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51 Hippocampal Development, Post-Natal Growth and Neurodevelopmental Outcome of Premature Newborns Following IUGR

Background: Severe placental insufficiency with fetal IUGR is generally associated with a decreased growth potential and a compromised neurodevelopmental outcome with learning difficulties and memory deficit. A recent study documented adverse effects of prematurity and IUGR on structural brain development (Borradori-Tolsa C et al. Ped Res 2004; 56:132–36). Hippocampus, in particular, has been shown to be affected by prematurity (Isaacs EB et al.Ped Res 2000; 47:713–20).Aims: 1) to investigate the effects of IUGR following placental insufficiency in preterm infants on postnatal growth and 2) to study the impact of IUGR on the hippocampal development and the correlation between hippocampal volumes and neurodevelopmental outcome at 18 months corrected age.Methods: 17 preterm infants born with IUGR following placental insufficiency (GA: 32.1±2.4 wks, BW < 10th percentile) were compared with 17 control infants matched for GA (GA: 31.8±2.2 wks) with normal BW. 3D-MRI to measure brain tissue volumes was performed at 40 wks PCA. We used a specially developed 3D rendering software, 3D Slicer that allows visualization of T2 weighted images in coronal, sagittal and axial plane in order to manually segment the hippocampus. Growth parameters were measured and neurodevelopmental outcome was assessed with the Bayley scales of infant development (MDI/PDI) at 18 months.Results: At term, infants born with IUGR had a marked reduction in cortical gray matter (CGM) volume and a smaller hippocampal volume compared to control infants. By age of 18 months, body weight, height, and head circumference (HC) were significantly lower (p<0.01) in the IUGR group. Mean MDI showed a trend to lower scores in children born with IUGR. PDI scores were not different in the 2 groups. However, within the total group we observed a significant positive correlation between hippocampal volume at term and MDI scores at 18 months (p<0.01).Conclusion: These findings suggest a particular vulnerability of the hippocampus to structural changes after placental insufficiency with IUGR which may be responsible for cognitive impairment in this population. In IUGR children catch-up growth at 18 months of age was not achieved for all three growth parameters.