Background: Intrauterine growth restriction (IUGR) affects 5-7% of all pregnancies. The most common cause of IUGR is decreased utero-placental perfusion (UPP). Diabetes mellitus, hypertension and prenatal infection have been associated with decreased UPP. IUGR has increased risk of neurodevelopmental delay (NDD) in childhood. Early Intervention (EI) offers therapeutic and supportive services for children less than three years, whereas Committee on Preschool Special Education (CPSE) assists children between age 3-5 years and Committee on Special Education (CSE) for children between age 5-21 years. There are currently no studies identifying neurodevelopmental outcomes of term neonates with IUGR and referral to therapeutic and supportive services.
Objective: To assess prevalence of NDD in term IUGR neonates and referral pattern.
Design/Methods: Retrospective chart review of mothers who delivered term IUGR infants at Flushing Hospital Medical Center and their child from January 2014 to October 2019. Data extracted include maternal demographics and medical history, child's neurodevelopmental history, therapeutic and supportive services referrals and services received. Electronic medical record and telephone visits were used to complete a questionnaire on services received. Data were analyzed using percentages.
Results: Of 125 with IUGR and follow up, 29 (23%) had NDD. Maternal history of those with NDD was compared to those without NDD for maternal diabetes mellitus 28% vs 18%, hypertension 14% vs 15%, anemia 17% vs 24% and infection 41% vs 39%. Of those with NDD, more than half (55%) were male. Almost all were delivered at 37 weeks (55%) and 38 weeks (28%) gestational age. Less than half (48%) were delivered vaginally. Majority had speech and language delay (83%), followed by motor delay (11%) and cognitive delay (6%). Of all term IUGR, only 14% were referred to EI. Of those with NDD 62% were referred to EI, 41% to CPSE and 21% to CSE. Speech and language therapy was received in 55%, physical therapy in 28% and occupational therapy in 24%.
Conclusions: A quarter of our term IUGR neonates had NDD. Speech and language delay was the most common NDD. Not all children with NDD were referred to EI, CPSE or CSE and not all received therapy. All children with IUGR can benefit from EI referral.
