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Early Hum Dev. 2010 Aug;86(8):515-21. doi: 10.1016/j.earlhumdev.2010.07.001. Epub 2010 Jul 31.

Antenatal antecedents of a small head circumference at age 24-months post-term equivalent in a sample of infants born before the 28th post-menstrual week.

Author information

1
Department of Neurology, Children's Hospital Boston and Harvard Medical School, Boston, MA, USA. alan.leviton@childrens.harvard.edu

Abstract

BACKGROUND:

Little is known about the antecedents of microcephaly in early childhood among children born at extremely low gestational age.

AIM:

To identify some of the antecedents of microcephaly at age two years among children born before the 28th week of gestation.

STUDY DESIGN:

Observational cohort study.

SUBJECTS:

1004 infants born before the 28th week of gestation.

OUTCOME MEASURES:

Head circumference Z-scores of <-2 and >or=-2, <-1.

RESULTS:

Risk of microcephaly and a less severely restricted head circumference decreased monotonically with increasing gestational age. After adjusting for gestational age and other potential confounders, the risk of microcephaly at age 2 years was increased if microcephaly was present at birth [odds ratio: 8.8 ((95% confidence interval: 3.7, 21)], alpha hemolytic Streptococci were recovered from the placenta parenchyma [2.9 (1.2, 6.9)], the child was a boy [2.8 (1.6, 4.9)], and the child's mother was not married [2.5 (1.5, 4.3)]. Antecedents associated not with microcephaly, but with a less extreme reduction in head circumference were recovery of Propionibacterium sp from the placenta parenchyma [2.9 (1.5, 5.5)], tobacco exposure [2.0 (1.4, 3.0)], and increased syncytial knots in the placenta [2.0 (1.2, 3.2)].

CONCLUSIONS:

Although microcephaly at birth predicts a small head circumference at 2 years among children born much before term, pregnancy and maternal characteristics provide supplemental information about the risk of a small head circumference years later. Two findings appear to be novel. Tobacco exposure during pregnancy, and organisms recovered from the placenta predict reduced head circumference at age two years.

PMID:
20674197
PMCID:
PMC2967731
DOI:
10.1016/j.earlhumdev.2010.07.001
[Indexed for MEDLINE]
Free PMC Article

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