Fetal growth restriction: Prenatal predictors of neonatal and late functional outcome

The studies reported in this thesis provide insight into the course of fetal growth restriction (FGR) from the prenatal period until school age. In part I we report on fetal cardiac function and found that left, right, and septal longitudinal annular displacement is reduced in FGR compared to age-matched controls when measured with an offline four-dimensional method named spatiotemporal image correlation (STIC). We recommend implementing STIC in clinical practice for obstetricians managing FGR. The results presented in part II demonstrate that prenatal brain sparing persists until three days after birth, and that it is associated with abnormal neurological performance one week after birth. Therefore, brain sparing may not be as protective as previously thought, but that shortly after birth it contributes to an altered neonatal circulation and neurological manifestation. At school age, however, differences in functional outcome between FGR children and controls became small (Part III). Based on the findings presented in this thesis, we advocate that medical caregivers should be aware of the consequences of fetal brain sparing, in both fetuses and infants subjected to FGR. Adequate postnatal care from parents and attention by educators may contribute towards further reducing the small differences we observed in functional outcome between SGA children and controls at school age.