合并脑损伤高危因素小于胎龄儿的生后早期运动发育特点

目的探讨合并脑损伤高危因素的小于胎龄儿的早期运动发育特点。方法回顾性纳入2022年2～10月在西安市儿童医院新生儿随访门诊随访, 合并脑损伤高危因素且在校正年龄(corrected age, CA)2～5周或CA14～17周随访并完成一次婴儿运动能力测试(Test of Infant Motor Performanc, TIMP)的小于胎龄儿(small for gestational age, SGA)和适于胎龄儿(appropriate for gestational age, AGA)共81例。CA2～5周随访到SGA 17例(SGA组), AGA 24例(AGA组);CA14～17周随访到SGA 20例(SGA组), AGA 20例(AGA组)。采用两独立样本t检验、秩和检验及χ2检验比较组间的人口学特征、脑损伤高危因素及TIMP各项评分的差异。结果 CA2～5周和CA14～17周, SGA组的出生体重均低于AGA组[(1 817.1±440.3)与(2 630.0±560.9)g, t=-4.98;(1 752.0±434.4)与(2 226.3±699.8)g, t=-2....     

母亲妊娠期高血压疾病对新生儿脑发育的影响

目的　探讨母亲妊娠期高血压疾病对新生儿脑发育的影响. 方法　采用颅脑超声测量56例妊娠期高血压疾病母亲的新生儿脑岛面积、周长及新生儿脑回宽度,并与53例同胎龄对照组新生儿相比较. 结果 对照组足月儿脑回宽度低于早产儿,脑岛面积与周长大于早产儿,差异有统计学意义(P<0.01).妊娠期高血压疾病组胎龄34周以上新生儿脑岛周长[胎龄≥37周:(87.43±10.21)mm;胎龄34～37周:(72.59±7.50)mm]与面积[胎龄≥37周:(413.60±90.05)mm2;胎龄34～37周:(285.71±48.62)mm2]明显小于对照组同胎龄新生儿脑岛周长[胎龄≥37周:(102.14±9.97)mm;胎龄34～37周:(78.42±10.14)mm]和面积[胎龄≥37周:(557.08±98.89)mm2;胎龄34～37周:(356.01±93.07)mm2],差异有统计学意义(P<0.05或0.01).妊娠期高血压疾病组小于胎龄儿发生率为30.36%(17/56),其脑回宽度宽于适于胎龄儿,脑岛面积与周长明显减小,差异均有统计学意义.妊娠期高血压疾病组新生儿均有肌张力增高,在新生儿行为神经测定评分时,主动、被动肌张力共8项都未扣分,但行为能力扣分较多,分值明显低于对照组(P<0.01). 结论 母亲妊娠期高血压疾病可造成新生儿脑发育欠佳,可通过颅脑超声测量新生儿脑岛面积、周长及脑回宽度予以评价.     

关于小于胎龄儿和大于胎龄儿胎盘终末绒毛血管形态的研究

小于胎龄儿 (SGA)是围产儿发病与死亡的主要危险因素之一 ,存活者在儿童期智力和体格方面均落后于正常儿。造成 SGA的原因有母体、胎儿、胎盘等多方面因素 ,其中胎盘功能性绒毛组织减少 ,胎盘绒毛广泛损伤或胎盘血管异常 ,均可影响胎儿的生长和发育。另外 ,在多种病理状态下 ,子宫 -胎盘血流量显著减少 ,影响氧和营养物质的输送 ,最后也会导致低出生体重儿和胎儿生长受限(FGR)。本研究对 SGA、大于胎龄儿(L GA)及正常儿胎盘绒毛内血管、绒毛横面积比及血管数进行测量比较 ,旨在了解 SGA和 L GA与胎盘微绒毛血管形态的关系。一、资…     

低出生体重儿的十大问题

凡婴儿出生体重不足2500g者均称之为低出生体重儿,包括早产儿、服龄在37～42周的足月小样儿和胳龄在42周以上胎盘功能不全的过期产儿。早产儿是指胎龄＜37周的婴儿,小于胎龄儿（SGA）是指出生体重低于同龄正常体重值的二个标准差或＜10个百分位。出生体重＜1500g者称极低出生体重儿,＜1000g则称超低出生体重儿。我国低体重儿出生率为4．75％～8．5％。早产儿死亡率占围产死亡的51．8％,SGA为8．3％。低体重儿死亡率在我国婴儿死亡率中占重要地位,故降低其死亡率对婴儿死亡率的下降起重要作用。早产儿主要是孕期不足,各器官形态及生…     

