1. Patients born both extremely premature and with severe growth restriction were found to have decreased level of functioning in multiple cognitive domains when assessed at 10 years old.
2. In addition to cognitive delays, patients born extremely premature with severe growth restriction were found to have a myriad of social impairments, including decreased social awareness, autism spectrum disorders, and difficulty with speech and social functioning.
Evidence Rating Level: 2 (Good)
Study Rundown: As extreme prematurity and severe growth restriction are each known causes of developmental delay, researchers sought to determine if the combination of the 2 put children at greater risk for developmental delay. Using participants from the multi-center Extremely Low Gestational Age Newborns (ELGAN) Study, researchers examined cognitive and behavioral ability at age 10 in those infants born before 28 weeks with severe growth restriction. Researchers evaluated a number of domains, including cognitive and academic function, autism spectrum traits, gross motor function, communication, and social responsiveness. Children born premature with severe growth restriction were more likely to have delays in a multitude of domains, including oral expression, working memory, auditory response, numeric operations, social awareness, and social cognitions. Severely growth restricted patients screened positive for post-traumatic stress according to both parent and patient survey responses. Teachers also reported more obsessions, compulsions, and social phobias in study participants. Though multiple domains were thoroughly investigated, findings are limited by the uncertainty of causation inherent in a retrospective cohort study. Clinically, these findings reaffirm the need for quality prenatal care which continues to advance in its ability to address both prematurity and fetal growth restriction.
In-Depth [retrospective cohort]: Researchers contacted participants in the ELGAN study from 1 of the 14 centers initially involved in the study; of the 966 eligible for recruitment, 889 were available for follow-up to assess various behavioral and cognitive delays. Eligibility criteria included extreme prematurity, defined as birth prior to 28 weeks gestation, and growth restriction, defined as weight z score (standard deviations; z scores of less than -2, between -2 and -1, and greater than -1 were included for comparison). A number of previously validated tests were used to evaluate cognitive and executive function, including the Differential Ability Scale-II (DAS-II), the Developmental Neuropsychological Assessment-II (NEPSY-II), the Oral and Written Language Scales (OWLS), the Social Communication Questionnaire (SCQ), the Wechsler Individual Achievement Test-III (WIAT-III), the Autism Diagnostic Interview–Revised (ADI-R), and the Social Responsiveness Scales (SRS). Overall, children who were both extremely premature and severely growth restricted (z score <-2) and those less growth restricted (≥-2 and <-1) were 1.5 to 2 times more likely to have delays in a multitude of these domains.
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