Patterns of retarded fetal growth

The measurement of weight, length and head circumference at birth was used to document the size and shape of infants born at term in a population where mothers are relatively short and underweight. Different patterns of intrauterine growth are proposed to explain the variation in the infant's appearance at birth. Most of the small-for-gestational-age infants were proportionately stunted. This pattern of fetal growth is probably characteristic of infants born to undernourished mothers in economically developing communities, and reflects prolonged intrauterine growth retardation.     

Preterm delivery but not intrauterine growth retardation is associated with young maternal age among primiparae in rural Nepal

Pregnancy during adolescence is associated with adverse birth outcomes, including preterm delivery and low birthweight. The nutrient availability to the fetus may be limited if the mother is still growing. This research aims to study the effects of pregnancy during adolescence in a nutritionally poor environment in rural Nepal. This study utilized data from a randomized controlled trial of micronutrient supplementation during pregnancy in south-eastern Nepal. Women of parity 0 or 1 and of age 相似文献   

Impact of intrauterine growth restriction on neurodevelopmental and growth outcomes in very low birthweight infants

The impact of intrauterine growth restriction (IUGR) in very low birthweight preterm infants weighing ≤ 1250g was determined by comparing longitudinal growth and neurodevelopmental outcome to an adjusted age of 36 months in 52 intrauterine growth restricted children, with 55 birthweight-matched and 56 gestational age-matched children. None of these children had chromosomal anomalies, congenital infections, or major congenital malformations. Gestational ages of intrauterine growth restricted, birthweight- and gestational age-matched infants were 30 (± 3), 26 (± 2), 29 (± 2) weeks; birthweights were 842 (± 232), 872 (± 201) and 1094 (± 142) g, respectively. Intrauterine growth restricted children had fewer complications during initial hospitalization ( p < 0.05), and had lower weights and head circumferences at follow-up ( p > 0.05). No significant differences were present in major neurodevelopmental disabilities between the intrauterine growth restricted and two comparison groups. Persistence of microcephaly was associated with adverse neurodevelopmental outcome.     

Protein metabolism in preterm infants with particular reference to intrauterine growth restriction

There is growing evidence that neonatal and long-term morbidity in preterm infants, particularly those born before 32 weeks' gestation, can be modified by attained growth rate in the neonatal period. Guidelines for optimal growth and the nutritional intakes, particular of protein, required to achieve this are not well defined. Due to delays in postnatal feeding and a lack of energy stores developed in the last trimester of pregnancy, preterm infants often suffer early postnatal catabolism until feeding is established. There are indications that infants born with intrauterine growth restriction have perturbations in protein metabolism. Therefore, they may have different protein requirements than appropriate for gestational age infants. This review summarises what is known about protein requirements and metabolism in the fetus and preterm infant, with particular emphasis on the distinct requirements of the growth-restricted infant.     

Conventional birth weight standards obscure fetal growth restriction in preterm infants

BACKGROUND AND OBJECTIVE: It has been suggested that fetal growth restriction (FGR) is associated with fetal maturation so that, compared with appropriately grown preterm infants, mortality and some neonatal morbidities may be reduced. The evidence for this is conflicting, and severe FGR has been shown to be harmful. In addition excessive growth has also been shown to be associated with poorer outcomes. As preterm infants are often also growth restricted, centiles for birth weights are distorted and may conceal the degree of growth restriction in a given infant. This study investigated whether using estimated fetal weights (EFW) might reveal the effects of hidden FGR. POPULATION AND METHODS: Using a 25-year database of preterm admissions to a single neonatal unit the ORs for mortality and neonatal morbidities for z scores for birth weight above and below the mean were computed and compared with those computed for z scores for EFW. RESULTS: In 7898 infants born at less than 35 weeks' gestation, the OR for mortality was lowest for birth weights between 1 SD and 3 SD above the mean, but was lowest for EFW between -2 SD and 0 SD below the mean. For periventricular haemorrhage, increasing FGR below the mean reduced the OR with both birth weight and EFW. Apparent reductions in OR for septicaemia, chronic lung disease, persistent ductus arteriosus and necrotising enterocolitis with birth weights of >1 SD above the mean were not seen with EFW. FGR of >-3 SD was associated with increased OR for necrotising enterocolitis with both birth weight and EFW. CONCLUSION: Using fetal growth rather than birth weight standards gives a better indication of the incidence and role of FGR in neonatal disease.     

