G118(P) Associations between postnatal growth rates and cognitive outcomes at age 16 years in infants born small-for-gestational-age at term

E Hallinan, M Fewtrell, V Palit, P Winyard, H Bedford
2018 Trainees session   unpublished
Neonatal Audit Programme (NNAP) suggests use varies according to level of care but did not differentiate dependent on those transferred in. Method IUT requests are coordinated by the regional transport team. Information was retrospectively reviewed from 01/11/16 to 31/12/16, just after starting collection on magnesium sulphate use. Comparison was made from 01/03/17 to 30/04/17. Gestation, base hospital, risk of preterm delivery and maternal history was also recorded. Results 189 cases were
more » ... wed, 104 in 2016 and 85 in 2017. 35 were ineligible since gestation was >34 +0 /40. 9.2% patients had no information recorded. In 2016, 8.5% referrals received magnesium sulphate (5/59). This increased to 11.7% in 2017 (8/68). Only one patient was >30 +0 /40. Twenty neonatal units featured, two from outof-region. The greatest use was at a level 2 unit (43%). 50% units recorded no use. Most referrals followed rupture of membranes associated with contractions. Conclusion Magnesium sulphate has clear benefit in the preterm population but appears to be under-utilised in our region. The majority of women met the criteria for magnesium but had not received it. Findings amongst the IUT group are below those reported by NNAP. Condition was only sought at the time of referral. Recommendation Increased recognition of national guidance is required alongside inter-collaborative working with obstetric teams. Results have been disseminated at the network meeting and a guideline is in progress. The transport service may offer a unique opportunity to prompt use in this potentially vulnerable group. Background Rapid post-natal growth is associated with increased risk of adult cardiovascular and metabolic disease. In preterm infants, rapid post-natal growth is also associated with improved long-term cognition. Small-for-gestational-age (SGA) term infants have increased risk of adverse long-term cognitive outcomes compared to appropriate-for-gestational-age (AGA) term infants; they are also prone to rapid post-natal 'catch-up' growth. It is therefore important to understand whether rapid post-natal growth in this population confers any long-term cognitive advantage, and balance this with recognised metabolic risks. Aims To investigate associations between post-natal growth in term-SGA infants and cognitive outcomes in adolescence. Methods 60 term-SGA infants were followed-up from birth to 16 years. Weight, head circumference (HC) and length were measured at enrolment, 6, 12 and 26 weeks, 9 and 18 months and 16 years. Measurements were converted to standard deviation scores (SDS) and changes in SDS between time points calculated. Cognitive outcomes were measured at 16 years to assess global intelligence (IQ); literacy and academic attainment (Wechsler Individual Attainment Test-reading and maths subtests); and executive functioning (Stroop Colour-
doi:10.1136/archdischild-2018-rcpch.114 fatcat:lt4jb6avojedjmedzmxswkxlca