born preterm (SGA-Preterm), 101 AGA neonates born at term (AGA-Term) and 69 AGA neonates born preterm (AGA-Preterm). Results and discussions Preterm neonates had difficulties of early neonatal adaptation, as indicated by a low APGAR score. Preterm neonates irrespective of birth weight, had a higher incidence of both HIE (26.1% SGA Preterm versus 11.8% SGA Term and 11.5% AGA Preterm compared to 0.0% AGA Term ) and IVH (20.3% SGA Preterm versus 7.9% SGA Term and 15.9% AGA Preterm compared to 0.0% AGA Term ). Conclusions Neonates born preterm have a poorer neurological outcome compared to term newborns, regardless of birth weight. SGA is an additional, aggravating factor for neurological injury. More extensive studies on the different subgroups of SGA newborns are required in order understand the underlying mechanisms. Keywords: newborn, neurological injury, fetal hypoxia Introduction Preterm and small for gestational age (SGA) births with associated intrauterine growth restriction (IUGR) have been linked to neonatal neurological morbidity [1-5]. These disturbances of intrauterine growth and development are caused by an impaired placental blood flow with subsequent chronic fetal hypoxia [6-9]. Fetal and neonatal brain development is vulnerable to oxidative stress from hypoxic–ischemic injury. Although, disturbances in vascular autoregulation and their effect on the immature vascular supply of the brain represent a common pathway to neurological damage, establishing a causal relationship between type and onset of the neurological insult and specific forms of brain injury is difficult due to the fact that the underlying mechanisms are mulifactorial and overlapping. Hypoxic ischemic encephalopathy (HIE) and intraventricular hemorrhage (IVH) represent the main clinical forms of brain injury that occur as a result of repeated episodes of ischemia-reperfusion during the prenatal, intrapartum or postnatal period [3, 10-12]. Aim of the study The purpose of the study was to evaluate the neurological outcome of SGA newborns versus neonates born preterm by evaluating the incidence, risk factors and underlying mechanisms of HIE and IVH in these newborns. Material and method A 3 year randomized case – control study was conducted between the 1st of January 2014 and the 31th of December 2016, at the Neonatology Department of the Clinic of Obstetrics, Gynecology and Neonatology, Emergency County Hospital, Timisoara. According to the literature, newborns are framed as being SGA if their length and/or height is less than two standard deviations (< -2SD) below the mean for gestational age or less than the 10th percentile (< Perc 10%) of a population-specific birth weight [13, 14]. Likewise, preterm birth is defined as a live birth that occurs prior to 37 weeks of gestation [15, 16]. 1 “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania 2 1 st Pediatric Clinic ”Louis Turcanu” Children’s Clinical and Emergency Hospital, Timisoara, Romania 3 Clinic of Obstetrics, Gynecology and Neonatology, “Pius Brânzeu” Emergency County Hospital, Timisoara, Romania 4 West University of Timişoara, Departament of Biology-Chemistry, Timişoara, România 5 Laboratory of Advanced Researches in Environmental Protection, Timişoara, România E-mail: teofanabizerea@yahoo.com, ramona.giurascu@gmail.com, constantinilie@umft.ro, angelescu.claudiu@ymail.com, omarginean@ymail.com, stefana.dezsi@yahoo.com