NEUROLOGICAL MANIFESTATIONS IN TERM SMALL-FOR-GESTATIONAL-AGE INFANTS: AN ALGORITHM FOR EARLY DIAGNOSIS (Literature Review)
Keywords:
term small-for-gestational-age infant (SGA), perinatal central nervous system (CNS) damage, placental insufficiency, neurological disorders, hypoxic-ischemic encephalopathy (HIE), cognitive deficits, cerebral palsy (CP), attention deficit hyperactivity disorder (ADHD), multidisciplinary rehabilitation, prognosisAbstract
The article presents a comprehensive analysis of the problem of neurological disorders in term small-for-gestational-age (SGA) infants, a group at high risk for adverse outcomes. The pathogenetic mechanisms of central nervous system (CNS) damage are examined, including placental insufficiency, hypoxia, nutritional deprivation, excitotoxicity, oxidative stress, and epigenetic modifications. The spectrum of clinical manifestations is described, ranging from acute neonatal syndromes to long-term consequences (cognitive deficits, cerebral palsy (CP), ADHD, ASD, epilepsy). Risk factors are systematized, and a scientifically grounded algorithm for early comprehensive diagnostics is proposed, incorporating prenatal monitoring, neonatal assessment (neurosonography (NSG), amplitude-integrated EEG (aEEG)/EEG, scales), advanced methods (MRI, evoked potentials (EP), genetic testing), and dynamic observation. The necessity of a multidisciplinary approach and continuous rehabilitation for SGA infants from the prenatal period through school age is substantiated. It is emphasized that early diagnosis and timely initiation of an individualized rehabilitation program are key factors for improving the neurological prognosis and quality of life in this vulnerable patient group. The work is based on the analysis of current literature data and clinical guidelines.
References
Баранов АА, Намазова-Баранова ЛС, Вишнева ЕА, и др. Профилактика, диагностика и коррекция нарушений развития у детей раннего возраста (Проект клинических рекомендаций). Педиатрия. Журнал им. Г.Н. Сперанского. 2023;102(2):7-38.
Баранов АА, Намазова-Баранова ЛС, Таточенко ВК, и др. Клинические рекомендации (протокол лечения) по ведению детей с задержкой внутриутробного развития (ЗВУР) и малой массой тела к гестационному возрасту (SGA). Педиатрия. Журнал им. Г.Н. Сперанского. 2017;96(4):145-163.
Баранов АА, Намазова-Баранова ЛС, Таточенко ВК, и др. Клинические рекомендации (протокол лечения) по ведению детей с задержкой внутриутробного развития (ЗВУР) и малой массой тела к гестационному возрасту (SGA). Педиатрия. Журнал им. Г.Н. Сперанского. 2017;96(4):145-163.
Володин НН, Дегтярев ДН, Руденко СВ, и др. Перинатальные исходы и долгосрочное развитие детей, рожденных с малой массой тела к гестационному возрасту (SGA). Вопросы современной педиатрии. 2020;19(5):382-391.
Володин НН, Дегтярев ДН, Руденко СВ, и др. Перинатальные исходы и долгосрочное развитие детей, рожденных с малой массой тела к гестационному возрасту (SGA). Вопросы современной педиатрии. 2020;19(5):382-391.
Заваденко НН, Суворин АВ, Румянцева АГ, и др. Возможности магнитно-резонансной томографии высокого разрешения (3 Тл) в диагностике минимальных дисгенезий головного мозга у детей с задержкой психического развития. Российский вестник перинатологии и педиатрии. 2021;66(3):67-75.
Зубарева ЕА, Петренко ЮВ, Стрижова НВ. Состояние нервной системы у новорожденных с задержкой внутриутробного развития. Журнал неврологии и психиатрии им. С.С. Корсакова. 2017;117(10):29-33.
Петренко ЮВ, Стрижова НВ, Зубарева ЕА. Значение нейросонографии в диагностике перинатальных поражений центральной нервной системы у новорожденных с задержкой внутриутробного развития. Ультразвуковая и функциональная диагностика. 2018;(2):68- 75.
Пыркова ЕВ, Чистякова ГН. Неврологические нарушения у доношенных новорожденных с задержкой внутриутробного развития. Российский вестник перинатологии и педиатрии. 2018;63(5):27-33.
Пыркова ЕВ, Чистякова ГН. Неврологические нарушения у доношенных новорожденных с задержкой внутриутробного развития. Российский вестник перинатологии и педиатрии. 2018;63(5):27-33.