超低/极低出生体重儿生长发育迟缓发生率调查

目的 调查珠江三角洲地区超低/极低出生体重儿(extremely/very low birth weight infants,ELBWI/VLBWI)出生时宫内发育迟缓(intrauterine growth retardation,IUGR)和出院时宫外发育迟缓(extrauterine growth retardation,EUGR)的发生率,为其出院后进行生长发育监测和干预提供依据.方法 回顾性调查广东省珠江三角洲地区9个城市的9家医院新生儿科于2010年7月1日至2011年6月30日期间出院的ELBWI/VBWI的住院资料,分别以出生时、出院时的体重在相应宫内生长速率期望值的第10百分位水平以下(生长曲线的第10百分位)定义为IUGR、EUGR,分别计算各胎龄组、各体重组、单胎与多胎组的IUGR、EUGR发生率,并计算各组EUGR较IUGR增加的发生率.生长曲线参照“Fenton生长曲线2003一胎儿、婴儿生长曲线(供早产儿参考)(WHO生长标准版)”.结果 318例ELBWI/VLBWI出生时IUGR发生率为33.3％(106例),出院时EUGR发生率为70.8％(225例).以出生胎龄(＜30周、＜32周、≥32周)进行分组统计,EUGR发生率分别为55.7％ (68/122)、66.9％ (79/113)、94.0％ (79/83)(x2=34.964,P=0.000),较IUGR发生率分别增加49.2％ (60/122)、51.3％ (58/113)、1.2％ (1/83) (x2 =63.024,P=0.000);以出生体重(≤1200 g、≤1350 g、＞1350 g)进行分组统计,EUGR发生率分别为83.8％ (88/105)、65.3％ (66/101)、63.4％ (71/112) (x2=13.009,P=0.001),较IUGR发生率分别增加42.9％ (45/105)、35.6％ (36/101)、33.9％(38/112)(x2=2.045,P=0.360);以单胎和多胎进行分组比较,则IUGR、EUGR及EUGR较IUGR增加的发生率,组间差异均无统计学意义(P＞0.05).结论 ELBWI/VLBWI出院时EUGR发生率仍然很高,出院时EUGR发生率随出生胎龄的增加或出生体重的降低而升高,且出院时EUGR较出生时IUGR增加的发生率随出生胎龄的降低而升高,但EUGR发生率与胎数无明显相关性.     

Neonatal infections: I—Maternal and cord serum IgG levels in relation to gestation and intrauterine growth

Fifty low birth weight babies (both preterms and intrauterine growth retarded) and their mothers were the subjects of the study. Ten fullterm babies weighing more than 3.0 kg and their mothers served as controls. The cord serum IgG levels were significantly lower in preterm babies compared to fullterm appropriate for gestational age (FT-AGA) and fullterm intrauterine growth retarded (FT-IUGR) babies. The cord serum IgG levels were not significantly different between FT-AGA and FT-IUGR babies. The maternal serum IgG levels were significantly higher than the cord serum IgG levels in preterm group whereas in fullterm AGA and IUGR groups cord serum IgG levels were significantly higher then the maternal serum IgG levels. There was no correlation between maternal and cord serum IgG levels. The cord serum IgG levels were significantly correlated with gestation even after controlling birth weight. The correlation between cord serum IgG levels and birth weight disappeared once qestation was controlled.     

Pre-eclampsia—An additional risk factor for cognitive impairment at school age after intrauterine growth restriction and very preterm birth

Objective

To explore the possible influence of pre-eclampsia on cognitive outcome in children born very preterm after intrauterine growth restriction (IUGR) and abnormal umbilical artery blood flow.

Methods

Cognitive function was evaluated at 5–8 years of age with Wechsler scales in 34 children born before 30 gestational weeks after IUGR (PT-IUGR) (11 children were exposed to maternal pre-eclampsia, 23 non-exposed) and in 34 children with no maternal pre-eclampsia and birth weight appropriate-for-gestational age (PT-AGA) matched for gestational age at birth, gender and age at examination.

