Background: The impact of growth restriction on perinatal morbidity is well known, but electroencephalographic (EEG) data on its influence are still scarce. Objectives: We aimed to analyze the influence of being born small for gestational age (SGA; defined as a birth weight <10th percentile) on the amplitude-integrated EEG (aEEG) score in the first 2 weeks of life in preterm infants born before 30 weeks of gestation, and its impact on later outcome. Methods: aEEG data obtained within the first 2 weeks of life on preterm infants born SGA and before 30 weeks of gestational age (GA) were analyzed retrospectively using a combined score [including background activity, occurrence of sleep-wake cycles (SWC) and suspected seizure activity]. Neurodevelopmental outcome was evaluated at 24 months by means of the Bayley Scales of Infant Development II and a standardized neurological examination. Results: One hundred and thirty-six patients were included (47 SGA and 89 controls). Infants with SGA had abnormal aEEG scores significantly more often (57 vs. 24%, p = 0.002) than infants born appropriate for gestational age (AGA). They also displayed SWC less frequently (65 vs. 96%, p = 0.001), were more likely to develop seizure activity (15 vs. 4%, p = 0.013) and had a normal neurodevelopmental outcome at the age of 2 years less frequently (36.2 vs. 59.6%, p = 0.02). Conclusion: Preterm infants born SGA and before 30 weeks of GA had less optimal scores on early aEEG and a poorer neurodevelopmental outcome at 24 months than the AGA controls.

1.
Vermont Oxford Network, 2012. http://www.vtoxford.org.
2.
Ego A: Definitions: small for gestational age and intrauterine growth retardation. J Gynecol Obstet Biol Reprod (Paris) 2013;42:872-894.
3.
Bardin C, Zelkowitz P, Papageorgiou A: Outcome of small-for-gestational age and appropriate-for-gestational age infants born before 27 weeks of gestation. Pediatrics 1997;100:E4.
4.
Garite TJ, Clark R, Thorp JA: Intrauterine growth restriction increases morbidity and mortality among premature neonates. Am J Obstet Gynecol 2004;191:481-487.
5.
von Beckerath AK, Kollmann M, Rotky-Fast C, Karpf E, Lang U, Klaritsch P: Perinatal complications and long-term neurodevelopmental outcome of infants with intrauterine growth restriction. Am J Obstet Gynecol 2013;208:130.e131-e136.
6.
Ochiai M, Kinjo T, Takahata Y, Iwayama M, Abe T, Ihara K, Ohga S, Fukushima K, Kato K, Taguchi T, Hara T: Survival and neurodevelopmental outcome of preterm infants born at 22-24 weeks of gestational age. Neonatology 2014;105:79-84.
7.
Leitner Y, Fattal-Valevski A, Geva R, Eshel R, Toledano-Alhadef H, Rotstein M, Bassan H, Radianu B, Bitchonsky O, Jaffa AJ, Harel S: Neurodevelopmental outcome of children with intrauterine growth retardation: a longitudinal, 10-year prospective study. J Child Neurol 2007;22:580-587.
8.
Watanabe K, Hayakawa F, Okumura A: Neonatal EEG: a powerful tool in the assessment of brain damage in preterm infants. Brain Dev 1999;21:361-372.
9.
Hellstrom-Westas L, Rosen I: Electroencephalography and brain damage in preterm infants. Early Hum Dev 2005;81:255-261.
10.
Klebermass K, Olischar M, Waldhoer T, Fuiko R, Pollak A, Weninger M: Amplitude-integrated EEG pattern predicts further outcome in preterm infants. Pediatr Res 2011;70:102-108.
11.
Ozdemir OM, Ergin H, Sahiner T: Electrophysiological assessment of the brain function in term SGA infants. Brain Res 2009;1270:33-38.
12.
Yerushalmy-Feler A, Marom R, Peylan T, Korn A, Haham A, Mandel D, Yarkoni I, Bassan H: Electroencephalographic characteristics in preterm infants born with intrauterine growth restriction. J Pediatr 2014;164:756-761.e751.
13.
Hellström-Westas LRI, de Vries LS, Greisen G: Amplitude-integrated EEG - classification and interpretation in preterm and term infants. NeoReviews 2006;7:e76-e87.
14.
