Head Circumference within the Normal Range and Neurodevelopmental Outcomes in Preterm Infants

Abstract

Objective We sought to determine if variation in head circumference (HC) within the range of normal (5th–10th and 90th–95th percentile) is associated with poor neurodevelopmental outcomes (NDO), which defined as mild or moderate delay by Bayley II psychometrics (BSID-II).

Study Design This is a secondary analysis of a randomized controlled trial assessing the benefits of magnesium for the prevention of cerebral palsy. Fetuses with a normal HC at birth defined as within 5th to 95th percentile were included. NDO were assessed at age 2 with BSID-II. Moderate delay was defined as a score <70 and mild delay as <85. HC was classified as small normal (5th–10th percentile), normal (10th–90th percentile), and large normal (90th–95th percentile). Logistic regression models adjusted for confounding. Linear regression models estimated the impact for every 1 cm of change in HC.

Results Of 1,236 included infants, 111 (8%) had small normal HC; 1,058 (85%) had normal HC; and 67 (5%) had large normal HC. Baseline characteristics were similar between groups. There was no association with changes in HC within the range of normal and developmental indices. When considered as a continuous variable, every 1 cm increase in HC was also not associated with a significant change in developmental indices.

Conclusion Within the normal range (5th–95th percentile), changes in HC did not correlate with changes in NDO at 2 years as measured by Bayley II scales.

Key Points

• It is unknown if variations in normal HC are associated with poor neurodevelopmental outcomes.

• Alterations in HC within the range of normal (5th–95th percentile) are not associated with adverse NDO.

• When considered as a continuous variable, a 1 cm increase in HC is not associated with adverse NDO.

• Changes in HC within the range of normal do not appear to be a pathologic change altering NDO.

Keywords

neurodevelopmental outcomes - head circumference - preterm infants - macrocephaly - microcephaly

Note

This study was presented at the Society for Maternal-Fetal Medicine's 40th Annual Pregnancy Meeting, Grapevine, Texas, February 3 to 8, 2020.

Publication History

Received: 20 November 2020

Accepted: 21 June 2021

Article published online:
29 July 2021

• References

• 1 Zedler BK, Mann AL, Kim MM. et al. Buprenorphine compared with methadone to treat pregnant women with opioid use disorder: a systematic review and meta-analysis of safety in the mother, fetus and child. Addiction 2016; 111 (12) 2115-2128
• 2 Haabrekke KJ, Slinning K, Walhovd KB, Wentzel-Larsen T, Moe V. The perinatal outcome of children born to women with substance dependence detoxified in residential treatment during pregnancy. J Addict Dis 2014; 33 (02) 114-123
• 3 Visconti KC, Hennessy KC, Towers CV, Howard BC. Chronic opiate use in pregnancy and newborn head circumference. Am J Perinatol 2015; 32 (01) 27-32
• 4 Heffron R, Mugo N, Hong T. et al; Partners Demonstration Project and the Partners PrEP Study Teams. Pregnancy outcomes and infant growth among babies with in-utero exposure to tenofovir-based preexposure prophylaxis for HIV prevention. AIDS 2018; 32 (12) 1707-1713
• 5 Freeman MP, Góez-Mogollón L, McInerney KA. et al. Obstetrical and neonatal outcomes after benzodiazepine exposure during pregnancy: results from a prospective registry of women with psychiatric disorders. Gen Hosp Psychiatry 2018; 53: 73-79
• 6 Lou HC, Hansen D, Nordentoft M. et al. Prenatal stressors of human life affect fetal brain development. Dev Med Child Neurol 1994; 36 (09) 826-832
• 7 Källén K. Maternal smoking during pregnancy and infant head circumference at birth. Early Hum Dev 2000; 58 (03) 197-204
• 8 Bateman DA, Chiriboga CA. Dose-response effect of cocaine on newborn head circumference. Pediatrics 2000; 106 (03) E33
• 9 Shankaran S, Das A, Bauer CR. et al. Association between patterns of maternal substance use and infant birth weight, length, and head circumference. Pediatrics 2004; 114 (02) e226-e234
• 10 Kuban KC, Allred EN, O'Shea TM. et al. Developmental correlates of head circumference at birth and two years in a cohort of extremely low gestational age newborns. J Pediatr 2009; 155 (03) 344-9.e1 , 3
• 11 García-Alix A, Sáenz-de Pipaón M, Martínez M, Salas-Hernández S, Quero J. [Ability of neonatal head circumference to predict long-term neurodevelopmental outcome]. Rev Neurol 2004; 39 (06) 548-554
• 12 Ochiai M, Nakayama H, Sato K. et al. Head circumference and long-term outcome in small-for-gestational age infants. J Perinat Med 2008; 36 (04) 341-347
• 13 Bier JB, Finger AS, Bier BA, Johnson TA, Coyle MG. Growth and developmental outcome of infants with in-utero exposure to methadone vs buprenorphine. J Perinatol 2015; 35 (08) 656-659
• 14 Sicard M, Nusinovici S, Hanf M. et al. Fetal and postnatal head circumference growth: synergetic factors for neurodevelopmental outcome at 2 years of age for preterm infants. Neonatology 2017; 112 (02) 122-129
• 15 Gampel SB, Nomura Y. Short and long-term effects of compromised birth weight, head circumference, and apgar scores on neuropsychological development. J Psychol Abnorm Child 2014; 3 (03) 3
• 16 Wright CM, Emond A. Head growth and neurocognitive outcomes. Pediatrics 2015; 135 (06) e1393-e1398
• 17 Pirozzi F, Nelson B, Mirzaa G. From microcephaly to megalencephaly: determinants of brain size. Dialogues Clin Neurosci 2018; 20 (04) 267-282
• 18 Aagaard K, Bach CC, Henriksen TB, Larsen RT, Matthiesen NB. Head circumference at birth and childhood developmental disorders in a nationwide cohort in Denmark. Paediatr Perinat Epidemiol 2018; 32 (05) 458-466
• 19 Rouse DJ, Hirtz DG, Thom E. et al; Eunice Kennedy Shriver NICHD Maternal-Fetal Medicine Units Network. A randomized, controlled trial of magnesium sulfate for the prevention of cerebral palsy. N Engl J Med 2008; 359 (09) 895-905
• 20 Hack M, Taylor HG, Drotar D. et al. Poor predictive validity of the Bayley Scales of Infant Development for cognitive function of extremely low birth weight children at school age. Pediatrics 2005; 116 (02) 333-341
• 21 Buck Louis GM, Grewal J, Albert PS. et al. Racial/ethnic standards for fetal growth: the NICHD fetal growth studies. Am J Obstet Gynecol 2015; 213 (04) 449.e1-449.e41
• 22 Bayley N. Comparisons of mental and motor test scores for ages 1-15 months by sex, birth order, race, geographical location, and education of parents. Child Dev 1965; 36: 379-411
• 23 Norton M. Callen's Ultrasonography in Obstetrics and Gynecology. 6th ed.. Philadelphia, PA: Elsevier; 2017
• 24 Raghuram K, Yang J, Church PT. et al; Canadian Neonatal Network, Canadian Neonatal Follow-Up Network Investigators. Head growth trajectory and neurodevelopmental outcomes in preterm neonates. Pediatrics 2017; 140 (01) 140
• 25 Simon NP, Brady NR, Stafford RL. Catch-up head growth and motor performance in very-low-birthweight infants. Clin Pediatr (Phila) 1993; 32 (07) 405-411
• 26 Johnson S, Moore T, Marlow N. Using the Bayley-III to assess neurodevelopmental delay: which cut-off should be used?. Pediatr Res 2014; 75 (05) 670-674