Poor Head Growth Research Articles

Case Report and Review: An Unusual Case of Fetal Traumatic Brain Injury

We herein report an unusual case of maternal road traffic accident with blunt trauma to the abdomen at 34 weeks of gestation followed by delivery of severely encephalopathic baby and also a brief review of similar previous reports.The baby had near normal transition, then progressively developed severe encephalopathy and multiple organ dysfunction attributed mainly to the intrauterine traumatic injury. The baby had multiple intra and extra axial bleeds,cerebral edema and diffuse axonal injury, as revealed by the CT scan. The baby was managed conservatively with various neuroprotective strategies similar to management in older children and thus cerebral edema/ hematomas subsided. The baby required ventilatory support, prolonged assisted ventilation/oxygen and the metabolic derangements were managed accordingly. The baby was discharged on oral Levetiracetam, multivitamins and nasogastric tube feeds. Baby was followed up sequentially till day 74 and on physical examination had poor head growth and increased muscle tone of the extremities. Neuroimaging revealed diffuse multicystic leukoencephalomalacia, hydrocephalus ex vacuo with cortical thinning. Intrauterine fetal brain injury is an uncommon incidence which causes mortality and significant morbidity in the child. Neuroimaging of the fetus after trauma to the mother can lead to early diagnosis and anticipation. Early vigorous neuroprotective measures and management may prevent mortality and reduce further brain insult in theseneonates. There is paucity of information on management of such cases thus they should be reported in detail forstudy and future references.

Association between preterm infant size at 1year and ADHD later in life: data from 1993 and 2004 Pelotas Birth Cohorts.

The objective of this study is to examine the association between preterm infants' size at 1 year and attention-deficit/hyperactivity disorder (ADHD) assessed categorically and dimensionally in childhood and adolescence. We studied infants born < 37weeks' gestation from two Brazilian birth cohorts (n = 653). ADHD was evaluated using the Development and Well-Being Assessment (DAWBA) interview at the age of 6years in one cohort and by a structured interview according toDSM-5 criteria at 18years in the other one. The presence of child attention difficulties was measured by the Strengths and Difficulties Questionnaire (SDQ) at 6 and 11years in the 2004 and 1993 cohorts, respectively. We estimated associations of weight, length, head circumference, and BMI z-scores at 1-year chronological age with ADHD using Poisson Regression Model; and with attention difficulties using Linear Regression, adjusting for covariates. Mean birth weight was 2500g and gestational age was 34.5weeks. The aggregated ADHD prevalence in the two cohorts was 2.7%, and the median score for attention difficulties was 3.0. We found that increased head circumference at 1 year was associated with a lower risk of ADHD diagnosis (RR = 0.7, 95% CI 0.4, 0.9; p = 0.04 per standard deviation difference) and with fewer dimensional attention symptoms. In sensitivity analysis with other mental disorders, head circumference was associated with depression, but not with anxiety. Our findings emphasize poor head growth in the first year of life as a potential determinant of attentional difficulties in the preterm infant population.

Retinopathy of Prematurity Requiring Treatment Is Closely Related to Head Growth during Neonatal Intensive Care Unit Hospitalization in Very Low Birth Weight Infants

Background: Retinopathy of prematurity (ROP) is caused by prenatal sensitization and postnatal insults to the immature retina. This process can be associated with the postnatal growth of preterm infants. We investigated whether ROP requiring treatment was associated with the postnatal growth failure of very low birth weight (VLBW) infants. Method: From a cohort of VLBW infants (birth weight <1,500 g) registered in the Korean Neonatal Network from January 2013 to December 2017, 3,133 infants with gestational age (GA) between 24 and 28 weeks were included in the study. Postnatal growth failure was defined when the change in each anthropometric z-score between birth and discharge was <10th percentile of the total population. Propensity score matching (PSM) at 1:1 was performed to match the distribution of GA and postnatal morbidities between infants with and without ROP requiring treatment. Prenatal factors and ROP were analyzed by conditional logistic regression. Results: Of 3,133 enrolled infants, 624 (19.9%) were diagnosed with ROP requiring treatment. After PSM, ROP requiring treatment was associated with postnatal growth failure assessed by head circumference (adjusted odds ratio [aOR] 1.91, 95% confidence interval [CI] 1.18–3.09), but not weight (aOR 1.45, 95% CI 0.97–2.17) and length (aOR 1.21, 95% CI 0.81–1.82). Conclusion: ROP requiring treatment was associated with poor head circumference growth, not with weight and length. Our findings suggest that ROP requiring treatment and poor head growth during NICU hospitalization are fundamentally related.

