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28: Effects on (neuro)developmental and behavioral outcome at 2 years of age of induced labor compared with expectant management in intra-uterine growth restricted infants–long term outcomes of the DIGITAT-trial
To study, in pregnancies complicated by intra-uterine growth restriction (IUGR) at term, the effect of being randomized to induction of labor on long-term developmental- and behavioral- outcomes, and to study the effect of neonatal condition at birth on these developmental outcomes.
We studied children included in a nationwide randomized controlled-trial comparing induction of labor with expectant management in pregnancies with IUGR at term. Parents of children included in the trial were asked to fill out two postal questionnaires at the age of 2-years: the Ages and Stages (ASQ) and Child Behaviour Checklist (CBCL). The ASQ is designed to detect developmental delay and the CBCL is a standardized parental report of children's behavior. We compared the number of children with an abnormal outcome in both arms, as well as the effect of perinatal morbidity, morbidity assessment index for newborns (MAIN score), gestational age at birth and birth weight on long-term outcome. Perinatal morbidity was defined as a 5 minute Apgar score <7, umbilical arterial pH <7.05 or NICU admission. The MAIN score is a validated numeric index of early neonatal outcomes.
We approached 488 (75%) of the 660 parents of children randomized in the trial. The response rate was 60%. 27% and 14% of the children had an abnormal score on the ASQ and CBCL, respectively (Table 1). Results of the questionnaires were comparable for both interventions. However, poor neonatal condition after birth and the MAIN score both strongly increased the chance of an abnormal ASQ score (Odds Ratios of 18 (95% CI 1.5-212, p=0.02) and 1.005 (95% CI 1.002; 1.005, p=0.01), respectively). We found no association between birth weight or gestational age at birth and the outcome of the ASQ or CBCL.
In women with IUGR at term, a policy of induction of labor does not affect developmental and behavioral outcome when compared to expectant management. However, in both policies adverse neonatal outcome and MAIN score (corrected for other possible variables) both have negative effects on the outcome on the long-term child development.