PFM.65 Impact of cerebral redistribution on neurological outcomes in small for gestational age babies: a systematic review

Background Cerebral redistribution (CR) in fetuses with growth restriction has been thought to be a protective, compensatory mechanism. Aim to systematically review the evidence on whether CR, as assessed by MCA Doppler, in small for gestational age (SGA) fetuses is associated with increased risk of adverse neurological outcomes. Methods Medline searched inception to September 2013. All studies reporting neurological/neurodevelopmental outcomes in term/preterm SGA babies with CR diagnosed by MCA Doppler included, after assessment by two people independently. Results 1180 citations retrieved, 8 studies included. Definitions of SGA and CR were variable, as were scales used for neurological outcomes. Study quality was variable. Compared to SGA babies with no CR, SGA term babies with CR had significantly increased risk of abnormal scores in motor (n = 2 studies) and state organisation (n = 1) areas (Neonatal Behavioural Assessment Scale (NBAS)) at 40 wks, but no differences were found in preterm babies for NBAS (n = 1). There was no significant difference in risk of IVH (n = 2). CR in preterm SGA babies was associated with increased adverse neurological outcome at 1 year (Bayleys scale (n = 1)) and CR in term babies increased risk of abnormal scores in communication and problem solving at 2 years (Ages Stages Questionnaire) compared to SGA babies with no CR. Conclusions Findings from a small number of variable quality studies suggest that SGA fetuses with CR may be at higher risk of neurological problems. However, more data are needed from adequately controlled good quality studies with appropriate longterm follow up before conclusions can be drawn.