Neurodevelopmental Outcome in Patients with Typical Imaging Features of Injury as a Result of Neonatal Hypoglycemia.

Previous reports described a pattern of hypoglycemia-induced damage predominantly affecting the parieto-occipital regions. The long-term neurological sequelae of severe neonatal hypoglycemic encephalopathy include developmental delay, poor head growth, learning or behavioral difficulties, visual impairment, and epilepsy. This study reports neurodevelopmental outcome of children with neonatal hypoglycemia-associated parieto-occipital brain injury who were evaluated in our pediatric neurology outpatient clinic for different neurological complaints. We retrospectively reviewed patients who were followed at Kocaeli University Hospital, Pediatric Neurology Department between 2007 and 2015. Patients (n=42) with predominately parieto-occipital lesions on magnetic resonance imaging (MRI) with the typical pattern of neonatal hypoglycemia were evaluated. Patients with documented hypoglycemia (n=21) were included in this study. Patients (n=9) with recurrent episodes of hypoglycemia longer than 12 hours were evaluated as prolonged hypoglycemia. Eleven patients (52.4%) experienced seizures in the neonatal period. Eighteen patients (85.7%) developed epilepsy during the follow-up. Refractory seizures were observed in 8 patients (38.1%). Nine patients (42.9%) manifested microcephaly, seven patients (33.3%) manifested cerebral palsy. Parieto-occipital involvement and the spasticity rate were statistically high in patients with prolonged hypoglycemia (p<0.01). Two patients had autistic features and four patients (19%) had attention deficit hyperactivity disorder. VEP studies could be performed in 18 of 21 patients. All patients had abnormal VEP results. We are of the opinion that most patients of neonatal hypoglycemia are not always documented. Patients under risk and patients with symptoms of hypoglycemia should be vigorously screened and treated to prevent neurologic impairments including cerebral palsy, epilepsy and visual disturbance.

Poor Head Growth Is Associated with Later Mental Delay among Vietnamese Preterm Infants: A Follow-up Study.

BackgroundPreterm infants in low- and middle-income countries are at high risk of poor physical growth, but their growth data are still scarce.ObjectivesTo describe the growth of Vietnamese preterm infants in the first 2 years, and to compare with references: World Health Organization (WHO) child growth standards, and healthy Southeast Asian (SEA) infants. Further, to assess the association between growth in the first year and neurodevelopment at 2 years corrected age (CA). MethodsWe conducted a cohort study to follow up preterm infants discharged from a neonatal intensive care unit for 2 years. Weight, length and head circumference (HC) were measured at 3, 12 and 24 months CA. Neurodevelopment was assessed using Bayley Scales of Infant and Toddler Development—3rd Edition at 24 months CA.ResultsOver 90% of the cohort showed catch-up weight at 3 months CA. Weight and length were comparable to healthy SEA but were lower than WHO standards. HC was significantly smaller than those of WHO standards with HC Z-scores steadily decreasing from −0.95 at 3 months CA to −1.50 at 24 months CA. Each one decrement of HC Z-score from 3 to 12 months CA was associated with nearly twice an increase in odds of mental delay at 24 months CA (odds ratio 1.89; 95% confidence interval 1.02–3.50).ConclusionVietnamese preterm infants exhibited early catch-up weight but poor head growth, which was associated with later delays in mental development. Our findings support the importance of HC measures in follow-up for preterm infants.

Early postnatal growth failure in preterm infants is not inevitable

BackgroundPreviously published data have demonstrated that preterm infants experience a fall across marked centile lines for weight in early life with early poor head growth also reported. This study describes...

Early Growth and Neurologic Outcomes of Infants with Probable Congenital Zika Virus Syndrome.

We report the early growth and neurologic findings of 48 infants in Brazil diagnosed with probable congenital Zika virus syndrome and followed to age 1–8 months. Most of these infants had microcephaly (86.7%) and craniofacial disproportion (95.8%). The clinical pattern included poor head growth with increasingly negative z-scores, pyramidal/extrapyramidal symptoms, and epilepsy.

Head circumferences of children born to HIV-infected and HIV-uninfected mothers in Zimbabwe during the preantiretroviral therapy era.

