OUTCOME OF VERY PRETERM SMALL-FOR-GESTATIONAL-AGE INFANTS - THE FIRST9 YEARS OF LIFE

Objective To determine the influence of intrauterine growth retardatio n of preterm infants on mortality and cognitive development. Design A nationwide study cohort of very preterm and/or small for gestational a ge infants (< 32 weeks and/or < 1500 g) born alive in 1983 in the Neth erlands. Assessment on neuromotor and cognitive development at five ye ars, and a parental questionnaire on school performance at nine years. Cognitive outcome is defined as handicap for mental and speech-langua ge development and need for special education. Sample 134 small for ge stational age infants (< 10th centile) and 410 appropriate for gestati onal age infants (between 25th and 75th centile) of all infants betwee n 25 and 32 weeks of gestational age were identified; infants with con genital malformations and not of caucasian race were excluded. Main ou tcome measures Neonatal mortality, in-hospital and five years mortalit y; Cognitive outcome at five years; School performance at nine years. Results The mortality risk for small for gestational age compared with appropriate for gestational age infants was significantly higher, aft er adjustment for gestational age, sex, multiple pregnancy and mode of delivery (OR 2.56, 95% CI 1.26-5.26), Small for gestational age infan ts showed more often gross motor and minor neurological dysfunction, b ut less cerebral palsy than appropriate for gestational age infants. C ognitive outcome at five years in small for gestational age infants wa s significantly worse than appropriate for gestational age infants str atified for mode of delivery OR 2.44 (95% CI 1.05-5.55). At nine years of age significantly more small for gestational age infants (16.4%) n eeded special education than appropriate for gestational age infants ( 11.9%). Conclusion Intrauterine growth retardation increases the risk of mortality and of cognitive disorders.