Objectives To assess the association of head circumference (HC) <10th percentile at birth and discharge from the neonatal intensive care unit (NICU) with neurodevelopment in very preterm (24–32 weeks’ gestational age) neonates, and to compare the association of HC and total cerebral volume (TCV) with neurodevelopmental outcomes.
Design In a prospective cohort, semiautomatically segmented TCV and manually segmented white matter injury (WMI) volumes were obtained. Multivariable regressions were used to study the association of HC and TCV with neurodevelopmental outcomes, accounting for birth gestational age, WMI and postnatal illness.
Setting Participants born in 2006–2013 at British Columbia Women’s Hospital were recruited.
Patients 168 neonates had HC measurements at birth and discharge and MRI at term-equivalent age (TEA). 143 children were assessed at 4.5 years.
Main outcome measures Motor, cognitive and language outcomes at 4.5 years were assessed using the Movement Assessment Battery for Children Second Edition (M-ABC) and Wechsler Preschool and Primary Scale of Intelligence Third Edition Full Scale IQ (FSIQ) and Verbal IQ (VIQ).
Results Small birth HC was associated with lower M-ABC and FSIQ scores. In children with small birth HC, small discharge HC was associated with lower M-ABC, FSIQ and VIQ scores, while normal HC at discharge was no longer associated with adverse outcomes. HC strongly correlated with TCV at TEA. TCV did not correlate with outcomes.
Conclusions Small birth HC is associated with poorer neurodevelopment, independent of postnatal illness and WMI. Normalisation of HC during NICU care appears to moderate this risk.
Data availability statement
No data are available. Data from this study are only available to researchers of the study team approved by our research ethics boards.
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REG and SPM are joint senior authors.
Contributors TS: statistical analysis and interpretation of data, drafting and revision of the manuscript. TG: analysis of neuroimaging data and critical revision of the manuscript. EK: acquisition of data and critical revision of the manuscript. VC, RB, ARS, REG, SPM: conception and design of the study, critical revision of the manuscript for important intellectual content.
Funding Funding was received from the Canadian Institutes of Health Research (CIHR) (MOP-142204 to SPM and REG) and the Kids Brain Health Network NCE. SPM is currently supported by the Bloorview Children’s Hospital Chair in Pediatric Neuroscience. REG is supported by the BC Children’s Hospital Research Institute. TS is supported by the CIHR Canada Graduate Scholarship-Master’s award, Ontario Ministry of Health Clinician Investigator Program and the Sickkids Research Institute Clinician Scientist Training Program.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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