Assisted reproductive technology (ART) is an infertility treatment used to assist women to become pregnant. Although the procedure is safe, there are gaps in understanding the association between treatment and adverse pregnancy outcomes (e.g., stillbirth) in the United States. The purpose of this study was to investigate the relationship between stillbirth delivery and ART. The 2 research questions addressed the association between methods of conception (ART versus non-ART) and the delivery of a stillbirth, and the association between multiple gestation pregnancy and risk of stillbirths. Retrospective cohort data from the States Monitoring ART collaborative were analyzed using Pearson's chi squared tests and log binominal regression models. Findings indicated that from 2006 to 2011, the average stillbirth rates were lower among ART-conceived pregnancies than non-ART conceived pregnancies. After controlling for confounding factors, ART-conceived pregnancies did not show increased risks of stillbirths compared to non-ART conceived pregnancies regardless of plurality. This lower risk of stillbirth was particularly significant during early pregnancies, before 28 weeks of gestation. Findings may be used to improve understanding of the use of ART treatment and its associated pregnancy outcomes. Findings may also be used to prevent stillbirths and to improve prenatal care, early stillbirth detection, and effective clinical management of fetal and maternal conditions during pregnancy.

Objective: To examine differences in the antenatal detection rate of small for gestational age (SGA) infants among several race-ethnicity groups and determine whether perinatal outcomes differ in antenatally detected versus undetected SGA infants according to race-ethnicity. Methods: A retrospective cohort study was conducted at a single tertiary care center that evaluated all deliveries of SGA infants >23 weeks gestation between January 2016-January 2020. Race and ethnicity were self-reported and categorized as non-Hispanic White, non-Hispanic Black, Hispanic, or Asian. The medical charts of those eligible were reviewed and the primary study outcomes were analyzed using multivariable logistic regression analyses with accompanying point estimates and 95% confidence intervals. Results: A total of 526 childbearing persons satisfied our predefined inclusion criteria. The predominant race-ethnicity group was non-Hispanic White who comprised 50% of the study population. Antenatal detection rate of SGA was found to be 38%. The detection rate, while not statistically different, ranged from 28-40% according to race-ethnicity with Asians having the lowest detection rates. Higher rates of preterm birth, labor induction, and lower median birthweights were observed in antenatally detected versus undetected SGA pregnancies. However, no significant differences were observed with regards to perinatal outcomes when antenatally detected versus undetected SGA was compared according to race-ethnicity. Conclusions: Antenatal detection may not be the primary solution to improving racial and ethnic disparities among SGA infants. Additional investigation to identify, address, and improve disparities in other areas of perinatal medicine is necessary to provide more equitable care. Further work to investigate the barriers to antenatal detection of SGA is warranted as an avenue for improving perinatal outcomes.

Objetivo: Avaliar, em uma coorte de bebês prematuros de muito baixo peso de nascimento, a influência da idade gestacional e da nutrição perinatal no desenvolvimento aos 24 meses de idade corrigida. Método: Foram estudadas 125 crianças pré-termo de muito baixo peso de nascimento nascidas ou internadas em uma unidade de terapia intensiva neonatal nas primeiras 48 horas de vida. Os bebês foram classificados como pequenos para a idade gestacional no nascimento (PIG) e na alta (PIG/PIG); adequados para a idade gestacional no nascimento (AIG) e pequenos para idade gestacional na alta (AIG/PIG); e adequados para a idade gestacional no nascimento (AIG) e na alta (AIG/AIG). A Bayley Scales of Infant and Toddler Development III (BSID-III) foi utilizada para a avaliação do neurodesenvolvimento aos 24 meses de idade corrigida. Resultados: 15 recém-nascidos nasceram ≤ 27 semanas, 73 entre 28-31 semanas e 37 > 31 semanas, as menores pontuações na BSID-III ocorreram no grupo mais imaturo. Por outro lado, 56 foram classificados como PIG/PIG, 55 como AIG/PIG, e 14 como AIG/AIG, não havendo diferença na BSID-III entre estes grupos, embora o grupo PIG/PIG tenha apresentado idade gestacional significativamente maior. Conclusão: Os recém-nascidos que foram PIG/PIG tinham idade gestacional maior do que os outros, e tiveram avaliação do neurodesenvolvimento semelhante, sugerindo que a nutrição perinatal desempenha um papel importante no desenvolvimento aos 2 anos de idade corrigida. / Aim: To assess the influence of gestational age and perinatal nutrition on development at 24 months corrected age in a cohort of very low birth weight preterm infants. Method: 125 very low birth weight preterm infants admitted to a neonatal intensive care unit within the first 48 hours of life were studied. The infants were classified as born small for gestational age (SGA) and still SGA at discharge (SGA/SGA); born adequate for gestational age (AGA) and SGA at discharge (AGA/SGA); and born AGA and still AGA age at discharge (AGA/AGA). The Bayley Scales of Infant and Toddler Development III (BSID-III) were used for assessment of neurodevelopment at 24 months corrected age. Results: 15 neonates were born at ≤27 weeks, 73 at 28–31 weeks, and 37 at >31 weeks with lowest BSID-III scores in the more immature group. 56 were classified as SGA/SGA, 55 as AGA/SGA, and 14 as AGA/AGA with no difference in BSID-III among the groups even though SGA/SGA group had significantly higher gestational age. Conclusion: Neonates who were SGA/SGA had higher gestational age than the others, and they had similar neurodevelopment assessment suggesting that perinatal nutrition plays an important role in development at 2 years corrected age.