妊娠结局和5岁时智力情况

为确定早产儿(PTB)和小于胎龄儿(SGA)对5岁时智力发育的影响,对459例儿童进行检测,其母亲为黑人,低经济收入,处于SGA危险人群。产前随诊根据早期B超检查确定胎龄划分为足月适于胎龄儿(AGA),足月SGA,小于同胎龄体重第10百分位,和<34周的PTB。被测试儿童平均年龄5.5±0.5岁,用WPPSI-R智商(IQ)测定。以IQ<75定为智力迟钝(MR)。应用单变量和多变量分析修正母亲年龄,教育程度,阅读水平,家庭环境,儿童性别和学龄前教育情况。     

早产极低体重儿(500～1500g)的死亡率及预后与成熟度的关系

WHO将出生体重≤1500g的早产儿定为极低体重儿(VLBW),仅占新生儿总数的1％,但围产期新生儿死亡率及发病率却达50％。作者回顾性报道1986～1992年Kln大学妇产医院136例出生体重500～1500g VLBW的死亡率及早期预后,尤其胎儿成熟度。染色体异常及胎儿畸形的早产儿除外。按其宫内生长曲线67例为适龄儿(AGA)及69例为小于孕龄儿(SGA)。 结果总死亡率为25％,AGA早产儿的死亡率较SGA高10％。500～750g极低体重早产儿组的存活率明显受胎儿成熟度的影响。性别对死亡率有明显影响,男性VLBW的死亡率为35％,明显高于女性的13％(P<0.01)。营养不良VLBW早产儿     

小于胎龄儿血糖的系统监测

目的　探讨小于胎龄儿 (small for gestational age infant,SGA儿 )血糖监测的重点对象及持续时间 ,减少血糖异常造成的损伤。　方法　对 37例出生 (2 .6± 2 .4) h (0 .2 5～ 10 .0 h,中位数 2 .0 h)、非 NICU收治、入院时无输液且未开始喂养的 SGA儿进行为时 (133± 115 ) h (16～ 5 2 4h,中位数 93h)的血糖监测。　结果　监测过程中 2 4例 (6 4% )出现血糖异常 ,其中低血糖 19例(5 1% ) ,高血糖 2例 (5 % ) ,高血糖及低血糖均有发生 3例 (8% )。血糖异常最后发生时间的中位数为10 h,其 95 %可信限为 5～ 5 5 h。 3例反复低血糖发生时间超过 2 40 h。逐步回归分析显示分娩方式与早期血糖水平有关 (P=0 .0 13) ,自然分娩者早期血糖水平高 ;出生体重越低 ,血糖异常最后发生时间越晚 (P<0 .0 1)。另外 ,分析结果显示男婴血糖异常最后发生时间较晚 (P=0 .0 8)。监测期间 ,所有SGA儿未出现血糖异常的相应症状 ,13例予以部分或全静脉营养。　结论　 SGA儿为血糖异常 ,特别是低血糖高危人群 ;对非自然分娩出生的 SGA儿 ,尤应注意早期血糖监测 ;对所有 SGA儿 ,尤其是出生体重及其百分位数低者、男婴应行动态血糖监测 ,并持续至出生后 5 5 h     

胰岛素样生长因子1和胰岛素促胎儿生长作用探讨

胰岛素等是调节胎儿生长的重要激素 ,近来胰岛素样生长因子对胎儿的促生长作用愈来愈受到重视 [1 ,2 ] 。本研究通过对 6 4例新生儿脐血清胰岛素样生长因子 1(IGF- 1)和胰岛素的检测 ,探讨 IGF-1和胰岛素在胎儿生长中的作用 ,分析影响 IGF- 1水平的相关因素。一、对象和方法1.研究对象 :6 4例新生儿 ,男 2 5例 ,女 39例 ,胎龄 2 9～ 42周 ,体重 130 0～410 0 g。适于胎龄 (AGA)儿 43例 ,小于胎龄 (SGA)儿 15例 ,大于胎龄 (L GA)儿 6例。2 .方法 :新生儿出生时采集脐血 4ml,测量胎盘重量、新生儿体重 ,身长和孕母身高。采用放免法测…     

我国小于胎龄儿现状分析

研究我国小于胎龄儿（SGA）的现状。方法　调研我国22个省、自治区、直辖市的86所医院提供的2005 - 01 - 01 T 00:00:00至2005 - 12 - 31 T 00:00:00出院的产科出生的新生儿（45 014例）中SGA的发生率,总结分析该86所医院新生儿科住院患儿（54 466例）中SGA的临床资料。结果　（1）产科出生的 新生儿中SGA 的发生率为6.61 %,其中早产儿中SGA发生率（13.10 %）高于足月儿（6.05 %）;（2）新生儿科住院患儿中SGA的比例为9.19 %;（3）SGA中窒息 、呼吸窘迫综合征（RDS） 、肺出血、呼吸暂停、缺氧缺血性脑病（HIE）、胃潴留、消化道出血、坏死性小肠结肠炎（NEC）、寒冷损伤综合征、先天畸形的构 成比高于适于胎龄儿（AGA）和大于胎龄儿（LGA）;（4）在SGA的转归中,治愈、好转率分别为57.47 %和27.41 %, 自动出院占13.17 %,病死率为1.95 %。其 中SGA病死率明显高于AGA和LGA, 而治愈好转率（84.88 %）则明显低于AGA 和LGA。 结论　我国新生儿科住院患儿中SGA的患病率和病死率较高,加强围生期监 测和干预以减少SGA发生、积极防治SGA并发症仍是我国目前围产工作的重点。     

