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Ultrasound Obstet Gynecol. 2015 Oct;46(4):398-404. doi: 10.1002/uog.14818.

Impact of cerebral redistribution on neurodevelopmental outcome in small-for-gestational-age or growth-restricted babies: a systematic review.

Author information

1
Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK.
2
Department of Women's and Children's Health, University of Liverpool, Liverpool, UK.
3
Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Wayne State University, Detroit, MI, USA.
4
Department of Paediatric Neurology and Neonatal Medicine, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.
5
Institute of Reproductive and Developmental Biology, Department of Surgery and Cancer, Imperial College London, London, UK.
6
Department of Development and Regeneration, KU Leuven, Leuven, Belgium.

Abstract

OBJECTIVES:

To review systematically the evidence on impact of cerebral redistribution, as assessed by fetal middle cerebral artery (MCA) Doppler, on neurological outcomes in small-for-gestational-age (SGA) or growth-restricted fetuses.

METHODS:

For this systematic review, MEDLINE was searched for all controlled studies reporting neurological outcomes in SGA or growth-restricted babies with cerebral redistribution based on MCA Doppler indices, from inception to September 2013. We used relative risk or odds ratios, with 95% CI, to identify the association of cerebral redistribution with neurological outcomes.

RESULTS:

The search yielded 1180 possible citations, of which nine studies were included in the review, with a total of 1198 fetuses. Definitions of SGA and cerebral redistribution were variable, as was study quality. Data could not be synthesized in meta-analyses because of heterogeneity in outcome reporting. Cerebral redistribution was not associated with increased risk of intraventricular hemorrhage in neonates (five studies; n = 806). When present in preterm fetuses, cerebral redistribution was associated with normal Neonatal Behavioral Assessment Scale (NBAS) scores at 40 weeks (one study; n = 62) but abnormal psychomotor development at 1 year of age on the Bayley scale (one study; n = 172). When present in term SGA fetuses, cerebral redistribution was associated with increased risk of motor and state organizational problems on NBAS (two studies; n = 158), and lower mean percentile scores in communication and problem solving at 2 years of age on the Ages and Stages Questionnaire (one study; n = 125).

CONCLUSIONS:

SGA fetuses with cerebral redistribution may be at higher risk of neurodevelopmental problems. More data are needed from adequately controlled studies with long-term follow-up before conclusions can be drawn. If these findings are true, there is a need to re-evaluate timing of delivery in the management of SGA fetuses, particularly when cerebral redistribution is found at term gestation.

KEYWORDS:

MCA; brain sparing; cerebral redistribution; cerebroplacental ratio; middle cerebral artery; neurodevelopment; neurological outcome

PMID:
25683973
DOI:
10.1002/uog.14818
[Indexed for MEDLINE]
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