Cerebral structure and metabolism and long-term outcome in small-for-gestational-age preterm neonates

In the present study, we compared brain development and metabolism of small-for-gestational-age (SGA) and appropriate-for-gestational-age (AGA) infants using proton magnetic resonance spectroscopy (¹H-MRS). We tested the hypothesis that intrauterine growth retardation caused by placental insufficiency is associated with changes in cerebral metabolism and is followed by an adverse neurodevelopmental outcome at the age of 2 y. Twenty-six AGA and 14 SGA (birth weight <P 2.3) preterm infants with no major ultrasound abnormalities were enrolled prospectively. At 32 and 41 wk postmenstrual age, ¹H-MRS and magnetic resonance imaging were performed. For ¹H-MRS, a volume of interest was placed in the basal ganglia and in the periventricular white matter. Using echo times of 31 and 144 ms N-acetylaspartate/choline (NAA/Cho), lactate/Cho, myo-inositol/Cho (mI/Cho), and glutamate-glutamine-γ-aminobutyric acid/Cho (Glx/Cho) ratios were compared between AGA and SGA groups. Griffiths' developmental quotient (DQ) values were assessed at 24 mo corrected age. Griffiths' DQ (AGA, 104 ± 10; SGA, 99 ± 9) and brain development assessed using magnetic resonance imaging showed no significant differences between both AGA and SGA groups, and NAA/Cho, Lac/Cho, mI/Cho, and Glx/Cho ratios were not significantly different between the groups. NAA/Cho ratios increased from 32 to 41 wk, whereas mI/Cho ratios decreased in both groups. No differences in cerebral metabolism, brain development, and DQ values between AGA and severely SGA infants could be demonstrated.