Objetivo: Avaliar, em uma coorte de bebês prematuros de muito baixo peso de nascimento, a influência da idade gestacional e da nutrição perinatal no desenvolvimento aos 24 meses de idade corrigida. Método: Foram estudadas 125 crianças pré-termo de muito baixo peso de nascimento nascidas ou internadas em uma unidade de terapia intensiva neonatal nas primeiras 48 horas de vida. Os bebês foram classificados como pequenos para a idade gestacional no nascimento (PIG) e na alta (PIG/PIG); adequados para a idade gestacional no nascimento (AIG) e pequenos para idade gestacional na alta (AIG/PIG); e adequados para a idade gestacional no nascimento (AIG) e na alta (AIG/AIG). A Bayley Scales of Infant and Toddler Development III (BSID-III) foi utilizada para a avaliação do neurodesenvolvimento aos 24 meses de idade corrigida. Resultados: 15 recém-nascidos nasceram ≤ 27 semanas, 73 entre 28-31 semanas e 37 > 31 semanas, as menores pontuações na BSID-III ocorreram no grupo mais imaturo. Por outro lado, 56 foram classificados como PIG/PIG, 55 como AIG/PIG, e 14 como AIG/AIG, não havendo diferença na BSID-III entre estes grupos, embora o grupo PIG/PIG tenha apresentado idade gestacional significativamente maior. Conclusão: Os recém-nascidos que foram PIG/PIG tinham idade gestacional maior do que os outros, e tiveram avaliação do neurodesenvolvimento semelhante, sugerindo que a nutrição perinatal desempenha um papel importante no desenvolvimento aos 2 anos de idade corrigida. / Aim: To assess the influence of gestational age and perinatal nutrition on development at 24 months corrected age in a cohort of very low birth weight preterm infants. Method: 125 very low birth weight preterm infants admitted to a neonatal intensive care unit within the first 48 hours of life were studied. The infants were classified as born small for gestational age (SGA) and still SGA at discharge (SGA/SGA); born adequate for gestational age (AGA) and SGA at discharge (AGA/SGA); and born AGA and still AGA age at discharge (AGA/AGA). The Bayley Scales of Infant and Toddler Development III (BSID-III) were used for assessment of neurodevelopment at 24 months corrected age. Results: 15 neonates were born at ≤27 weeks, 73 at 28–31 weeks, and 37 at >31 weeks with lowest BSID-III scores in the more immature group. 56 were classified as SGA/SGA, 55 as AGA/SGA, and 14 as AGA/AGA with no difference in BSID-III among the groups even though SGA/SGA group had significantly higher gestational age. Conclusion: Neonates who were SGA/SGA had higher gestational age than the others, and they had similar neurodevelopment assessment suggesting that perinatal nutrition plays an important role in development at 2 years corrected age.

