CONTEXT: Children who experienced intrauterine growth restriction (IUGR) may be at increased risk for adverse neurologic developmental outcomes during the school-age years of life.
OBJECTIVE:To estimate the effect of IUGR on cognition and behavior in school-aged children.DATA SOURCES: Medline, Embase, and PsycINFO were searched for English-language articles published after 1980.DATA SELECTION We included case-control studies reporting cognitive and/or behavioral data of children who had IUGR and were evaluated afterfifth birthday.
DATA EXTRACTION:Cognitive data from 15 studies and behavioral data from 6 studies were selected with a total of 1559 cases and 1630 controls. The cognitive scores and behavioral outcomes were extracted.
RESULTS:The controls had significantly higher cognitive scores than the children with IUGR (standardized mean difference [SMD] -0.38, 95% confidence interval [CI] -0.51 to -0.25, P < .00001). The IQ scores of the IUGR group were not significantly correlated with mean birth weight and gestational age (P > .05). Five trials were included in the behavioral outcomes trial, the behavior scores were significantly different between the groups with and without IUGR (SMD 0.31, 95% CI 0.13 to 0.48, P = .001). The incidence of attention-deficit/ hyperactivity disorder (ADHD) was not significantly different between 2 groups (P = .11).
LIMITATIONS:The number of studies that assessed behavioral and ADHD outcome is small.
CONCLUSIONS:The findings demonstrate that IUGR is associated with lower cognitive scores in school-age children. However, further large-scale trials are needed to assess the effects of IUGR on the outcome of behavioral disorder and ADHD.Neonatal Division, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China Dr P. Chen conceptualized and designed the study, and reviewed and revised the manuscript; Dr J. Chen carried out the initial analyses, and drafted the initial manuscript; Drs Bo and Luo collected data, and critically reviewed the manuscript; and all authors approved the fi nal manuscript as submitted and agree to be accountable for all aspects of the work. By 2 to 3 years after birth, infants with IUGR will undergo catch-up growth of both the body and head 3 ; however, approximately 10% of IUGR cases do not achieve catch-up growth and exhibit persistent growth delay. 4 Many studies have shown that IUGR is associated with increased neonatal morbidity and mortality as well as cardiovascular disease, insulin resistance, diabetes mellitus type 2, dyslipidemia, and end-stage renal disease in adulthood. In addition, numerous large-scale follow-up studies have shown that IUGR is associated with significant neurodevelopmental impairment across a range of outcomes in children. [5][6][7] The effects of IUGR persist beyond the neonatal period and may have a profound impact on childhood development. To date, neurodevelopment in school-age children with IUGR has received comparatively little attention. Here, we present a meta-analysis and systematic review...