Results

The subjects in the PT-IUGR group exposed to maternal pre-eclampsia had lower mean verbal IQ (VIQ) (mean ± SD 74 ± 16) and lower full scale IQ (FSIQ) (70 ± 19) in comparison with both the non-exposed PT-IUGR (VIQ 89 ± 15; p = 0.013; FSIQ 83 ± 14, p = 0.029), and, the PT-AGA group (VIQ 96 ± 15, p < 0.001; FSIQ 90 ± 14, p = 0.001). The differences remained significant after adjustment for known confounders. VIQ and FSIQ did not differ between the non-exposed IUGR and PT-AGA children.

Conclusion

Fetal exposure to maternal pre-eclampsia seems to have an additional negative impact to that of IUGR on cognitive function in children born very preterm.     

The relation of arterial stiffness with intrauterine growth retardation

Background: Much epidemiological evidence has linked low birthweight with late cardiovascular risk. Intrauterine growth retardation (IUGR) is associated with the increased risk of cardiovascular disease in adult life; it is unclear whether the relationship is present at younger ages. We evaluated whether abdominal aortic stiffness was altered in patients with IUGR (born at term with birthweight small for gestational age) in younger ages. Methods: Thirty‐two (24 girls and eight boys) IUGR children aged 8.77 ± 2.05 years were enrolled in the study. The birthweight was traced from the medical records. Their gestational ages were 38.9 ± 0.85 weeks and birthweights 2130 ± 198 g, respectively. Thirty‐one healthy subjects who had normal gestational age and birthweight, matched for age and sex were recruited as a control group. Aortic strain, pressure strain elastic modulus (Ep), and normalized Ep and aortic distensibility were measured by a sphygmomanometer and transthoracic echocardiography in all subjects from the abdominal aorta. Results: There was no statistically significant difference between the study and the control groups in sex, mean age, body mass index, lipid profile, leptin, insulin‐like growth factor‐1 or insulin‐like growth factor binding protein 3. In IUGR children, aortic strain (0.201 ± 0.027 vs 0.254 ± 0.031, P < 0.001) and aortic distensibility (1.08 ± 0.19 vs 1.42 ± 0.24, P < 0.001) were significantly lower compared with the control group. However Ep (188 ± 36.2 vs 146 ± 27.1, P < 0.001) and normalized Ep (2.97 ± 0.40 vs 2.1 ± 0.39, P < 0.001) were significantly higher in IUGR patients. Conclusions: This study demonstrates that abdominal aortic stiffness is increased in IUGR patients. These data suggest that prenatal events could be related to cardiovascular risk in later life.     

Risk factors for preterm and small-for-gestational-age babies: a cohort from the Pacific Islands Families Study

AIM: To explore risk factors that are associated with preterm birth and full-term small-for-gestational-age (SGA) birth for a Pacific population. METHODS: Data were gathered from the Pacific Islands Families Study. Mothers of a cohort of 1398 Pacific infants born in South Auckland, New Zealand during 2000 were interviewed when their infants were 6 weeks old. Mothers were questioned regarding maternal health, antenatal care and life-style behaviours. Data regarding birth outcomes were obtained from hospital records. Analyses focused on 1324 biological mothers who gave birth to a singleton and had valid data for birth outcomes. RESULTS: Of 1324 singleton infants, the mean birthweight was 3.60 kg with standard deviation of 0.60 kg. Fifty-two (3.9%) had birthweight less than 2500 g. Ninety-four (7.1%) were born at less than 37 weeks of gestation. Most socio-demographic factors were not associated with poor birth outcomes. Primiparous birth, less frequent attendance of antenatal care and mother's history of high blood pressure were associated with preterm birth and SGA. Smoking during pregnancy increased the odds of having an SGA but not preterm birth. On the other hand, unplanned/unsure pregnancy and prior early pregnancy loss were associated with preterm birth but not SGA. CONCLUSION: Corroborating research conducted with other populations, most of the internationally and nationally recognised risk factors for preterm birth and SGA are also important for Pacific people. Smoking seems to explain more poor birth outcomes in Pacific Islands than in the New Zealand population as a whole.     