Objectives:To describe the head growth of children according to maternal and child HIV infection status.Design:Longitudinal analysis of head circumference data from 13 647 children followed from birth in the ZVITAMBO trial, undertaken in Harare, Zimbabwe, between 1997 and 2001, prior to availability of antiretroviral therapy (ART) or cotrimoxazole prophylaxis.Methods:Head circumference was measured at birth, then at regular intervals through 24 months of age. Mean head circumference-for-age Z-scores (HCZ) and prevalence of microcephaly (HCZ < −2) were compared between HIV-unexposed children, HIV-exposed uninfected (HEU) children and children infected with HIV in utero (IU), intrapartum (IP) and postnatally (PN).Results:Children infected with HIV in utero had head growth restriction at birth. Head circumference Z-scores remained low throughout follow-up in IP children, whereas they progressively declined in IU children. During the second year of life, HCZ in the PN group declined, reaching a similar mean as IP-infected children by 21 months of age. Microcephaly was more common among IU and IP children than HIV-uninfected children through 24 months. HEU children had significantly lower head circumferences than HIV-unexposed children through 12 months.Conclusion:HIV-infected children had lower head circumferences and more microcephaly than HIV-uninfected children. Timing of HIV acquisition; influenced HCZ, with those infected before birth having particularly poor head growth. HEU children had poorer head growth until 12 months of age. Correlations between head growth and neurodevelopment in the context of maternal/infant HIV infection, and further studies from the current ART era, will help determine the predictive value of routine head circumference measurement.

Poor postdischarge head growth is related to a 10% lower intelligence quotient in very preterm infants at the chronological age of five years

目的 与之前多集中于幼儿期的研究不同，本研究分析生于2003年至2009年胎龄小于32周的早产儿5岁时的头部发育与认知能力之间的关系。 方法 对澳大利亚提洛尔地区的273例极早产儿分别在出生时、出院时、纠正胎龄3、12、24个月和实际年龄5岁时测定头围。头围低于均值一个标准差者定义为不达标。5岁时，使用韦氏学龄前和学龄期儿童智力量表(第三版)评估智商(intelligence quotient，IQ)。 结果 婴儿3个月时头围不达标者智商(90[20-122])者与头围正常者智商(98[20-138])比较中位数较低(P＝0.001)，并且从3个月起更容易表现为认知发育迟滞。 结论 3个月开始的头围不达标与IQ降低10%持续相关，该研究为头颅发育障碍，尤其是出现在出院后早期，与认知能力下降相关进一步提供了证据。

Association between neonatal morbidities and head growth from birth until discharge in very-low-birthweight infants born preterm: a population-based study.

To evaluate the possible association between major neonatal morbidities and poor head growth from birth to discharge home in very-low-birthweight (VLBW) infants born preterm. Population-based observational study comprising 12 992 infants (6340 male, 6652 female) of 24 to 32 weeks' gestation, and birthweight ≤1500g. Severe head growth failure (HGF) was defined as a decrease in head circumference z-score >2 z-scores, and moderate HGF as a decrease of 1 to 2 z-scores. Multinomial logistic regression analysis was applied to determine morbidities associated with HGF. Severe HGF occurred in 4.5% and moderate HGF in 20.9% of infants. Each unit increase in head circumference z-score at birth was associated with increased odds for severe and moderate HGF (odds ratios [OR] 5.29, 95% confidence intervals [CI] 4.67-6.00, and OR 2.38, 95% CI 2.23-2.54 respectively). Both severe and moderate HGF were associated with respiratory distress syndrome (OR 2.03, 95% CI 1.58-2.62, and OR 1.66, 95% CI 1.48-1.85 respectively); bronchopulmonary dysplasia (OR 3.38, 95% CI 2.33-4.91, and OR 1.87, 95% CI 1.52-2.30 respectively); necrotizing enterocolitis (OR 2.89, 95% CI 2.04-4.09, and OR 1.72, 95% CI 1.38-2.16 respectively), and sepsis (OR 2.06, 95% CI 1.69-2.50, and OR 1.38, 95% CI 1.24-1.53 respectively). Major neonatal morbidities were associated with HGF in VLBW infants born preterm. Identification of whether this is a direct effect of these morbidities or mediated through nutritional or growth factors may enable interventions to improve postnatal head growth of infants born preterm.

Poor postdischarge head growth is related to a 10% lower intelligence quotient in very preterm infants at the chronological age of five years.