Скоромец АА, Скоромец ТА, Кистенева ВБ, и др. Когнитивные нарушения у детей с перинатальным поражением центральной нервной системы в отдаленном периоде. Журнал неврологии и психиатрии им. С.С. Корсакова. Специальные выпуски. 2022;(2):32-37.
Ханакаева ЛХ, Гудимова ВИ, Байбарина ЕН, и др. Возможности магнитно-резонансной томографии в оценке структурных изменений головного мозга у детей с задержкой внутриутробного развития. Российский вестник перинатологии и педиатрии. 2021;66(2):198-206.
Ханакаева ЛХ, Гудимова ВИ, Байбарина ЕН, и др. Особенности когнитивного развития детей, рожденных с задержкой внутриутробного развития, в возрасте 3-7 лет. Российский вестник перинатологии и педиатрии. 2019;64(1):42-48.
Bastek JA, Sharma D, Pinar H, et al. Placental pathology and neurodevelopmental outcome in preterm infants with intrauterine growth restriction. J Matern Fetal Neonatal Med. 2014;27(10):1048-1054.
Bora S, Pienaar A, Inder TE, et al. White matter microstructure of small for gestational age preterm infants: a diffusion tensor imaging study. Pediatr Res. 2020;87(6):1095-1102.
Chalak LF, Rollins L, Dai R, et al. Amplitude-integrated EEG patterns in neonates born small for gestational age. J Perinatol. 2019;39(8):913-919.
Dammann O, Kuban KC, Leviton A. Perinatal brain damage in preterm newborns: a biomarker perspective. Curr Opin Neurol. 2023;36(2):190-197.
Dudink S, Greenough A. Follow-up of infants with intrauterine growth restriction. Curr Opin Pediatr. 2014;26(2):138-143.
Eixarch E, Crispi F. Assessment of fetal brain function in growth restriction. Fetal Diagn Ther. 2021;48(3):199-210.
Eixarch E, Meler E, Iraola A, et al. Neurodevelopmental outcome in infants with intrauterine growth restriction: a systematic review. J Matern Fetal Neonatal Med. 2020;33(24):4107-4119.
Fattuoni C, Galli F, Beccaria F, et al. Neurodevelopmental outcomes in term and late preterm small for gestational age children at 2 years. Early Hum Dev. 2019;133:63-68.
Figueras F, Gardosi J. Intrauterine growth restriction: new concepts in antenatal surveillance, diagnosis, and management. Am J Obstet Gynecol. 2019;220(6):545-559.
Figueras F, Gratacós E. Update on the diagnosis and management of fetal growth restriction. Obstet Gynecol. 2023;141(1):147-158.
Francis A, van Batenburg-Eddes T, de Groot L, et al. Executive function deficits in preterm and small-for-gestational-age children at school age. Early Hum Dev. 2020;148:105128.
Geva R, Eshel R, Leitner Y, et al. Neuropsychological outcome of children with intrauterine growth restriction: a 9-year prospective study. Pediatrics. 2006;118(1):91-100.
Gortner L, van Huizen M, Rath W, et al. S100B and brain-derived neurotrophic factor (BDNF) in term newborns with hypoxic-ischemic encephalopathy: a pilot study. Neonatology. 2017;111(3):248-254.
Gressens P, Fleiss B, Rakic S, et al. The impact of fetal growth restriction on the developing brain: from mechanisms to interventions. Nat Rev Neurol. 2022;18(10):621-636.
Groom A, Painter RC, Roseboom TJ. Prenatal stress and endocrine programming of brain and behaviour: a focus on metabolic hormones. J Neuroendocrinol. 2021;33(2):e12942.
Indraccolo U, Indraccolo G, Corradetti A, et al. Neurodevelopmental outcome in children born small for gestational age: a focus on psychiatric disorders. J Matern Fetal Neonatal Med. 2024:1-10.
Kersbergen KJ, Groenendaal F, Benders MJ, et al. Brain volumes at term-equivalent age in preterm infants with and without intrauterine growth restriction. Pediatr Res. 2018;84(3):387-394.
Kokkinidou P, Koutsioukis S, Kontopoulos E, et al. Advanced neuroimaging techniques in the assessment of the small-for-gestational- age fetal and neonatal brain. J Perinatol. 2022;42(9):1029-1038.
Levy-Shalev R, Sheiner E, Wainstock T, et al. Early-term and full-term small-for-gestational-age neonates: long-term neurological and cognitive outcome. J Matern Fetal Neonatal Med. 2021;34(23):3943-3950.