Objetivo: Avaliar, em uma coorte de bebês prematuros de muito baixo peso de nascimento, a influência da idade gestacional e da nutrição perinatal no desenvolvimento aos 24 meses de idade corrigida. Método: Foram estudadas 125 crianças pré-termo de muito baixo peso de nascimento nascidas ou internadas em uma unidade de terapia intensiva neonatal nas primeiras 48 horas de vida. Os bebês foram classificados como pequenos para a idade gestacional no nascimento (PIG) e na alta (PIG/PIG); adequados para a idade gestacional no nascimento (AIG) e pequenos para idade gestacional na alta (AIG/PIG); e adequados para a idade gestacional no nascimento (AIG) e na alta (AIG/AIG). A Bayley Scales of Infant and Toddler Development III (BSID-III) foi utilizada para a avaliação do neurodesenvolvimento aos 24 meses de idade corrigida. Resultados: 15 recém-nascidos nasceram ≤ 27 semanas, 73 entre 28-31 semanas e 37 > 31 semanas, as menores pontuações na BSID-III ocorreram no grupo mais imaturo. Por outro lado, 56 foram classificados como PIG/PIG, 55 como AIG/PIG, e 14 como AIG/AIG, não havendo diferença na BSID-III entre estes grupos, embora o grupo PIG/PIG tenha apresentado idade gestacional significativamente maior. Conclusão: Os recém-nascidos que foram PIG/PIG tinham idade gestacional maior do que os outros, e tiveram avaliação do neurodesenvolvimento semelhante, sugerindo que a nutrição perinatal desempenha um papel importante no desenvolvimento aos 2 anos de idade corrigida. / Aim: To assess the influence of gestational age and perinatal nutrition on development at 24 months corrected age in a cohort of very low birth weight preterm infants. Method: 125 very low birth weight preterm infants admitted to a neonatal intensive care unit within the first 48 hours of life were studied. The infants were classified as born small for gestational age (SGA) and still SGA at discharge (SGA/SGA); born adequate for gestational age (AGA) and SGA at discharge (AGA/SGA); and born AGA and still AGA age at discharge (AGA/AGA). The Bayley Scales of Infant and Toddler Development III (BSID-III) were used for assessment of neurodevelopment at 24 months corrected age. Results: 15 neonates were born at ≤27 weeks, 73 at 28–31 weeks, and 37 at >31 weeks with lowest BSID-III scores in the more immature group. 56 were classified as SGA/SGA, 55 as AGA/SGA, and 14 as AGA/AGA with no difference in BSID-III among the groups even though SGA/SGA group had significantly higher gestational age. Conclusion: Neonates who were SGA/SGA had higher gestational age than the others, and they had similar neurodevelopment assessment suggesting that perinatal nutrition plays an important role in development at 2 years corrected age.

Introdução: Idade gestacional (IG) e peso ao nascer, assim como a frequência de nascimentos PIG (pequeno para idade gestacional), são importantes preditores da morbimortalidade neonatal. Os partos cesáreos têm sido indicados como um dos fatores que tem colaborado para o aumento da prematuridade. Conhecer a distribuição populacional da IG segundo tipo de parto e estabelecer a proporção de nascimentos considerados PIG e seus fatores de risco pode contribuir para o conhecimento do perfil dos nascidos vivos no Município de São Paulo (MSP). Objetivos: Estudar o padrão de distribuição da idade gestacional nos nascimentos ocorridos no MSP; calcular a prevalência de PIG com base em três curvas de crescimento fetal (Alexander, Fenton e Kim e Intergrowth); e investigar os fatores risco para PIG. Metodologia: Estudo transversal com base nos dados do Sistema de Informações sobre Nascidos Vivos (Sinasc). Foram estudados nascimentos hospitalares e de gestações únicas, nos anos de 2013 e 2014, no município de São Paulo. Realizou-se uma análise de distribuição dos nascimentos segundo IG, comparando tipo de parto e de hospital (SUS e não SUS). Para cálculo da prevalência de PIG usou-se a idade gestacional baseada na data da última menstruação (DUM) e as três curvas de crescimento fetal citadas. Foi empregada a regressão multinível para avaliação dos fatores de risco materno, do recém-nascido e socioeconômicos individuais, sendo a variável de contexto a vulnerabilidade do distrito de residência. Resultados: Houve um desvio à esquerda da IG para o total de nascimentos e entre os nascidos na rede não SUS, mais acentuado entre nascimentos por cesárea. A mediana de IG na rede SUS foi 39 semanas e na rede não SUS, 38. A prevalência de PIG variou consideravelmente, sendo 6,4 por cento dos nascimentos utilizando a curva