Hyaline membrane disease and intraventricular haemorrhage in small for gestational age infants

19 small for gestational age (SGA) infants with gestational ages less than or equal to 32 weeks were matched with 19 appropriate for gestational age (AGA) preterm neonates with similar risk factors for intraventricular haemorrhage and hyaline membrane disease. Gestational age, 1- and 5-minute Apgar scores, type of delivery, survival rate, use of corticosteroids before delivery, sex, twinning, presence of premature rupture of membranes, and birth date were comparable in the two groups. Gestational age of both groups was 30 (+/- 1.8) weeks, and birthweights were 919 (+/- 202) g (SGA group) and 1268 (+/- 212) g (AGA group). The incidences of hyaline membrane disease and intraventricular haemorrhage were different: 74 and 42% respectively for AGA neonates, 5 and 11% respectively for SGA infants. We suggest that a stressful environment in utero may enhance maturation and prevent hyaline membrane disease and intraventricular haemorrhage.     

Hyaline membrane disease,alkali, and intraventricular haemorrhage.

The relation between intraventricular haemorrhage (IVH) and hyaline membrane disease (HMD) was studied in singletons that came to necropsy at Hammersmith Hospital over the years 1966-73. The incidence of IVH in singleton live births was 3-22/1000 and of HMD 4-44/1000. Although the high figures were partily due to the large number of low birthweight infants born at this hospital, the incidence of IVH in babies weighing 1001-1500 g was three times as great as that reported in the 1658 British Perinatal Mortality Survey. Most IVH deaths were in babies with HMD, but the higher frequency of IVH was not associated with any prolongation of survival time of babies who died with HMD as compared with the 1958 survey. IVH was seen frequently at gestations of up to 36 weeks in babies with HMD but was rare above 30 weeks'' gestation in babies without HMD. This indicated that factors associated with HMD must cause most cases of IVH seen at gestations above 30 weeks. Comparison of clinical details in infants with HMD who died with or without IVH (at gestations of 30-37 weeks) showed no significant differences between the groups other than a high incidence of fits and greater use of alkali therapy in the babies with IVH. During the 12 hours when most alkali therapy was given, babies dying with IVD received a mean total alkali dosage of 10-21 mmol/kg and those dying without IVH 6-34 mmol/kg (P less than 0-001).There was no difference in severity of hypoxia or of metabolic acidosis between the 2 groups. Babies who died with HMD and germinal layer haemorrhage (GLH) without IVH had received significantly more alkali than those who died with HMD alone, whereas survivors of severe respiratory distress syndrome had received lower alkali doses than other groups. It is suggested that the greatly increased death rate from IVH in babies with HMD indicates some alteration of management of HMD (since 1958) as a causative factor. Liberal use of hypertonic alkali solutions is the common factor which distinguishes babies dying with GLH and IVH from other groups of babies with HMD. Although the causal nature of this association remains unproved, it seems justifiable to lrge caution in alkali usage.     

Hyaline membrane disease, alkali, and intraventricular haemorrhage

The relation between intraventricular haemorrhage (IVH) and hyaline membrane disease (HMD) was studied in singletons that came to necropsy at Hammersmith Hospital over the years 1966-73. The incidence of IVH in singleton live births was 3-22/1000 and of HMD 4-44/1000. Although the high figures were partily due to the large number of low birthweight infants born at this hospital, the incidence of IVH in babies weighing 1001-1500 g was three times as great as that reported in the 1658 British Perinatal Mortality Survey. Most IVH deaths were in babies with HMD, but the higher frequency of IVH was not associated with any prolongation of survival time of babies who died with HMD as compared with the 1958 survey. IVH was seen frequently at gestations of up to 36 weeks in babies with HMD but was rare above 30 weeks' gestation in babies without HMD. This indicated that factors associated with HMD must cause most cases of IVH seen at gestations above 30 weeks. Comparison of clinical details in infants with HMD who died with or without IVH (at gestations of 30-37 weeks) showed no significant differences between the groups other than a high incidence of fits and greater use of alkali therapy in the babies with IVH. During the 12 hours when most alkali therapy was given, babies dying with IVD received a mean total alkali dosage of 10-21 mmol/kg and those dying without IVH 6-34 mmol/kg (P less than 0-001). There was no difference in severity of hypoxia or of metabolic acidosis between the 2 groups. Babies who died with HMD and germinal layer haemorrhage (GLH) without IVH had received significantly more alkali than those who died with HMD alone, whereas survivors of severe respiratory distress syndrome had received lower alkali doses than other groups. It is suggested that the greatly increased death rate from IVH in babies with HMD indicates some alteration of management of HMD (since 1958) as a causative factor. Liberal use of hypertonic alkali solutions is the common factor which distinguishes babies dying with GLH and IVH from other groups of babies with HMD. Although the causal nature of this association remains unproved, it seems justifiable to lrge caution in alkali usage.     

