Small for Gestational Age - Körperliche, neurologische und kognitive Entwicklung bis ins Erwachsenenalter

Zusammenfassung

Hintergrund und Fragestellung: Die körperliche, neurologische und kognitive Entwicklung ehemaliger small for gestational age (SGA)-Geborener bis in das Erwachsenenalter wurde in den letzten Jahren immer häufiger untersucht. Ziel dieses Reviewartikels ist es, die Studien über Mortalität, Morbidität, die körperliche, neurologische und kognitive Entwicklung von SGA-Kindern zu vergleichen und solche Ergebnisse zusammenzufassen, welche trotz unterschiedlicher Studiendesigns erkennbar sind.

Methodik: In den Studien wurden einerseits very low birth weight SGA-Kinder (VLBW-SGA) mit appropriate for age-Kindern (VLBW-AGA) mit einem Geburtsgewicht unter 1500 g bzw. unter 1250 g verglichen. Andererseits wurden full-term SGA-Kinder (FT-SGA) mit FT-AGA-Kindern verglichen.

Ergebnisse: SGA-Kinder blieben mit dem Wachstum unter der 10. Perzentile, wenn sie nicht spätestens bis zum Ende des 2. Lebensjahres aufgeholt hatten. Zerebralparesen traten bei VLBW-SGA-Kindern seltener auf als bei VLBW-AGA-Kindern. VLBW-SGA- bzw. FT-SGA-Kinder hatten häufiger kognitive Entwicklungsprobleme als VLBW-AGA- bzw. FT-AGA-Kinder. Die kognitiven Entwicklungsprobleme zeigten sich vor allem im Schulbereich. Im Erwachsenenalter konnten nur geringe Unterschiede in der kognitiven Entwicklung gefunden werden. Ein niedriger Sozialstatus sowie eine persistierende Mikrozephalie waren häufig mit einer schlechteren neurologischen und kognitiven Entwicklung verbunden.

Schlussfolgerung und Diskussion: SGA-Kinder haben ein erhöhtes Risiko für geringeres Wachstum und kognitive Entwicklungsprobleme. Ob diese kognitiven Entwicklungsprobleme tatsächlich bis in das Erwachsenenalter bestehen bleiben, müssen weitere Langzeitstudien zeigen.

Abstract

Background: The somatic, neurological and cognitive development of children born small for gestational age (SGA) until adulthood was assessed in recent studies. Studies that assessed mortality, morbidity, somatic, neurological and cognitive development of SGA children were compared.

Materials and Methods: In the studies very low birth weight SGA children were compared to very low birth weight appropriate for age children (AGA, birth weight below 1500 g or 1250 g). Full-term SGA children were compared to full-term appropriate for age children. Growth of SGA children remained under the 10th percentile, if catch up growth did not occur until the end of the second year. Cerebral palsy appeared more often in VLBW-AGA than in VLBW-SGA children. Cognitive development problems appeared in VLBW-SGA and FT-SGA children more often than in VLBW-AGA and FT-AGA children. These cognitive development problems were observed mainly as poor school performance. When reaching adulthood, the differences in cognitive function seem to be less significant. Low socioeconomic status and persistence of microcephaly were associated with problems in neurological and cognitive development.

Conclusions and Discussion: Growth and cognitive development problems appeared more often in SGA children. More longterm studies are necessary to show, if these cognitive development problems remain significant until adulthood.