Intergrowth e 12,4 por cento e 12,2 por cento com base nas curvas de Fenton e Kim e Alexander, respectivamente. Maiores prevalências de PIG foram encontradas em extremos de IG, pré-termos e termos tardios. Os fatores de risco para PIG, independente da prematuridade, foram malformação congênita, RN sexo feminino, primiparidade e pré-natal com menos de quatro consultas. Entre os não PT também estiveram associados: mãe adolescente, baixa escolaridade materna, raça/cor negra e gestante usuária do SUS, bem como morar em distrito com alta vulnerabilidade. Recém-nascidos PT estiveram associados com idade materna acima de 35 anos. Conclusão: A diferença na duração da gestação está relacionada ao tipo de hospital em que ocorrem os nascimentos e à alta frequência de cesáreas na rede privada. As prevalências de PIG foram bastante distintas entre as curvas, mostrando que esse indicador deve ser avaliado com cautela, pois alguns RN podem ser erroneamente classificados como PIG. O contexto de vulnerabilidade no MSP esteve associado a nascer PIG de forma discreta. Os fatores de risco individuais explicaram melhor o desfecho e foram diferentes segundo a prematuridade, desvantagens socioeconômicas e foram risco apenas entre não prematuros / Introduction: Gestational age (GA), birth weight and the frequency of small for gestational age (SGA) births are important predictors of neonatal morbidity and mortality. Cesarean section has been indicated as one of the factors that has contributed to the increase of prematurity. The aims of this study were to know the population distribution of GA according to type of delivery and to establish the proportion of births considered SGA and how its risk factors may contribute to the knowledge of the profile of live births in the city of São Paulo (SP). Another important objectives were study the pattern of distribution of gestational age in the births occurred in SP, to assess the prevalence of SGA based on three fetal growth curves (Alexander, Fenton and Kim and Intergrowth) and investigate the risk factors for SGA. Methodology: Cross-sectional study based on data from the Live Birth Information System (Sinasc). We studied hospital births and single pregnancies, in the years of 2013 and 2014, in the city of São Paulo. An analysis of the distribution of births according to GA, comparing type of delivery and hospital (public and private) was performed. Gestational age based on the date of the last menstruation (LMP) and the three fetal growth curves were used to calculate the prevalence of SGA. Multilevel regression was used to assess maternal, newborn and socioeconomic risk factors, with the context variable being the vulnerability of the residence district. Results: There was a shift to the left of the GA for total births and among those born in the private hospitals, more pronounced among cesarean births. The median GA in the public hospitals was 39 weeks and in the privates, 38. The prevalence of SGA varied considerably, with 6.4 per cent of births using the Intergrowth curve and 12.4 per cent and 12.2 per cent based on the curves of Fenton and Kim and Alexander, respectively. Higher prevalences of SGA were found in preterm (PT), and late term extremes. The risk factors for SGA, independent of prematurity, were congenital malformation, female newborn, primiparity and prenatal with less than four visits. Among the non preterms were also associated: adolescent mother, low maternal schooling, race / black color and pregnant user public health service, as well as living in a district with high vulnerability. PT newborns were associated with maternal age above 35 years. Conclusion: The difference in the length of gestation is related to the type of hospital where births occur and the high frequency of cesarean sections in the private hospitals. As SGA prevalences were very different between the curves, showing that this indicator should be evaluated with caution, some items may be erroneously classified as SGA. The context of vulnerability in SP was associated with being born SGA discretely. Individual risk factors better explain the outcome and were different according to a prematurity, socioeconomic disadvantages and were only risk among non preterms

