Obstetrics Department, Hospital Clínico Universitario Lozano Blesa Zaragoza, Instituto Aragonés de Ciencias de la Salud, University of Zaragoza, Zaragoza, Spain.
Ultrasound Obstet Gynecol. 2014 Jan;43(1):41-7. doi: 10.1002/uog.12556.
To assess the effects of late small-for-gestational-age (SGA) birth and late prematurity on cognitive outcomes and structural changes in the central nervous system at primary school age, using a novel approach to examine changes in neuronal integrity of the retina.
We conducted a cross-sectional study of 347 children aged 6-13 years, including in the analysis only infants born after 34 weeks' gestation. We recorded all perinatal outcomes through a survey of parents. Neuronal damage was evaluated using optical coherence tomography of the retina. In a subgroup of 112 children aged 6-8 years, visuospatial perception was evaluated with the Children's Bender Visual Motor Gestalt Test.
The proportions of SGA and late preterm children were 11.8 and 6.3%, respectively. Prematurity and SGA were simultaneously present in five children. When compared with controls, SGA children showed significantly lower than average retinal nerve fiber layer (RNFL) thickness (94.1 vs 98.8 μm; P = 0.007) and an increased percentage of abnormal Bender scores (27.3 vs 6.2%; P = 0.017) (odds ratio 5.6 (95% CI, 1.2-26.8)). These differences increased when late SGA infants with a birth weight below the 3(rd) percentile were compared with SGA infants with a birth weight between the 3(rd) and 10(th) percentiles and with controls, for RNFL thickness (92.5 vs 94.6 and 98.8 μm, respectively; P = 0.021) and abnormal Bender tests (33.3 vs 25.0 and 6.2%, respectively; P = 0.036). However, no differences were found in retinal structure and visuomotor performance between late preterm and term infants.
These data suggest that late SGA and late prematurity induce a distinct neuronal pattern of structural changes that persist at school age. Late-onset SGA infants are at increased risk for axonal loss in the retina and present specific visuomotor difficulties.
采用一种新方法检测视网膜神经元完整性的变化，评估小于胎龄儿（SGA）和晚期早产对学龄儿童认知结果和中枢神经系统结构的影响。
我们对 347 名 6-13 岁的儿童进行了横断面研究，仅对 34 周后出生的婴儿进行了分析。我们通过对父母进行调查记录了所有围产期结局。使用视网膜光学相干断层扫描评估神经元损伤。在 112 名 6-8 岁的儿童亚组中，使用儿童 Bender 视觉运动 Gestalt 测试评估视空间感知。
SGA 和晚期早产儿的比例分别为 11.8%和 6.3%。有 5 名儿童同时存在早产和 SGA。与对照组相比，SGA 儿童的视网膜神经纤维层（RNFL）厚度明显较低（94.1 对 98.8 μm；P = 0.007），异常 Bender 评分的百分比增加（27.3%对 6.2%；P = 0.017）（比值比 5.6（95%可信区间，1.2-26.8））。当将出生体重低于第 3 百分位的晚期 SGA 婴儿与出生体重处于第 3-10 百分位的 SGA 婴儿和对照组进行比较时，这些差异在 RNFL 厚度（92.5 对 94.6 和 98.8 μm，分别；P = 0.021）和异常 Bender 测试（33.3 对 25.0 和 6.2%，分别；P = 0.036）时增加。然而，晚期早产儿和足月婴儿的视网膜结构和视动表现无差异。
这些数据表明，晚期 SGA 和晚期早产引起了持续到学龄期的明显的神经元结构变化模式。晚期发病的 SGA 婴儿发生轴索丢失的风险增加，并出现特定的视动困难。
