UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia.
Perinatal Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
Dev Neurosci. 2024;46(2):84-97. doi: 10.1159/000530492. Epub 2023 May 10.
Fetal growth restriction (FGR) and small for gestational age (SGA) infants have increased risk of mortality and morbidity. Although both FGR and SGA infants have low birthweights for gestational age, a diagnosis of FGR also requires assessments of umbilical artery Doppler, physiological determinants, neonatal features of malnutrition, and in utero growth retardation. Both FGR and SGA are associated with adverse neurodevelopmental outcomes ranging from learning and behavioral difficulties to cerebral palsy. Up to 50% of FGR, newborns are not diagnosed until around the time of birth, yet this diagnosis lacks further indication of the risk of brain injury or adverse neurodevelopmental outcomes. Blood biomarkers may be a promising tool. Defining blood biomarkers indicating an infant's risk of brain injury would provide the opportunity for early detection and therefore earlier support. The aim of this review was to summarize the current literature to assist in guiding the future direction for the early detection of adverse brain outcomes in FGR and SGA neonates. The studies investigated potential diagnostic blood biomarkers from cord and neonatal blood or serum from FGR and SGA human neonates. Results were often conflicting with heterogeneity common in the biomarkers examined, timepoints, gestational age, and definitions of FGR and SGA used. Due to these variations, it was difficult to draw strong conclusions from the results. The search for blood biomarkers of brain injury in FGR and SGA neonates should continue as early detection and intervention is critical to improve outcomes for these neonates.
胎儿生长受限(FGR)和小于胎龄儿(SGA)的婴儿死亡风险和发病率增加。尽管 FGR 和 SGA 婴儿的出生体重均低于胎龄,但 FGR 的诊断还需要评估脐动脉多普勒、生理决定因素、新生儿营养不良特征和宫内生长迟缓。FGR 和 SGA 都与不良神经发育结局相关,从学习和行为困难到脑瘫不等。多达 50%的 FGR 婴儿直到出生前后才被诊断出来,但这种诊断缺乏对脑损伤或不良神经发育结局风险的进一步指示。血液生物标志物可能是一种很有前途的工具。定义表明婴儿脑损伤风险的血液生物标志物将为早期发现提供机会,从而更早地提供支持。本综述的目的是总结目前的文献,以协助指导未来对 FGR 和 SGA 新生儿不良脑结局的早期检测方向。研究调查了来自 FGR 和 SGA 人类新生儿脐带和新生儿血液或血清的潜在诊断血液生物标志物。结果往往存在异质性,且常与所检查的生物标志物、时间点、胎龄以及 FGR 和 SGA 的定义有关。由于这些差异,很难从结果中得出强有力的结论。在 FGR 和 SGA 新生儿中寻找脑损伤的血液生物标志物的研究应继续进行,因为早期发现和干预对于改善这些新生儿的结局至关重要。