Vielfältige Studien haben bereits Zusammenhänge zwischen niedrigem Geburtsgewicht und der Entwicklung von Adipositas und eines metabolischen Syndroms im späteren Lebensalter dargestellt. Umfangreiche Daten liegen vor allem für frühgeborene Neonaten vor. Ziel dieser Arbeit ist deshalb die Bewertung perinataler Parameter und der frühen Entwicklung reifer SGA – Neugeborener. Für die vorliegende prospektive Studie wurden 50 Neugeborene mit einem Geburtsgewicht < 10. Perzentile und 50 eutrophe Neugeborene erfasst. Bei allen Kindern wurden anamnestische Befunde zum Schwangerschaftsverlauf, die Biometrie der Eltern sowie Daten zur Geburt und zum stationären Verlauf erfasst. Mit Hilfe eines standardisierten Fragebogens an die niedergelassenen Kinderärzte erfolgte die Nachbeobachtung der Kinder hinsichtlich der Gewichts–, Längen– und Kopfumfangsentwicklung sowie der Ernährung bis zur 15. Lebenswoche. Die Ergebnisse der Studie zeigen, dass nur 13% der SGA – Kinder ein genetisch vermindertes Wachstumspotential haben. Demnach liegt bei der Mehrzahl der SGA – Geborenen ein pathologischer Mechanismus zugrunde. Während der Schwangerschaft waren in der SGA – Gruppe häufiger uterine Perfusionsstörungen bei einem erhöhten Auftreten von Präeklampsien oder Nikotinabusus darstellbar. Die SGA – Kinder wurden häufiger per sectionem geboren und zeigten zu einem erhöhten Anteil Dysmaturitätszeichen als Ausdruck einer intrauterinen Stress– oder Mangelsituation. Aufgrund der perinatalen Risiken sollte die Geburt dieser Kinder in einem Perinatalzentrum erfolgen. In der SGA – Gruppe bestand eine signifikante Korrelation zwischen Gestationsalter und Geburtsgewicht, deshalb ist eine individuelle Abwägung des Geburtszeitpunktes zur Nutzung des noch vorhandenen intrauterinen Wachstumspotentials erforderlich. Kinder der SGA – Gruppe bedurften häufiger einer intensivmedizinischen Betreuung und hatten einen längeren stationären Aufenthalt als Kinder der Vergleichsgruppe; Säurebasenstatus, APGAR – Werte und Blutdruck unterschieden sich nicht. Während des stationären Aufenthaltes wurden die SGA – Neonaten vermehrt zugefüttert und zeigten eine geringere postnatale Gewichtsabnahme. Nach der Entlassung kam es, bezogen auf die Körperlänge, zu einer stärkeren und rascheren Gewichtszunahme bei SGA – Kindern, während die Längendifferenz zunächst bestehen blieb. Ein frühes Aufholwachstum, welches sich in dieser Studie isoliert auf das Gewicht bezieht, ist hinsichtlich späterer metabolischer Störungen als möglicher Risikofaktor zu werten.

Introdução: Idade gestacional (IG) e peso ao nascer, assim como a frequência de nascimentos PIG (pequeno para idade gestacional), são importantes preditores da morbimortalidade neonatal. Os partos cesáreos têm sido indicados como um dos fatores que tem colaborado para o aumento da prematuridade. Conhecer a distribuição populacional da IG segundo tipo de parto e estabelecer a proporção de nascimentos considerados PIG e seus fatores de risco pode contribuir para o conhecimento do perfil dos nascidos vivos no Município de São Paulo (MSP). Objetivos: Estudar o padrão de distribuição da idade gestacional nos nascimentos ocorridos no MSP; calcular a prevalência de PIG com base em três curvas de crescimento fetal (Alexander, Fenton e Kim e Intergrowth); e investigar os fatores risco para PIG. Metodologia: Estudo transversal com base nos dados do Sistema de Informações sobre Nascidos Vivos (Sinasc). Foram estudados nascimentos hospitalares e de gestações únicas, nos anos de 2013 e 2014, no município de São Paulo. Realizou-se uma análise de distribuição dos nascimentos segundo IG, comparando tipo de parto e de hospital (SUS e não SUS). Para cálculo da prevalência de PIG usou-se a idade gestacional baseada na data da última menstruação (DUM) e as três curvas de crescimento fetal citadas. Foi empregada a regressão multinível para avaliação dos fatores de risco materno, do recém-nascido e socioeconômicos individuais, sendo a variável de contexto a vulnerabilidade do distrito de residência. Resultados: Houve um desvio à esquerda da IG para o total de nascimentos e entre os nascidos na rede não SUS, mais acentuado entre nascimentos por cesárea. A mediana de IG na rede SUS foi 39 semanas e na rede não SUS, 38. A prevalência de PIG variou consideravelmente, sendo 6,4 por cento dos nascimentos utilizando a curva Intergrowth e 12,4 por cento e 12,2 por cento com base nas curvas de Fenton e Kim e Alexander, respectivamente. Maiores prevalências de PIG foram encontradas em extremos de IG, pré-termos e termos tardios. Os fatores de risco para PIG, independente da prematuridade, foram malformação congênita, RN sexo feminino, primiparidade e pré-natal com menos de quatro consultas. Entre os não PT também estiveram associados: mãe adolescente, baixa escolaridade materna, raça/cor negra e