Glucagon for hypoglycaemia in infants small for gestational age.

Twenty five infants who were small for gestational age received glucagon (0.5 mg/day by continuous infusion) in the treatment of hypoglycaemia. Twenty responded within three hours with a rise in blood glucose concentration to above 4 mmol/l. Five subjects subsequently required hydrocortisone to maintain glucose concentrations. Rebound hypoglycaemia occurred in nine infants after rapid discontinuation of glucagon or interruption of the intravenous infusions. Response was poor after maternal beta blockade.     

Lean body mass in small for gestational age and appropriate for gestational age infants

Dual photon absorptiometry using 153Gd in a whole-body scanner was used to measure lean body mass (LBM) in 51 newborn infants. LBM% decreased exponentially with increasing gestational age in both small for gestational age (SGA) and appropriate for gestational age (AGA) infants. In preterm SGA and AGA infants LBM was 104% and 103%, respectively, indicating that no fat was detectable. In term SGA infants LBM was 98%, which corresponded to 48 gm fat on average, and in term AGA infants LBM was 87%, which corresponded to 452 gm fat on average. The LBM%, ponderal index, and skinfold thickness were significantly different between AGA and SGA infants. Infants with clinical signs of intrauterine wastage had significantly higher LBM% than did infants without signs of weight loss. Our results on LBM% by dual photon absorptiometry agree with earlier dissection data; the clinically applicable methods of (1) height combined with weight (i.e., ponderal index), (2) skinfold thickness, and (3) scoring by clinical observations are useful for the estimation of lack of fat as an indicator of intrauterine growth retardation.     

Total energy expenditure in small for gestational age infants.

OBJECTIVE: To measure total energy expenditure and body composition in small for gestational age (SGA) infants, to investigate hypermetabolism. METHODS: A cross-sectional study was performed in 52 small for gestational age (SGA) measured at 5 weeks of age, using existing data from appropriate for gestational age (AGA) infants as controls. The doubly-labelled water technique was used to assess both total energy expenditure and body composition in both cohorts of infants. RESULTS: Multiple regression analysis revealed that expressing energy expenditure per kg fat free mass adjusts for body composition in infants of this age. Regression analysis also showed that the relation between total energy expenditure and fat free mass differed between the two groups. CONCLUSION: These data indicate that for a given fat free mass, the total energy expenditure of SGA infants is greater than that of AGA infants. Such data should be taken into account when energy requirements for SGA infants are being considered.     

Total energy expenditure in small for gestational age infants.

AIM: To measure total energy expenditure and body composition in small for gestational age (SGA) infants in order to investigate proposed hypermetabolism in such babies. METHODS: A cross sectional study of 52 SGA infants measured at 5 weeks of age was made, using existing data from appropriate for gestational age (AGA) infants as controls. The double labelled water technique was used to assess both total energy expenditure and body composition. RESULTS: Multiple regression analysis showed that expressing energy expenditure per kg fat free mass adjusts for body composition in infants of this age. The relation between total energy expenditure and fat free mass differed between the two groups. CONCLUSION: These data indicate that for a given fat free mass the total energy expenditure of SGA infants is greater than that of AGA infants. Such data should be taken into account when energy requirements for SGA infants are being considered.     

Transepidermal water loss in newborn infants. VIII. Relation to gestational age and post-natal age in appropriate and small for gestational age infants

In 68 appropriate for gestational age (AGA) and 33 small for gestational age (SGA) infants, transepidermal water loss was studied during the first four weeks after birth. The method used to measure evaporation rate is based on measurement of the water vapour pressure gradient close to the skin surface. All measurements were made at an ambient humidity of 50% and with the infants calm and quiet. At all the investigated post-natal ages in both AGA and SGA infants, an exponential relationship was found between transepidermal water loss (g/m2 h) and gestational age, this loss being much higher in the pre-term infants than in those born at term. The transepidermal water loss was generally lower in SGA than in AGA infants during the first week of post-natal life, irrespective of gestational age at birth. There was a gradual decrease in transepidermal water loss with increasing post-natal age in both pre-term AGA and pre-term SGA infants. Three weeks after birth this water loss tended to be higher in pre-term SGA infants than in pre-term AGA infants of corresponding gestational age.     

