Small heads and neurodevelopment

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It is well known by pediatricians that microcephaly in children is a major predictor of poor neurodevelopment. Microcephaly at term birth is a consistent indicator of a poor outcome. However, there is much less information available for preterm infants without chromosome anomalies or other developmental causes of microcephaly. In this issue of The Journal, Kuban et al evaluated 958 infants born before 28 weeks gestational age for microcephaly at birth. They then followed head growth and evaluated neurodevelopment at 2 years of age. The surprising outcome was that microcephaly at birth did not result in microcephaly at 2 years of age for most of the infants. The infants with microcephaly at birth but without microcephaly at 2 years had equivalent outcomes to the infants without microcephaly at 2 years. In contrast, and as anticipated, preterm infants who had microcephaly at 2 years of age had bad neurodevelopmental outcomes. Therefore, extremely preterm infants can “grow out” of microcephaly and do well.

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