Psychological development in children born with very low birth weight after severe intrauterine growth retardation: a 10-year follow-up study

Children born small for gestational age (SGA) and children having very low birth weight, less than 1500 g, are claimed to be at risk of developmental problems, even when obvious pathology and disability are absent. In this study, sensorimotor and cognitive development of 14 medically healthy, very-low-birth-weight and small-for-gestational-age children were investigated. The children were born at the Karolinska Hospital between 1979 and 1981. At the time of the assessment, the children were aged 8.7-11.2 years. The assessment instruments included the Wechsler Intelligence Scale for Children, a modified version of the Bruininks-Oseretsky Test of Motor Proficiency, as well as selected subtests from the Halstead-Reitan Neuropsychological Battery and from the Southern California Tests of Sensory Integration. Information was also obtained from obstetric, neonatal and pediatric records, which included early developmental assessments. As a control group, 14 children were recruited and matched for age, sex and socio-economic background. The very-low-birth-weight-small-for-gestational-age group scored significantly lower on measures of visuospatial ability, non-verbal reasoning, strategy formation and gross-motor coordination. The group differences were largely attributable to the subnormal performance of eight of the very-low-birth-weight-small-for-gestational-age children. These children, who also tended to be born earliest (less than 33 weeks), had a high incidence of behavioral and educational problems. These findings are consistent with the view that the very preterm infant develops a different neurobehavioral organization than a full-term infant. Developmental deficits may become increasingly evident in the early school years.     

早产儿宫外生长迟缓发生情况及危险因素

目的探讨新生儿重症监护室(NICU)早产低出生体重儿宫外生长迟缓(EUGR)发生情况及危险因素。方法对本院NICU2006年1月至12月早产低出生体重儿EUGR发生情况及相关因素进行回顾性分析。结果EUGR发生率39.22%。EUGR组胎龄(33.73±1.89)周与非EUGR组(33.54±2.04)周比较,差异无统计学意义(t=6.59,P(0.05),但EUGR组出生体重(1648.58±304.22)g较非EUGR组(2017.63±325.53)g(t=-5.12)低,胎儿生长迟缓(FGR)、宫内缺氧、产前或产间感染及生后并发症发生率、呼吸机治疗率EUGR组分别为68.3%、41.7%、41.7%、68.3%、13.3%较非EUGR组分别为7.5%、24.7%、25.8%、31.2%、3.2%高,肠外营养(PN)及外源性肺表面活性物质(PS)应用率EUGR组分别为11.7%、5.0%较非EUGR组分别为24.7%、16.1%低,两组比较,差异均有统计学意义(P(0.05)。出生体重低(OR=1.003,P<0.05),FGR(OR=20.723,P<0.05),生后出现并发症(OR=7.580,P<0.05)及未应用PN(OR=0.024,P<0.05)是EUGR发生的危险因素。结论EUGR发生与多因素有关,预防产前及生后各危险因素,及时合理治疗是避免EUGR的关键。     

早产儿宫外生长迟缓发生情况及危险因素

目的 探讨新生儿重症监护室(NICU)早产低出生体重儿宫外生长迟缓(EUGR)发生情况及危险因素.方法 对本院NICU 2006年1月至12月早产低出生体重儿EUGR发生情况及相关因素进行回顾性分析.结果 EUGR发生率39.22%.EUGR组胎龄(33.73±1.89)周与非EUGR组(33.54±2.04)周比较,差异无统计学意义(t=6.59,P＞0.05),但EUGR组出生体重(1648.58±304.22)g较非EUGR组(2017.63±325.53)g(t=-5.12)低,胎儿生长迟缓(FGR)、宫内缺氧、产前或产间感染及生后并发症发生率、呼吸机治疗率EUGR组分别为68.3%、41.7%、41.7%、68.3%、13.3%较非EUGR组分别为7.5%、24.7%、25.8%、31.2%、3.2%高,肠外营养(PN)及外源性肺表面活性物质(PS)应用率EUGR组分别为11.7%、5.0%较非EUGR组分别为24.7%、16.1%低,两组比较,差异均有统计学意义(P＜0.05).出生体重低(OR=1.003,P＜0.05),FGR(OR=20.723,P＜0.05),生后出现并发症(OR=7.580,P＜0.05)及未应用PN(OR=0.024,P＜0.05)是EUGR发生的危险因素.结论 EUGR发生与多因素有关,预防产前及生后各危险因素,及时合理治疗是避免EUGR的关键.     