Manning N, Savasi VM, Cavallaro A, et al. Small for gestational age and neurodevelopmental outcomes: a systematic review and meta- analysis. BJOG. 2022;129(10):1565-1574.
McCowan LM, Figueras F, Anderson NH. Evidence-based national guidelines for the management of suspected fetal growth restriction: comparison, consensus, and controversy. Am J Obstet Gynecol. 2019;220(6):555-563.
Miller SL, Huppertz B, Graham CH, et al. Placental vascular-related complications of pregnancy and the neurodevelopmental outcomes of the offspring. Am J Obstet Gynecol. 2021;225(2):98-112.
Monier I, Blondel B, Ego A, et al. Poor neurodevelopmental outcome in small-for-gestational-age term infants: a population-based study. Paediatr Perinat Epidemiol. 2015;29(5):424-433.
Okumura A, Hayakawa F, Kato T, et al. Amplitude-integrated electroencephalography in the early prediction of neurodevelopmental outcome in term infants with hypoxic-ischemic encephalopathy. Brain Dev. 2019;41(4):318-325.
Ortiz J, Mussalli G, Chaves-Carballo E, et al. Small for Gestational Age Infant: An Evidence-Based Approach to Management. World J Clin Pediatr. 2021;10(1):1-14.
Parker LA, Melamed N, Meir K, et al. The risk of neurodevelopmental impairment in small-for-gestational-age neonates. Ultrasound Obstet Gynecol. 2023;61(3):336-344.
Rao S, Minnes S, Singer LT, et al. Long-term behavioral outcomes of children born small for gestational age: a systematic review and meta-analysis. Pediatrics. 2023;151(5):e2022057989.
Sharma D, Shastri S, Sharma P. Intrauterine Growth Restriction - Antenatal and Postnatal Aspects. Clin Perinatol. 2016;43(1):121-138.
Spittle AJ, Orton J, Doyle LW, et al. Early developmental intervention programs post-discharge from hospital for preterm infants. Cochrane Database Syst Rev. 2023;5(5):CD005495.
Spittle AJ, Treyvaud K, Doyle LW, et al. Early developmental intervention programs provided post hospital discharge to prevent motor and cognitive impairment in preterm infants. Cochrane Database Syst Rev. 2015;11(11):CD005495.
Tich SN, Anderson PJ, Doyle LW, et al. Co-occurrence of white matter injury and intrauterine growth restriction and outcomes at age 7 years. Pediatrics. 2017;140(6):e20171295.
Tolsa CB, Zimine S, Warfield SK, et al. Early alteration of structural and functional brain development in premature infants born with intrauterine growth restriction. Pediatr Res. 2004;56(1):132-138.
Treyvaud K. Parent and family outcomes following very preterm or very low birth weight birth: a review. Semin Perinatol. 2014;38(3):164-169.
van der Pal SM, Maguire-Ferguson AC, Davie G, et al. Identifying infants at risk for developmental coordination disorder: a prospective cohort study. Pediatrics. 2023;151(6):e2022058160.
van Wassenaer-Leemhuis AG, van der Pal-de Bruin KM, de Winter AF, et al. Social-emotional problems in 4-year-old moderately preterm and term-born children: a population-based study. Early Hum Dev. 2021;159:105359.
Miller SL, Supramaniam VG, Jenkin G, et al. Effects of intrauterine growth restriction on the developing brain. Pediatr Res. 2016;79(5):631-641.
Lodygensky GA, West T, Stumpert C, et al. The impact of placental dysfunction on the developing brain: the role of neuroinflammation. J Neuroinflammation. 2020;17(1):293.
Malamud-Potamovich L, Oren A, Sivan Y, et al. Neurosonographic findings in term small-for-gestational-age infants: a cohort study. J Ultrasound Med. 2018;37(8):1897-1905.
Geva R, Eshel R, Leitner Y, et al. Neuropsychological outcome of children with intrauterine growth restriction: a 9-year prospective study. Pediatrics. 2006;118(1):91-100.
Tordjman S, Somogyi E, Coulon N, et al. Epigenetic modifications of the brain-derived neurotrophic factor gene in intrauterine growth restriction. Epigenomics. 2019;11(3):235-248.
Orton J, Spittle A, Doyle L, et al. Do early intervention programs improve cognitive and motor outcomes for preterm infants after discharge? A systematic review. Dev Med Child Neurol. 2009;51(11):851-859.
