Abstract
Introduction: The association between decreased head growth and impaired neurodevelopment has been shown, however, the impact of neonatal head growth on cognitive development is still a matter of debate.
Objective: To examine whether the patterns of head growth in the neonatal period is associated with susceptibility to cognitive impairment at 24 months corrected age (CA) in very preterm infants (VPI).
Methods: This prospective cohort study analyzed VPI with a birthweight < 1500 g and gestational age < 32 wks. Head circumference (HC) were recorded weekly from birth to 28 days of life. Cognitive impairment was defined by a Bayley-III score < 85 at 24 months CA. Longitudinal HC change was defined as Δz-score between birth and 28 days of life measurements (Intergrowth-21st). The association between HC Δz-scores and cognitive outcomes was evaluated by estimating crude OR with 95%CI. ROC curve allowed us to evaluate the predictivity of HC Δz-scores on the cognitive impairment. Results are shown by estimating the area under the curve (AUC) with 95%CI. Youden’s index was used to define the best cut-off; sensitivity, specificity, positive and negative predictive value with 95%CI were estimated.
Results: A total of 11 infants (GA 28.2 ± 1.0 wks, birthweight 910 ± 222 g) were included. The mean cognitive Bayley score was 96 ± 6.7. Cognitive impairment was documented in 2 (18.2%) infants. HC Δz-score ≤−1.1 is the one predicting cognitive impairment (OR 95 [95%CI 1.5-6088, p 0.03]), AUC (1.00[95%CI 0.71-1.00]), sensitivity (100% [95%CI 34.2-100]), specificity (100% [95%CI 70.1-100]), positive predictive value (100% [95%CI 34.2-100]) and negative predictive value (100% [95%CI 70.1-100]).
Conclusion: HC Δz-score ≤-1.1 could be an accurate tool for predicting poor cognitive outcomes in VPI at 28 days of life.
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