This study examined the relationship between head growth and cognitive outcome at the age of five years in preterm infants born at less than 32 weeks of gestation from 2003 to 2009, as previous research has mostly focused on outcomes in toddlers. The head circumference of 273 very preterm infants born in Tyrol, Austria, was measured at birth, discharge, the corrected ages of three, 12 and 24 months and the chronological age of five years. Suboptimal head size was defined as a head circumference of more than one standard deviation below the mean. Full-scale intelligence quotient (IQ) at five years was determined using Wechsler Preschool and Primary Scales of Intelligence, third edition. Infants with a suboptimal head size at the age of three months had a significantly lower median IQ than those with a normal head size (90 [20-122] versus 98 [20-138], p = 0.001) and from three months onwards they were more likely to exhibit cognitive delay. A suboptimal head size from the age of three months was consistently related to a 10% lower IQ, and this study adds further evidence that head growth failure, especially during the early postdischarge period, is related to impaired cognitive abilities.

Head growth of undernourished children in rural Nepal: association with demographics, health and diet

Background: Brain development in early childhood is a key determinant of later cognition, social achievement and educational success. Head circumference (HC) measurements are a simple method to assess brain growth, yet reports of these measurements are uncommon in nutritional surveys of undernourished children. Objective: To evaluate HC measurements in a population of rural Nepali children and relate these measurements to demographics, health and diet. Methods: An observational study of head growth was nested within a longitudinal evaluation of a livestock-based agricultural intervention in rural Nepal. Between 538 and 689 children (aged 6 months to 8 years) were measured (height, weight, HC) at each of six survey visits. A total of 3652 HC measurements were obtained. Results were converted to Z-scores (WHO Anthro). Results: Mean head circumference Z-scores (HCZ) diminished progressively over the first 4 years of life; a decline of 30% occurred between 3 and 4 years of age (−1.73 to −2.45, P < 0.0001). Overall, 56% of HCZ were <−2. Gender-adjusted HCZ (but not other measurements) were significantly lower for girls than boys [mean (SD) −2.31 (1.0) vs −1.99 (0.094), P < 0.0001]; girls more often had microcephaly (61% vs 50%, P < 0.0001). For children <3 years of age, HCZ were better in those who had eaten two or more animal-source foods (ASFs) within the previous 24 h [−1.69 (.05) vs −2.08 (0.10), P = 0.001] than in those who had eaten none or only one; HCZ correlated with the number of ASFs consumed (P < 0.001). Regression analyses demonstrated that the main determinants of HCZ were age, weight-for-age Z-scores (WAZ) and gender; 43% of the variance in HCZ in younger children was explained by WAZ and ASF consumption. Conclusion: HCs reflect brain size in young children; brain size is linked to cognitive function. Poor head growth represents another facet of the ‘silent emergency’ of child undernutrition. Routine HCZ assessments may contribute to better understanding of the links between poverty and cognitive development.

Poor postnatal head growth in very preterm infants is associated with impaired neurodevelopment outcome

To examine the association between neurodevelopmental outcome and head circumference (HC) in a cohort of very preterm infants and in this context to investigate the relevance of suboptimal head size. Somatometric data were obtained at birth, discharge and 3, 12 and 24 months for all infants born in Tyrol <32 weeks gestational age. Growth data are presented as z scores. HC was defined as microcephaly (>2 SD below mean), suboptimal (>1 SD below mean) or normal head size (<1 SD below mean). Neurodevelopmental outcome was quantified at 12 and 24 months using the Bayley Scales of Infant Development II. The percentage of infants with suboptimal head size increased until the age of 24 months and was related to adverse outcome. The association was strongest between HC at 3 months and psychomotor and mental outcome as quantified using the Bayley Scales of Infant Development. Poor postnatal head growth was common in our study cohort. Both microcephaly and suboptimal head size were associated with impaired neurodevelopmental outcome. Suboptimal head size at 3 months was found to be particularly associated with adverse neurodevelopmental outcome.