gestante usuária do SUS, bem como morar em distrito com alta vulnerabilidade. Recém-nascidos PT estiveram associados com idade materna acima de 35 anos. Conclusão: A diferença na duração da gestação está relacionada ao tipo de hospital em que ocorrem os nascimentos e à alta frequência de cesáreas na rede privada. As prevalências de PIG foram bastante distintas entre as curvas, mostrando que esse indicador deve ser avaliado com cautela, pois alguns RN podem ser erroneamente classificados como PIG. O contexto de vulnerabilidade no MSP esteve associado a nascer PIG de forma discreta. Os fatores de risco individuais explicaram melhor o desfecho e foram diferentes segundo a prematuridade, desvantagens socioeconômicas e foram risco apenas entre não prematuros / Introduction: Gestational age (GA), birth weight and the frequency of small for gestational age (SGA) births are important predictors of neonatal morbidity and mortality. Cesarean section has been indicated as one of the factors that has contributed to the increase of prematurity. The aims of this study were to know the population distribution of GA according to type of delivery and to establish the proportion of births considered SGA and how its risk factors may contribute to the knowledge of the profile of live births in the city of São Paulo (SP). Another important objectives were study the pattern of distribution of gestational age in the births occurred in SP, to assess the prevalence of SGA based on three fetal growth curves (Alexander, Fenton and Kim and Intergrowth) and investigate the risk factors for SGA. Methodology: Cross-sectional study based on data from the Live Birth Information System (Sinasc). We studied hospital births and single pregnancies, in the years of 2013 and 2014, in the city of São Paulo. An analysis of the distribution of births according to GA, comparing type of delivery and hospital (public and private) was performed. Gestational age based on the date of the last menstruation (LMP) and the three fetal growth curves were used to calculate the prevalence of SGA. Multilevel regression was used to assess maternal, newborn and socioeconomic risk factors, with the context variable being the vulnerability of the residence district. Results: There was a shift to the left of the GA for total births and among those born in the private hospitals, more pronounced among cesarean births. The median GA in the public hospitals was 39 weeks and in the privates, 38. The prevalence of SGA varied considerably, with 6.4 per cent of births using the Intergrowth curve and 12.4 per cent and 12.2 per cent based on the curves of Fenton and Kim and Alexander, respectively. Higher prevalences of SGA were found in preterm (PT), and late term extremes. The risk factors for SGA, independent of prematurity, were congenital malformation, female newborn, primiparity and prenatal with less than four visits. Among the non preterms were also associated: adolescent mother, low maternal schooling, race / black color and pregnant user public health service, as well as living in a district with high vulnerability. PT newborns were associated with maternal age above 35 years. Conclusion: The difference in the length of gestation is related to the type of hospital where births occur and the high frequency of cesarean sections in the private hospitals. As SGA prevalences were very different between the curves, showing that this indicator should be evaluated with caution, some items may be erroneously classified as SGA. The context of vulnerability in SP was associated with being born SGA discretely. Individual risk factors better explain the outcome and were different according to a prematurity, socioeconomic disadvantages and were only risk among non preterms

Vielfältige Studien haben bereits Zusammenhänge zwischen niedrigem Geburtsgewicht und der Entwicklung von Adipositas und eines metabolischen Syndroms im späteren Lebensalter dargestellt. Umfangreiche Daten liegen vor allem für frühgeborene Neonaten vor. Ziel dieser Arbeit ist deshalb die Bewertung perinataler Parameter und der frühen Entwicklung reifer SGA – Neugeborener. Für die vorliegende prospektive Studie wurden 50 Neugeborene mit einem Geburtsgewicht < 10. Perzentile und 50 eutrophe Neugeborene erfasst. Bei allen Kindern wurden anamnestische Befunde zum Schwangerschaftsverlauf, die Biometrie der Eltern sowie Daten zur Geburt und zum stationären Verlauf erfasst. Mit Hilfe eines standardisierten Fragebogens an die niedergelassenen Kinderärzte erfolgte die Nachbeobachtung