Children born with intrauterine growth restriction: Neurodevelopmental outcome

Intrauterine growth restriction (IUGR) is a pathological prenatal process that is characterized by a decrease in fetal growth velocity, resulting in a fetus that did not attain its full growth potential. It has heterogeneous parental, placental, and fetal triggering mechanisms. IUGR rates are increased in multiple rearing conditions where fetal under-nutritional processes are evoked. IUGR is thought to elicit a fetal programming process that has lifelong repercussions. IUGR is often accompanied by increased prenatal, perinatal, and postnatal complications. Processes aimed at conserving vitality take place, but these processes do not suffice to preserve neurodevelopmental integrity. The neurodevelopmental deficits are often mild, comprised of changes in muscle tone, arousal, coordination deficits, visuo-motor and visuospatial organizational deficits, lower verbal skills, lower intellectual competence, attention and executive disorders, and emotion regulation difficulties. Increased risk for learning disabilities is noted as well. Neurodevelopmental outcome is mediated primarily by growth catch-up velocity. Weight and height gain rates are of particular predictive value during early infancy, while head circumference is of added value later on during childhood. Socioeconomical support systems and socioemotional processes may moderate outcome. Intervention with IUGR-related processes requires the attention and care of well-coordinated multidisciplinary medical and paramedical teams. Practical guidelines are presented.

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