Microcephaly is associated with early adverse neurologic outcomes in hypoplastic left heart syndrome

Hypoplastic left heart syndrome (HLHS) is associated with significant mortality and morbidity. Fetal head growth abnormalities have been identified in a subset of HLHS fetuses, but it is unclear whether specific patterns of maladaptive growth affect clinical outcomes. We hypothesized that poor fetal head growth is associated with an increased frequency of adverse clinical outcomes. We retrospectively examined a cohort of HLHS patients from midgestation to 1 y of age. Fetal and birth anthropometric measurements were analyzed using the Olsen standard, and clinical outcomes were obtained. A total of 104 HLHS patients were identified over a 12-y period; fetal data were available in 38 cases. HLHS neonates demonstrated a high incidence of microcephaly (12%), small head size (27%), and poor head growth (32%). All-cause mortality was 31% at 30 d and 43% at 1 y. Neurologic outcomes were observed in 12% of patients and were significantly increased with microcephaly (43 vs. 4%; P = 0.02). The average length of hospital stay following stage I palliation was 33.4 ± 33 d, correcting for early death. In term nonsyndromic HLHS, fetal and neonatal microcephaly are associated with early adverse neurologic outcomes but not mortality.

Head Growth in Preterm Infants: Correlation With Magnetic Resonance Imaging and Neurodevelopmental Outcome

Extremely preterm birth is associated with adverse neurodevelopmental sequelae. Head circumference has been used as a measure of brain growth. There are limited data relating head circumference to MRI. The purpose of this work was to establish the relationship between head circumference with brain MRI at term-equivalent age and to relate head circumference with neurodevelopmental outcome at 2 years. Two hundred and twenty-seven preterm infants (birth weight of <1250 g or <30 weeks' gestation) were recruited. Head circumference was measured at birth, term, and 2 years' corrected age, and z scores were computed. Microcephaly was defined as a head circumference z score of less than -2 SDs for age and gender. MRI scans at term (n = 214) were graded for white and gray matter abnormalities, and segmented volumes were calculated for different tissue types. Outcome at 2 years' corrected age (n = 202) included scores on the Bayley Scales of Infant Development II. Microcephaly increased from 7.5% at term to 29.7% at 2 years. There was no significant relationship between head circumference and white or gray matter abnormalities on MRI. There was a strong correlation between head circumference and brain volume at term. At term, microcephalic infants had significantly decreased volumes for total brain tissue and most segmented volumes compared with infants with normal head circumference, but only deep nuclear gray matter volume remained significantly lower when adjusted for total intracranial volume. At 2 years, microcephaly was associated with poorer cognitive and motor development and an increased rate of cerebral palsy. Brain volume is a determinant of head size at term. Microcephaly is associated with a reduction of brain tissue volumes, especially deep nuclear gray matter, which suggests a selective vulnerability. Poor postnatal head growth in preterm infants becomes more evident by 2 years and is strongly associated with poor neurodevelopmental outcome and cerebral palsy.

Improving head growth in very preterm infants – a randomised controlled trial I: neonatal outcomes

Background:Infants born very preterm are at an increased risk of poor growth in the post-natal period. Poor brain growth in this critical period may result from inadequate nutrition, and has...

Relation between Intrauterine Growth and Subsequent Intellectual Disability in a Ten-year Population Cohort of Children in Western Australia

The authors investigated the association between intrauterine growth and intellectual disability (ID). The appropriateness of intrauterine growth was assessed using percentage of optimal birth weight, a measure that accounts for gestational age, maternal height, parity, and infant sex. Using population-based record linkage, singleton Caucasian and Aboriginal children born in Western Australia in 1983-1992 and alive in 2002 with ID of unknown cause (n = 2,625) were compared with children without ID (n = 217,252). The odds of ID increased with less-than-optimal intrauterine growth. In Caucasian children, after adjustment for sociodemographic factors, severe growth restriction was associated with development of mild-moderate ID among preterm births (<37 weeks) (odds ratio (OR) = 1.71, 95% confidence interval (CI): 1.06, 2.77) and term births (> or =37 weeks) (OR = 2.42, 95% CI: 1.88, 3.12) and with severe ID (OR = 4.79, 95% CI: 2.59, 8.83) among term births. Effects were similar among Aboriginal children. Severe growth restriction (OR = 3.2, 95% CI: 1.3, 7.9) and poor head growth (OR = 3.6, 95% CI: 1.4, 9.0) were independently associated with severe ID. Infants with excess intrauterine growth were more likely to be diagnosed with ID associated with autism spectrum disorder (OR = 2.36, 95% CI: 0.93, 6.03). These findings suggest that inappropriate intrauterine growth, less than or greater than optimal birth weight, is associated with development of ID.

