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Increased Morbidity in Severe Early Intrauterine Growth Restriction

Journal of Perinatology volume 24, pages 435–440 (2004)Cite this article

Abstract

OBJECTIVE: To determine the relative frequencies of complications in severe early intrauterine growth-restricted (IUGR) infants.

METHODS: All infants 32 weeks gestation or less with birth weight less than the fifth percentile admitted from January 1991 to December 1998 were identified retrospectively. Two infants were identified for each IUGR case: the subsequent admission with birth weight ±100 g of the case, and the subsequent admission with the same gestational age. Infants with multiple congenital anomalies, congenital infections or admission after 48 hours of age were excluded. Maternal and neonatal demographic data, neonatal morbidity and mortality until discharge were gathered by chart review.

RESULTS: A total of 39 IUGR identified infants met criteria, with 41 gestational age infants and 33 birth weight infants. Mean birth weights and gestational ages for the IUGR group, gestational age group, and birth weight group were 744 g and 29.6 weeks, 1370 g and 29.7 weeks, and 781 g and 25.5 weeks respectively. Mortality was higher for IUGR infants than gestational age infants (20.5 vs 0%), but less than the birth weight infants (30%). In surviving infants, total ventilator days, total oxygen days, days to full feeds, and patent ductus arteriosis, were higher for IUGR infants than gestational age infants, but less than birth weight infants. Hypoglycemia, direct hyperbilirubinemia, necrotizing enterocolitis (NEC), thrombo-cytopenia, chronic lung disease and feeding difficulties occurred more frequently in IUGR infants than in both other groups. Length of stay for survivors and incidence of retinopathy of prematurity (ROP) was similar for the IUGR and birth weight infants.

CONCLUSIONS: Infants born prematurely who are also severely IUGR have higher neonatal morbidity and mortality when compared to infants of similar gestational age. The surviving IUGR infants had less intraventricular hemorrhage and periventricular leukomalacia than less mature infants of comparable birth weight, but a similar incidence of ROP and length of stay. They had a higher incidence of NEC, direct hyperbilirubinemia and chronic lung disease, probably due to end-organ damage in utero from chronic placental insufficiency. These findings highlight the unique pattern of mortality and morbidity seen in infants with severe early IUGR.

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References

  1. Lapillone A, Peretti N, Ho PS, Claris O, Salle BL . Aetiology, morphology and body composition of infants born small for gestational age. Acta Paediatr Suppl 1997;423:173–176.

    Article  Google Scholar 

  2. Dincsoy MY, Kim YM, Siddiq F, Garcia MG, Williams H . Intracranial hemorrhage in small-for gestational-age neonates: comparison with weight-matched appropriate-for-gestational-age infants. Clin Pediatr 1988;27:21–26.

    Article  CAS  Google Scholar 

  3. Amin H, Singhal N, Sauve RS . Impact of intrauterine growth restriction on neurodevelopmental and growth outcomes in very low birth weight infants. Acta Paediatr 1997;86:306–314.

    Article  CAS  Google Scholar 

  4. Tyson JE, Kennedy K, Broyles S, Rosenfeld CR . The small for gestational age infant: accelerated or delayed pulmonary maturation? Increased or decreased survival? Pediatrics 1995;95:534–538.

    CAS  PubMed  Google Scholar 

  5. Palo P, Erkkola R . Risk factors and deliveries associated with preterm, severely small for gestational age fetuses. Am J Perinatal 1993;10:88–91.

    Article  CAS  Google Scholar 

  6. Ley D, Wide-Swensson D, Lindroth M, Svenningsen N, Marsal K . Respiratory distress syndrome in infants with impaired intrauterine growth. Acta Pediatr 1997;86:1090–1096.

    Article  CAS  Google Scholar 

  7. Gortner L, Wauer RR, Stock GJ . et al. Neonatal outcome in small for gestational age infants: do they really better? J Perinatal Med 1999;27:484–489.

    Article  CAS  Google Scholar 

  8. Ruys-Dudok van Heel I, de Leeuw R . Clinical outcome of small for gestational age preterm infants. J Perinatal Med 1989;17:77–83.

    Article  CAS  Google Scholar 

  9. Bernstein IM, Horbar JD, Badger GJ, Ohlsson A, Golan A . Morbidity and mortality among very-low-birth-weight neonates with intrauterine growth restriction. Am J Obstet Gynecol 2000;182:198–206.

    Article  CAS  Google Scholar 

  10. Chen SJ, Vohr BR, Oh W . Effects of birth order, gender and intrauterine growth retardation on the outcome of very low birth weight in twins. J Pediatr 1993;123:132–136.

    Article  CAS  Google Scholar 

  11. Bardin C, Zelkowitz P, Papageorgiou A . Outcome of small-for-gestational age and appropriate-for-gestational age infants born before 27 weeks of gestation. Pediatrics 1997;100:e4.

    Article  CAS  Google Scholar 

  12. Malcolm G, Ellwood D, Devonald K, Beilby R, Henderson-Smart D . Absent or reversed end diastolic flow velocity in the umbilical artery and necrotising enterocolitis. Arch Dis Child 1991;66:805–807.

    Article  CAS  Google Scholar 

  13. Newell SJ . Enteral feeding of the micropremie. Clin Perinatol 2000;27:221–234.

    Article  CAS  Google Scholar 

  14. Robel-Tillig E, Vogtmann C, Faber R . Postnatal intestinal disturbances in small-for-gestational-age premature infants after prenatal haemodynamic disturbances. Acta Pediatr 2000;89:324–330.