Plasma leptin levels of large for gestational age and small for gestational age infants

The hormone leptin produced in the adipose tissue is involved in the regulation of body weight. This study investigates whether plasma leptin levels are related to an infant's birthweight, and whether the levels change with feeding. We measured plasma leptin levels from infants who were large for gestational age (n = 21), small for gestational age (n = 21), and appropriate for gestational age (n = 20). Two blood samples were collected before and after breastfeeding from each infant and plasma leptin concentrations were determined by radioimmunoassay. Leptin concentration was found to be increased in large for gestational age infants and to be decreased in small for gestational age infants compared with the level in appropriate for gestational age infants. There was a positive correlation between plasma leptin levels and both the infants' birthweights and the body mass indexes. Plasma leptin concentrations were found to be decreased during fasting and to be increased after feeding (p < 0.01). It is concluded that the plasma leptin levels correlate with the size of adipose tissue mass and are related to the nutritional status.     

Neonatal behavior of small for gestational age infants

The behavioral pattern of small for gestational age (SGA) infants differs from that of appropriate for gestational age (AGA) infants. Maternal malnutrition and SGA infants being a common problem in our country, we assessed the behavior of 36 full term SGA infants using the Brazelton scale. These infants had an excellent orienting capacity, state control and self quieting. Their motor performance was fair and autonomic regulation showed a good recovery over first 10 days. A comparison of this behavior with full term AGA infants showed a better orientation in SGA infants. Though there was a significant difference in motor, state regulation, and autonomic regulation, by the end of the first month they recovered to the same level as the AGA infants. The pattern of SGA behavior described is at marked variance with most of other reports from abroad.     

小于胎龄儿发病情况分析

目的　评估正常孕产妇分娩的小于胎龄儿 (SGA)的患病率及死亡率。方法　回顾分析 1998年～2 0 0 2年在我院分娩胎龄为 3 7～ 41周的SGA ,依据新生儿出生体重的百分位数将SGA分为大于第 5百分位 ,但小于第 10百分位SGA(SGA1) ;小于第 5百分位SGA(SGA2 )。将孕母患妊娠合并症及胎儿畸形者予以剔除。将同期正常孕产妇分娩的适于胎龄儿 (AGA)作为对照组。比较 3组胎龄、出生体重、身长 ,入新生儿重症监护病房 (NICU)率、低血糖、肺透明膜病 (RDS)、吸入性肺炎、机械通气、红细胞增多症、高胆红素血症、败血症及 1minApgar评分≤ 7分、发生率等指标。 结果　观察对象共 4546例 (AGA组 43 2 3例 ,SGA1组 13 0例 ,SGA2组 93例 )。 3组胎龄相似 (P均 >0 .0 5) ;SGA组出生体重、身长均明显低于AGA组 (P均 <0 .0 0 1) ;低血糖、RDS、吸入性肺炎、机械通气、高胆红素血症和败血症 3组之间无统计学差异 (P均 >0 .0 5)。SGA入新生儿重症监护病房率、红细胞增多症和新生儿窒息的发生率显著高于AGA组 ,且存在出生体重越低危险越大趋势。结论　与AGA相比 ,正常孕产妇分娩足月SGA某些新生儿疾病的发生率显著增加     

Glucose kinetics in glucose-infused small for gestational age infants

To evaluate the maturation of glucose homeostasis in the small for gestational age (SGA) neonate, glucose kinetics were measured with 78% enriched D-[U-13C]glucose by the prime plus constant infusion technique in nine SGA infants and compared with the rate obtained in seven term appropriate for gestational age infants and 13 preterm appropriate for gestational age infants. All of the infants had received glucose intravenously from birth and continued to receive the glucose infusion throughout the study. Fasting plasma glucose and plasma insulin concentrations and plasma [13/12C]ratios were measured during the steady state turnover period. From this data, the glucose production rate was derived. During the turnover period, the SGA and both groups of appropriate for gestational age infants had similar average plasma glucose, plasma insulin, plasma glucagon concentrations, and similar persistent rates of glucose production during glucose infusion. We conclude that under stimulation of glucose infusion, the SGA infant and his AGA counterpart have similar hormonal regulatory responses as well as functional integrity in handling glucose during the second day after birth.     

Aetiology and classification of small for gestational age infants

Objective: To determine important aetiological factors in small gestational age (SGA) infants and the effectiveness of anthropometric indexes in identifying patterns of growth retardation.
Methodology: Eighty-four SGA infants and 81 controls were enrolled. Maternal biological, lifestyle and psychosocial factors were compared for the total group and the term Caucasian subset. Anthropometric indexes were also examined in relation to growth patterns.
Results: Decreased maternal size, poor weight gain, previous SGA infant and smoking were significantly associated with SGA status. Poor parental education and unemployment was increased in the study group. Mothers of SGA infants, especially the term Caucasian group, had a greater prevalence of hypertension and depressive and stress symptomatology. Ponderal index failed to identify discreet patterns of disproportionate/proportionate growth retardation.
Conclusion: Biological, lifestyle and psychosocial differences remain important aetiological factors of intrauterine growth retardation. Identification of specific patterns of growth retardation by ponderal index remains controversial.