Klebermass K, Kuhle S, Olischar M, Rucklinger E, Pollak A, Weninger M: Intra- and extrauterine maturation of amplitude-integrated electroencephalographic activity in preterm infants younger than 30 weeks of gestation. Biol Neonate 2006;89:120-125.
15.
Olischar M, Klebermass K, Kuhle S, Hulek M, Kohlhauser C, Rucklinger E, Pollak A, Weninger M: Reference values for amplitude-integrated electroencephalographic activity in preterm infants younger than 30 weeks' gestational age. Pediatrics 2004;113:e61-e66.
16.
Sisman J, Campbell DE, Brion LP: Amplitude-integrated EEG in preterm infants: maturation of background pattern and amplitude voltage with postmenstrual age and gestational age. J Perinatol 2005;25:391-396.
17.
Griesmaier E, Santuari E, Edlinger M, Neubauer V, Waltner-Romen M, Kiechl-Kohlendorfer U: Differences in the maturation of amplitude-integrated EEG signals in male and female preterm infants. Neonatology 2014;105:175-181.
18.
Kidokoro H, Kubota T, Hayashi N, Hayakawa M, Takemoto K, Kato Y, Okumura A: Absent cyclicity on aEEG within the first 24 h is associated with brain damage in preterm infants. Neuropediatrics 2010;41:241-245.
19.
Wikstrom S, Pupp IH, Rosen I, Norman E, Fellman V, Ley D, Hellstrom-Westas L: Early single-channel aEEG/EEG predicts outcome in very preterm infants. Acta Paediatr 2012;101:719-726.
20.
Fenton TR: A new growth chart for preterm babies: Babson and Benda's chart updated with recent data and a new format. BMC Pediatr 2003;3:13.
21.
Maynard DE: EEG processing by the Cerebral Function Monitor (CFM). Ann Anesthesiol Fr 1979;20:170-174.
22.
Bayley N: Manual of Bayley Scales of Infant Development II, ed 2. San Antonio, Psychological Corporation, 1993.
23.
Amiel-Tison C: Neuromotor status; in Taeusch HW, Yogman MW (eds): Follow-Up Management of the High Risk Infant. Boston, Little, Brown and Co., 1987, pp 115-126.
24.
Rosenbaum PL, Palisano RJ, Bartlett DJ, Galuppi BE, Russell DJ: Development of the Gross Motor Function Classification System for cerebral palsy. Dev Med Child Neurol 2008;50:249-253.
25.
Duncan JR, Cock ML, Harding R, Rees SM: Relation between damage to the placenta and the fetal brain after late-gestation placental embolization and fetal growth restriction in sheep. Am J Obstet Gynecol 2000;183:1013-1022.
26.
Rees S, Mallard C, Breen S, Stringer M, Cock M, Harding R: Fetal brain injury following prolonged hypoxemia and placental insufficiency: a review. Comp Biochem Physiol A Mol Integr Physiol 1998;119:653-660.
27.
Tolsa CB, Zimine S, Warfield SK, Freschi M, Sancho Rossignol A, Lazeyras F, Hanquinet S, Pfizenmaier M, Huppi PS: Early alteration of structural and functional brain development in premature infants born with intrauterine growth restriction. Pediatr Res 2004;56:132-138.
28.
Osredkar D, Toet MC, van Rooij LG, van Huffelen AC, Groenendaal F, de Vries LS: Sleep-wake cycling on amplitude-integrated electroencephalography in term newborns with hypoxic-ischemic encephalopathy. Pediatrics 2005;115:327-332.
29.
Natalucci G, Rousson V, Bucher HU, Bernet V, Hagmann C, Latal B: Delayed cyclic activity development on early amplitude-integrated EEG in the preterm infant with brain lesions. Neonatology 2013;103:134-140.
30.
Scher MS: Normal electrographic-polysomnographic patterns in preterm and full-term infants. Semin Pediatr Neurol 1996;3:2-12.
31.
Soubasi V, Mitsakis K, Sarafidis K, Griva M, Nakas CT, Drossou V: Early abnormal amplitude-integrated electroencephalography (aEEG) is associated with adverse short-term outcome in premature infants. Eur J Paediatr Neurol 2012;16:625-630.
32.
Griesmaier E, Burger C, Ralser E, Neubauer V, Kiechl-Kohlendorfer U: Amplitude-integrated electroencephalography shows mild delays in electrocorticalactivity in preterm infants born small for gestational age. Acta Paediatr 2015, Epub ahead of print.
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