Background Infants born small-for-gestational age (SGA) are at increased risk of developmental difficulties. Identifying those most at risk is challenging. We examined the effect of neonatal body composition and customised birthweight centiles on neurocognitive and behavioural outcomes at age 2.
Study design Prospective cohort study of term infants from the Cork BASELINE Birth Cohort Study classified into the following exposure groups: a birth weight <10th customised centile (SGA, n=51); body fat percentage at birth <10th centile (thin-for-gestational age (TGA, n=51)) or both SGA and TGA infants (small- and thin-for-gestational age (STGA), n=13). The SGA, TGA and STGA groups were compared with a reference (unexposed) group of appropriate-for-gestational age (AGA, n=189) infants. Outcome was assessed at 24 months using the Bayley Scales of Infant Development Version III and the Child Behaviour Checklist.
Results Outcomes in the SGA infants did not differ significantly from the AGA group. TGA infants had significantly lower scores across all three domains, with a 0.35, 0.38 and 0.41 SD reduction in language, cognitive and motor scale scores, respectively. STGA infants had poorer cognitive outcome with a median cognitive scale score of 90 (IQR 85–95) compared with 95 (IQR 90–100) in the AGA reference group, p=0.005. The adjusted OR of developmental delay at 2 years was 5.00 (95% CI 1.46 to 17.13, p=0.010) in the STGA group.
Conclusion TGA infants, in particular those born STGA, are at increased risk of developmental delay at 2 years compared with the AGA infants.
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Contributors SMO completed analysis of the data and drafted the first and subsequent drafts of the manuscript. GH was responsible for the neurodevelopmental assessments, data reporting and editing of the final manuscript. ASK provided statistical input into the study design, planned and supervised the data analysis and planned and edited the final manuscript. JOBH aided in study design, governance of the BASELINE Birth Cohort Study and contributed to the final manuscript. LCK is the principal investigator of the SCOPE pregnancy study, and co-investigator of the BASELINE Birth Cohort. LCK assisted in the study design and manuscript preparation. MK aided in study design, governance of the BASELINE Birth Cohort Study and contributed and edited the final manuscript. DMM is the principal investigator of the BASELINE Birth Cohort Study and planned the study design and governed its execution. DMM aided in data analysis, manuscript planning, preparation and final editing.
Funding The Cork BASELINE Birth Cohort Study was funded by the National Children's Research Centre and the UK Food Standards Agency (FSA TO7060). GH was partly funded by an educational grant from Danone Nutricia. The Irish Centre for Fetal and Neonatal Translational Research is a Science Foundation Ireland funded Centre (12/RC/2272). The SCOPE study was funded by the Health Research Board, Ireland (CSA/2007/2).
Competing interests JOBH has received separate funding from Danone Nutricia.
Ethics approval Cork Research Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Data from the Cork BASELINE Birth Cohort Study can be made available to researchers following application to the research committee with a completed research application form. These are available on request through our research team. Contact details and further information are available on www.baselinestudy.net.
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