Hepatitis B immunization in low birthweight infants: do they need an additional dose?

AIM: To determine the influence of gestation and weight on the development of protective anti-HB levels and geometric mean titres after three doses of HBV vaccine and to ascertain the need for a fourth dose in low birthweight infants. METHODS: Hepatitis B vaccine (Enivac HB, Panacea Biotec Ltd., India) was given to 82 preterm (PT) and 60 term intrauterine growth-retarded (T-IUGR) infants at birth and at 6, 10 and 14wk of life. RESULTS: Protective anti-HB levels (>10 mIU/ml) were reached in 86.6% (71/82) of PT infants and 96.7% (58/60) of T-IUGR infants after three doses of HBV vaccine (p = 0.044). The odds of having a protective response after the third dose of HBV vaccine was 1.25 (95% CI 1.02-1.53) with every one-week increase in gestation (p = 0.032). Birthweight was not associated with the development of a protective immune response. After the third dose, only 66.7% (8/12) of the PT infants whose mothers had anti-HB antibodies, developed protective anti-HB levels compared with 90% (63/70) of those with no maternal antibodies (p = 0.028). In PT infants after the fourth dose, there was a significant increase in the proportion of infants with protective antibody levels (8.6%, 95% CI 0.6-16.6%) among those with no maternal antibodies and 12.2% overall (95% CI 6.0-21.3) (p = 0.031 to 0.002) over that reached with the third dose. Administration of the fourth dose to T-IUGR infants did not confer such a benefit. CONCLUSION: In HBV-endemic areas, PT infants, irrespective of their birthweights, may benefit from an additional dose of hepatitis B vaccine in a schedule starting at birth. This approach will prevent vertical transmission and bring their immune response up to par with term infants. Term intrauterine growth-retarded infants should be vaccinated as per the schedule recommended for normal term infants. However, studies in other settings with different vaccine formulations and a longer follow-up period will be required before this strategy can be practised more widely.     

Effects of recombinant human growth hormone treatment in intrauterine growth-retarded preterm newborn infants on growth, body composition and energy expenditure

The effects of recombinant human growth hormone treatment during the early postnatal period on growth, body composition and energy expenditure were studied in seven intrauterine growth-retarded newborns. Seven infants were studied as controls. No differences were seen in bodyweight or height gain (15.9 ± 1.5g/kg per day and 1.02 ± 0.24cm/week in the treated and 16.3 ± 1.4g/kg per day and 1.11 ± 0.30 cm/week in the control group). Skinfold growth rate was 0.52 ± 0.20 mm/week in the treated vs. 0.56 ± 0.28 mm/week in the control group. Total body water (as a percentage of body-weight, 80 ± 3.0% vs. 80 ± 4.0%) and energy expenditure (67.5 ± 7.4 vs. 66.7 ± 6.4kcal/kg per day) using ²H₂¹⁸O showed identical results in both groups. We conclude that recombinant human growth hormone treatment directly after birth in intrauterine growth-retarded newborn infants results neither in an increase in growth rate nor a change in body composition or energy expenditure during the early postnatal period.     

Neonatal water metabolism: an objective postnatal index of intrauterine fetal growth

The water metabolism of 103 newborn babies was determined over the first 10 postnatal days, by measuring water turnover rates by means of an isotope dilution technique. This technique involves the oral administration of the non-radioactive isotope of water, 2H2O, and the measurement of its urinary excretion by infrared spectrophotometry. The slope of the excretion curve after equilibration with the infant's body water was mathematically expressed as the rate constant. Using multiple obstetric and paediatric criteria, the babies were clinically classified into one of three categories, fully grown ("normal'), borderline or clearly growth retarded. The median values of the rate constants X 10(4) (h-1) for the three groups were 73.3, 85.9 and 100.2 and were highly significantly different from each other (P less than 0.0005) with no overlap of the 97% non-parametric confidence limits of each group. Neonatal water turnover increased with the clinical degree of intrauterine fetal growth retardation and within the limits of this study, this finding was unaffected by gestational age, birth weight or the neonatal environment. The results suggest that neonatal water metabolism is an objective postnatal index of fetal growth retardation.