Long-term neurodevelopment in preterm SGA In preterm SGA infants, the majority of longitudinal studies reviewed by the committee focused on extremely premature (Feldman and Eidelman, 2006; Kono et al., 2007; Paavonen et al., 2007; Leonard et al., 2008) or very low birth weight (VLBW) (Litt et al., 1995; Hack, 1998; Brandt et al., 2003; Kilbride et al., 2004; Litt et al., 2005; Feldman and Eidelman, 2006; Hille et al., 2007; Paavonen et al., 2007; Strang-Karlsson et al., 2008a, 2008b) infants. Among 14 studies in children, 11 found that SGA was associated with cognitive and/or neurodevelopment impairments, although this relationship may be modified by degree of postnatal catch-up growth and maternal-child interactions (Casey et al., 2006; Feldman and Eidelman, 2006). In general, the effect size was proportional to the severity of prematurity (Calame et al., 1983; Feldman and Eidelman, 2006; Kono et al., 2007). The two studies conducted among adolescents found an association of VLBW with IQ (Hille et al., 2007) and breathing-related sleep disorders (Paavonen et al., 2007). Among adults, VLBW was associated with emotional instability (Strang-Karlsson et al., 2008b) and SGA with lower head circumference among individuals who did not fully catch up in their head circumference growth during their first 12 months of life.

Effect size was again assessed for cognitive measures. Of 19 studies reviewed, 13 reported cognitive scores by SGA status; of these, 1 reported a lower Bayley score (Feldman and Eidelman, 2006) and 12 reported lower IQ measures (Escalona, 1982; Calame et al., 1983; Silva et al., 1984; Holwerda-Kuipers, 1987; Litt et al., 1995; McCarton et al., 1996; Hutton et al., 1997; Kilbride et al., 2004; Litt et al., 2005; Casey et al., 2006; Hille et al., 2007; Kono et al., 2007) associated with preterm SGA status, although these differences were not always statistically significant. Among 2-year-old children, one study found an 8-point difference in the Bayley Mental Development Index score (Feldman and Eidelman, 2006). In contrast, a study conducted among 3.5-year-old children found no differences in IQ scores associated with preterm SGA (Escalona, 1982). Among the rest of studies with children (Calame et al., 1983; Silva et al., 1984; Holwerda-Kuipers, 1987; Litt et al., 1995; McCarton et al., 1996; Hutton et al., 1997; Kilbride et al., 2004; Litt et al., 2005; Casey et al., 2006; Kono et al., 2007), IQ differentials were 2-11 points. The only study among adults that reported IQ, documented a 2-point differential associated with VLBW. Overall, the cognitive differentials appear to be relatively stronger among individuals born SGA preterm (mean ± std. dev: 6.5 ± 3.8 IQ points, n = 11 studies) than among those born SGA term (5.3 ± 3.0, n = 9 studies IQ points). However, as with term SGA, the meaning of these still relatively small differentials is unclear because in the vast majority of studies the average scores for individuals born preterm SGA fell within the normal IQ range.



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