Schlüsselwörter

Small for gestational age - Mortalität - Morbidität - kognitive Entwicklung

Key words

Small for gestational age - mortality - morbidity - cognitive development

Literatur

• 1 McIntire D D, Bloom S L, Casey B M. u. Mitarb . Birth weight in relation to morbidity and mortality among newborn infants.  N Engl J Med. 1999;  340 1234-1238
• 2 Strauss R S. Adult functional outcome of those born small for gestational age.  JAMA. 2000;  283 625-632
• 3 Robertson C MT, Etches P C, Kyle J M. Eight-year performance and growth of preterm, small for gestational age infants: a comparative study with subjects matched for birth weight or for gestational age.  J Pediatr. 1990;  116 19-26
• 4 Bylund B, Crvin T, Finnström O. u. Mitarb . Morbidity and neurological function of very low birthweight infants from the newborn period to 4 y of age. A prospective study from the south-east region of Sweden.  Acta Paediatr. 1998;  87 758-763
• 5 Korkman M, Liikanen A, Fellman V. Neuropsychological consequences of very low birth weight and asphyxia at term: follow-up until school-age.  J Clin Exp Neuropsychol. 1996;  18 220-233
• 6 Pryor J, Silva P A, Brooke M. Growth, development and behaviour in adolescents born small-for-gestational-age.  J Paediatr Child Health. 1995;  31 403-407
• 7 Paz I, Gale R, Laor A. u. Mitarb . The cognitive outcome of full-term small for gestational age infants at late adolescence.  Obstet Gynecol. 1995;  85 452-456
• 8 Smedler A C, Faxelius G, Bremme K. u. Mitarb . Psychological development in children born with very low birth weight after severe intrauterine growth retardation: a 10-year follow-up study.  Acta Paediatr. 1992;  81 197-203
• 9 Hutton  J L, Pharoah  P OD, Cooke  R WI. u. Mitarb . Differential effects of preterm birth and small gestational age on cognitive and motor development.  Arch Dis Child. 1997;  76 F75-F81
• 10 Kok J H, den Ouden A L, Verloove-Vanhorick S P. u. Mitarb . Outcome of very preterm small for gestational age infants: the first nine years of life.  Br J Obstet Gynaecol. 1998;  105 162-168
• 11 Hadders-Algra M, Touwen B C. Body measurements, neurological and behavioural development in six-year-old children born preterm and/or small-for-gestational-age.  Early Hum Dev. 1990;  22 1-13
• 12 Gortner L, Wauer R R, Stock G J. u. Mitarb . Neonatal outcome in small for gestational age infants: do they really better?.  J Perinat Med. 1999;  27 484-489
• 13 Witlin A G, Saade G R, Mattar F. u. Mitarb . Predictors of neonatal outcome in women with severe preeclampsia or eclampsia between 24 and 33 weeks’ gestation.  Am J Obstet Gynecol. 2000;  182 607-611
• 14 Sung I, Vohr B, Oh W. Growth and neurodevelopmental outcome of very low birth weight infants with intrauterine growth retardation: comparison with control subjects matched by birth weight and gestational age.  J Pediatr. 1993;  123 618-624
• 15 Walther F J. Growth and development of term disproportionate small-for-gestational age infants at the age of 7 years.  Early Hum Dev. 1988;  18 1-11
• 16 Amin H, Singhal N, Sauve R S. Impact of intrauterine growth restriction on neurodevelopmental and growth outcomes in very low birthweight infants.  Acta Paediatr. 1997;  86 306-314
• 17 Villar  J, Smeriglio  V, Martorell  R. u. Mitarb . Heterogeneous growth and mental development of intrauterine growth-retarded infants during the first 3 years of life.  Pediatrics. 1984;  74 783-791
• 18 Vohr B R, Oh W. Growth and development in preterm infants small for gestational age.  J Pediatr. 1983;  103 941-945
• 19 Low  J A, Handley-Derry  M H, Burke  S O. u. Mitarb . Association of intrauterine fetal growth retardation and learning deficits at age 9 to 11 years.  Am J Obstet Gynecol. 1992;  167 1499-1505
• 20 Westwood M, Kramer M S, Munz D. u. Mitarb . Growth and development of full-term nonasphyxiated small-for-gestational-age newborns: follow-up through adolescence.  Pediatrics. 1983;  71 376-382
• 21 Low J A, Galbraith R S, Muir D. u. Mitarb . Intrauterine growth retardation: a study of long-term morbidity.  Am J Obstet Gynecol. 1982;  142 670-677
• 22 Hack M, Breslau N, Weissman B. u. Mitarb . Effect of very low birth weight and subnormal head size on cognitive abilities at school age.  N Engl J Med. 1991;  325 231-237
• 23 Scherjon S, Briet J, Oosting H. u. Mitarb . 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.  Pediatrics. 2000;  105 385-391
• 24 Calame A, Fawer C L, Cleys V. u. Mitarb . Neurodevelopmental outcome and school performance of very-low-birth-weight infants at 8 years of age.  Eur J Pediatr. 1986;  145 461-466
• 25 Pena I C, Teberg A J, Finello K M. The premature small-for-gestational-age infant during the first year of life: comparison by birth weight and gestational age.  J Pediatr. 1988;  113 1066-1073
• 26 Veelken N, Stollhoff K, Claussen M. Development and perinatal risk factors of very low-birth-weight infants. Small versus appropriate for gestational age.  Neuropediatrics. 1992;  23 102-107
• 27 Goldenberg R L, Hoffmann H J, Cliver S P. Neurodevelopmental outcome of small-for-gestational-age infants.  Eur J Clin Nutr. 1998;  52 S54-S58
• 28 Fitzhardinge P M, Steven E M. The small-for-date infant. II. neurological and intellectual sequelae.  Pediatrics. 1972;  50 50-57
• 29 Strauss R S, Dietz W H. Effects of intrauterine growth retardation in premature infants on early childhood growth.  J Pediatr. 1997;  130 95-102
• 30 Paz I, Seidman D S, Danan Y L. u. Mitarb . Are children born small for gestational age at increased risk of short stature?.  Am J Dis Child. 1993;  147 337-339
• 31 Strauss R S, Dietz W H. Growth and development of term children born with low birth weight: effects of genetic and environmental factors.  J Pediatr. 1998;  133 67-72
• 32 Paz I, Laor A, Gale R. u. Mitarb . Term infants with fetal growth restriction are not at increased risk for low intelligence scores at age 17 years.  J Pediatr. 2001;  138 87-91