der Kinder hinsichtlich der Gewichts–, Längen– und Kopfumfangsentwicklung sowie der Ernährung bis zur 15. Lebenswoche. Die Ergebnisse der Studie zeigen, dass nur 13% der SGA – Kinder ein genetisch vermindertes Wachstumspotential haben. Demnach liegt bei der Mehrzahl der SGA – Geborenen ein pathologischer Mechanismus zugrunde. Während der Schwangerschaft waren in der SGA – Gruppe häufiger uterine Perfusionsstörungen bei einem erhöhten Auftreten von Präeklampsien oder Nikotinabusus darstellbar. Die SGA – Kinder wurden häufiger per sectionem geboren und zeigten zu einem erhöhten Anteil Dysmaturitätszeichen als Ausdruck einer intrauterinen Stress– oder Mangelsituation. Aufgrund der perinatalen Risiken sollte die Geburt dieser Kinder in einem Perinatalzentrum erfolgen. In der SGA – Gruppe bestand eine signifikante Korrelation zwischen Gestationsalter und Geburtsgewicht, deshalb ist eine individuelle Abwägung des Geburtszeitpunktes zur Nutzung des noch vorhandenen intrauterinen Wachstumspotentials erforderlich. Kinder der SGA – Gruppe bedurften häufiger einer intensivmedizinischen Betreuung und hatten einen längeren stationären Aufenthalt als Kinder der Vergleichsgruppe; Säurebasenstatus, APGAR – Werte und Blutdruck unterschieden sich nicht. Während des stationären Aufenthaltes wurden die SGA – Neonaten vermehrt zugefüttert und zeigten eine geringere postnatale Gewichtsabnahme. Nach der Entlassung kam es, bezogen auf die Körperlänge, zu einer stärkeren und rascheren Gewichtszunahme bei SGA – Kindern, während die Längendifferenz zunächst bestehen blieb. Ein frühes Aufholwachstum, welches sich in dieser Studie isoliert auf das Gewicht bezieht, ist hinsichtlich späterer metabolischer Störungen als möglicher Risikofaktor zu werten.

The aim of this study was to examine differences and associations concerning physical activity and cognitive functioning among children born preterm in comparison to those born full term. The sample consisted of 130 children at early school age (mean = 7.8 years), born at a gestational age (GA) of 23 - 42 weeks, and categorized into three groups; children born full term (GA 39 - 42), moderately preterm (GA 34 – 36) and very preterm (GA 23 - 33). Physical activities were perceived from parents’ ratings by use of the Child behaviour checklist (CBCL), and cognitive functioning by WISC-IV. Results showed that children born moderately preterm performed comparable to children born full term, both regarding physical activity ratings and cognitive performance. Children born very preterm were found to have significantly poorer full scale IQ, lower physical performance, fewer sport activities, and were less lateralized, in comparison to both children born full term and those born moderately preterm. Conclusion: a very preterm birth seems to generate long-term effects on physical activities, sport performance and cognitive functioning. Thus, more focus should be paid to children born at a very low GA to identify early deviations and to provide interventions to improve cognitive functioning and enhance physical performance; also in contexts other than sport activities. / Syftet med denna studie var att undersöka skillnader och samband mellan fysisk aktivitet och kognitivt fungerande inom gruppen för tidigt födda barn och i jämförelse med fullgångna barn. Urvalet bestod av 130 barn i tidig skolålder (medel = 7.8 år), födda i gestationsålder (GA) mellan 23 – 42 veckor kategoriserade i tre grupper; fullgångna barn (GA 39 – 42), moderat förtidigt födda (GA 34 – 36) och mycket förtidigt födda (GA 23 – 33). Fysisk aktivitet undersöktes utifrån föräldrars skattning genom användande av Child behaviour checklist (CBCL) och kognitivt fungerande utifrån WISC-IV. Resultaten visade att de moderat för tidigt födda barnen presterade jämförbart med de fullgångna barnen både vad beträffar fysisk aktivitet och kognitivt fungerande. De mycket för tidigt födda barnen visade sig ha signifikant sämre fullskale-IQ, lägre sportsliga prestationer, färre antal sporter och var mindre lateraliserade, jämfört med både de fullgångna barnen och de moderat förtidigt födda. Slutsats: en mycket förtidig födsel tycks generera långvariga effekter på fysiska aktiviteter, sportsliga prestationer och kognitivt fungerande. Således bör större fokus läggas på barn födda med en mycket låg GA för att identifiera tidiga avvikelser och tillhandahålla interventioner för att förbättra kognitivt fungerande och stimulera/förhöja fysiska prestationer; även i andra kontexter än sportsliga aktiviteter.