    Article  CAS  Google Scholar 

  15. Ewer AK, McHugo JM, Chapman S, Newell SJ . Fetal echogenic gut: a marker of intrauterine gut ischaemia? Arch Dis Child 1993;69:510–513.

    Article  CAS  Google Scholar 

  16. Alexander GR, Himes JH, Kaufman RB, Mor J, Kogan M . A United States national reference for fetal growth. Obstet Gynecol 1996;87:163–168.

    Article  CAS  Google Scholar 

  17. Stringer MD, Thornton JG, Mason GC . Hyperechogenic fetal bowel. Arch Dis Child Fetal Neonatal Ed 1996;74:F1–2.

    Article  CAS  Google Scholar 

  18. Shanklin DR, Cooke RJ . Effects of intrauterine growth on intestinal length in the human fetus. Biol Neonate 1993;64:76–81.

    Article  CAS  Google Scholar 

  19. Xu RJ, Mellor DJ, Birtles MJ, Reynolds GW, Simpson HV . Impact of intrauterine growth retardation on the gastrointestinal tract and the pancreas in newborn pigs. J Pediatr Gastroenterol Nutr 1994;18:231–240.

    Article  CAS  Google Scholar 

  20. Flecknell PA, Wootton R, John M, Royston JP . Pathologic features of intra-uterine growth retardation in the piglet: differential effects on organ weights. Diagn Histopathol 1981;4:295–298.

    CAS  PubMed  Google Scholar 

  21. Tanaka M, Natori M, Ishimoto H, Miyazaki T, Kobayashi T, Nozawa S . Experimental growth retardation produced by transient period of uteroplacental ischemia in pregnant Sprague–Dawley rats. Am J Obstet Gynecol 1994;171:1231–1234.

    Article  CAS  Google Scholar 

  22. Ernst LM, Salafia CM, Carter AM, Pezzullo JC . Hepatic histology in intrauterine growth retardation following uterine artery ligation in the guinea pig. Pediatr Pathol 1993;13:763–772.

    Article  CAS  Google Scholar 

  23. Detmer A, Carter AM, Thomas CR . The metabolism of free fatty acids and tricylglycerols by the fetal liver in a guinea pig model of intrauterine growth retardation. Pediatr Res 1992;32:441–446.

    Article  CAS  Google Scholar 

  24. Boehm G, Muller DM, Teichmann B, Krumbiegel P . Influence of intrauterine growth retardation on parameters of liver function in low birth weight infants. Eur J Pediatr 1990;149:396–398.

    Article  CAS  Google Scholar 

  25. Boehm G, Teichmann B, Krumbiegel P . Hepatic biotransformation capacity in low-birth-weight infants as measured with the [15N]methacetin urine test: influences of gestational age, postnatal age, and intrauterine growth retardation. Biol Neonate 1995;68:19–25.

    Article  CAS  Google Scholar 

  26. Boehm G, Senger H, Braun W, Beyreiss K, Raiha NC . Metabolic differences between AGA- and SGA-infants of low birth weight. I. Relationship to intrauterine growth retardation. Acta Paediatr Scand 1988;77:19–23.

    Article  CAS  Google Scholar 

  27. Lane RH, Flozak AS, Ogata ES, Bell GI, Simmons RA . Altered hepatic gene expression of enzymes involved in energy metabolism in the growth-retarded fetal rat. Pediatr Res 1996;39:390–394.

    Article  CAS  Google Scholar 

  28. Bisquera JA, Cooper TR, Berseth CL . Impact of necrotizing enterocolitis on length of stay and hospital charges in very low birth weight infants. Pediatrics 2002;109:423–428.

    Article  Google Scholar 

  29. Akre O, Lipworth L, Cnattingius S, Sparen P, Ekbom A . Risk factor patterns for cryptorchidism and hypospadius. Epidemiology 1999;10:364–369.

    Article  CAS  Google Scholar 

  30. Weidner IS, Moller H, Jensen TK, Skakkebach NE . Risk factors for cryptorchidism and hypospadius. J Urol 1999;161:1606–1609.

    Article  CAS  Google Scholar 

  31. Fredell L, Lichtenstein P, Pedersen NL, Svensson J, Nordenskjold A . Hypospadius is related to birth weight in discordant monozygotic twins. J Urol 1998;160:2197–2199.

    Article  CAS  Google Scholar 

  32. Hussain N, Chaghti A, Herndon A . et al. Hypospadius and early gestation growth restriction in infants. Pediatrics 2002;109:473–478.

    Article  Google Scholar 

  33. Barker DJ . Intrauterine programming of coronary heart disease and strokes. Acta Paediatr Suppl 1997;143:178–182.

    Article  Google Scholar 

  34. Leeson CPM, Kattenhorn M, Morely R, Lucas A, Deanfield JE . Impact of low birth weight and cardiovascular risk factors on endothelial function in early adult life. Circulation 2001;103:1264–1268.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatrics, Johns Hopkins University, Baltimore, MD, USA

    Susan W Aucott MD, Pamela K Donohue ScD & Frances J Northington MD

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Aucott, S., Donohue, P. & Northington, F. Increased Morbidity in Severe Early Intrauterine Growth Restriction. J Perinatol 24, 435–440 (2004). https://doi.org/10.1038/sj.jp.7211116

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