White matter lesions in term infants with neonatal encephalopathy: Correlation with later scans and neurodevelopmental outcome

Background: The commonest brain abnormality after perinatal hypoxic–ischaemia and neonatal encephalopathy (NE) is damage to the basal ganglia (BGT). However there are infants who escape this damage but have abnormally appearing white matter (WM). The long-term outcome of these children has not been well defined. Aim: To evaluate, in term infants with NE and abnormally appearing WM but normal BGT on neonatal MRI scan, the evolution of the scans in the first 1–2 years and the relation of the imaging findings to neurodevelopmental outcome at 2–4 years. Subjects/Methods: From a cohort of 270 term infants with perinatal asphyxia and NE (without evidence of systemic infection, a metabolic, or a congenital disorder), born at or referred to the Hammersmith Hospital, London (1991–2000) 46 infants had normally appearing BGT but abnormal WM on neonatal scans; 18 infants had normal scans. Follow-up scans were obtained in 57 infants. Griffiths developmental scales, standardized neurological examination and HC, evidence of cerebral palsy (CP), visual, hearing, language, feeding and behavioural problems) was obtained in all infants. Parental and ethical permission from the Hammersmith Hospital REC was obtained. Results: Median (range) of gestation was 40.1 weeks (36– 42 weeks), birth weight 3.26 kg (2.0–4.82 kg), head circumference (HC) 35.0 cm (31–39.1 cm), Apgar scores at 1/5 min was 2 (0–9)/6 (0–10), pH 6.97 (6.56–7.37). 38 infants (59%) were male; 26 had Sarnat stage I and 38 had stage II NE. WM abnormality on neonatal scans was mild in 20, moderate in 14, severe in 9 and severe with haemorrhage in 3; 18 infants had normal scans. Follow up scans were normal in 18, mildly abnormal in 18, moderate in 9, severe in 8 and severe with marked tissue loss in 4. Neonatal and later grading of scans remained the same 67%; improved in 12% and deteriorated in 21% by one grade. There was no difference in the perinatal data bar HIE staging between the infants in the different WM groupings at birth or follow-up. Mean (range) DQ at a median age of 3 years in children with normal WM was 109 (88–125), with mild WM 106 (85–124), moderate WM 88 (40–126), severe WM 71 (45–95) severe with haemorrhage 50 (40–60). In contrast, the neurological exam score was only low in the severe WM group. Six children had CP but only two were not independently ambulant. Followup scan abnormalities included a PVL-like appearance, reduced thalamic size and cortical abnormality. The more severe follow up scans were associated with CP, poor head growth, early feeding problems, language delay, squint and behavioural difficulties. Discussion: Follow-up scans of infants with NE show that neonatal WM abnormality may lead to significant long-term problems. Early and late scans correlate but the change in grading in 33% suggests that external factors may influence outcome. Outcome at 2–4 years can be significantly abnormal in those with moderate and severe scan abnormality. Despite few major motor problems these infants require prolonged follow up and considerable support [1]. Reference [1] Marlow N, et al. Arch Dis Child 2005;90:F380–7.

Accelerated postnatal head growth follows preterm birth

Background: Poor growth after preterm birth, particularly poor head growth, is associated with impaired neurodevelopmental outcome. Objective: To evaluate weight gain and head growth between birth and term in a...

Paediatric consequences of fetal growth restriction

The evidence for outcome following fetal growth restriction (FGR) has previously been inferred from studies, based on babies who were born small for gestational age (SGA). Great care is required when evaluating studies in this area due to a number of potential confounders. It does appear, however, that FGR is associated with an increased risk of poor neurological outcome. This includes an increased risk of cerebral palsy in babies greater than 32 weeks' gestation. Below 32 weeks, the effects of prematurity appear to negate the effects of FGR. FGR is also associated with cognitive deficit and behaviour problems. Babies with poor prenatal head growth appear to have a worse cognitive outcome. However, the role of ‘fetal brain sparing’ remains unclear, as impaired cognitive outcome is still evident in babies with appropriate head growth. Recent studies, which have identified FGR more accurately using fetal growth standards, have found an increased incidence of major intracranial injury and other adverse neonatal outcomes, which had previously been thought to occur less frequently in FGR babies. FGR is also associated with poor postnatal growth. The majority of children with FGR demonstrate catch-up growth in the first 2 years of life. Children who fail to demonstrate catch-up growth have a high risk of long-term growth problems. There is evidence of impaired growth hormone activity in some children with FGR who have persistent poor growth in the postnatal period.