超低出生体重儿八例临床分析

目的　探讨提高超低出生体重儿（ＥＬＢＷＩ）存活率、降低病残率的办法。　方法　８例ＥＬＢＷＩ平均胎龄２５．６±１．７周，平均体重（７６９±１１３）ｇ，均有一种或多种并发症，经产前胎内运转，产时积极复苏，重视护理、保暖及呼吸管理，积极防治并发症，保持液体、酸碱平衡及合理的静脉营养，防治感染，并早期干预。　结果　８例全部成活，平均住院（４６±１２）天，出院体重（２．１３±０．２４）ｋｇ。随访１年。３个月时智测４例异常，其中３例轻度脑发育不良；１岁时智测１例轻度异常，脑ＣＴ均正常。　结论　正确合理的救治，可提高ＥＬＢＷＩ的存活率，而早期干预，则可降低其病残率     

Does being born small-for-gestational-age affect cerebellar size in neonates?

Objective: To investigate how cerebellar vermis height (CVH) and transverse cerebellar diameter (TCD) measurements are affected in SGA neonates.

Methods: A total of 176 [88 SGA and 88 appropriate for gestational age (AGA)] neonates between 26 and 42 weeks of gestation were included. Midsagittal plane through the anterior fontanel and coronal plane through the left mastoid fontanel were used to measure CVH and TCD, respectively. CVH and TCD values were considered normal when they were ≥?10th percentile, according to nomograms of AGA neonates.

Results: Thirty-six asymmetric SGA neonates, 52 symmetric SGA neonates and their 88 gestational age-matched AGA controls were studied. The percentages of neonates with normal CVH and TCD in the symmetric SGA sub-group were significantly lower than those in the AGA and asymmetric SGA sub-groups. The percentages with normal CVH and TCD in the asymmetric SGA sub-group were also found to be low when compared with the AGA sub-group.

Conclusion: Growth and development of cerebellum may be less spared in SGA neonates. Further studies with larger series are needed in order to evaluate how being born SGA (symmetric and asymmetric) affects cerebellar size and also to see how these findings influence the neurocognitive outcomes of these infants at long-term follow-up.     

Neonatal transverse cerebellar diameter in normal and growth-restricted infants

OBJECTIVE: To assess the transverse cerebellar diameter (TCD) in preterm and term neonates with normal growth or growth restriction. METHODS: TCD was sonographically measured after birth in 404 neonates born between 23 and 42 weeks of gestation. The study included two groups: Group 1: 334 appropriately grown for gestational age (AGA) neonates (both birthweight (BW) and head circumference (HC) were between the 3rd and 97th centiles), which were subdivided into two subgroups according to the HC measurements. Group 2: 70 small for gestational age (SGA) neonates (BW <3rd centile), were further divided into three subgroups according to HC measurements. RESULTS: In Group 1 of AGA neonates, a linear growth function was observed between the TCD and GA (R = 0.914, P < 0.00001, TCD = 0.279 + 0.142 X GA), and between TCD and HC (R = 0.886, P < 0.00001, TCD = -0.333 + 1.777 X HC). The percentage of neonates with normal TCD (> or =10th centile) was more than 85% of the AGA and asymmetric SGA subgroups, and 60.7% of the microcephalic SGA subgroup (P < 0.02). CONCLUSIONS: This study provides normative data of neonatal TCD across gestational age. TCD measurement via sonography is a new adjunctive criterion for objectively assessing gestational age in infants when a precise determination of gestational age is necessary. This is very important since utility of the TCD is effective for both AGA and asymmetric SGA infants.     

Brain growth in preterm infants is affected by the degree of growth restriction at birth

Abstract

Objective: Documentation of examination of brain structural development by magnetic resonance imaging (MRI) beyond the neonatal period is scarce for both preterm and small for gestational age (SGA) infants.

Aim: To investigate structural brain development during infancy in preterm children born SGA by MRI.

Methods: A total of 205 preterm infants, 139 appropriate for gestational age (AGA) and 66 SGA, of which 33 had birth weight (BW)?<?3rd percentile and 33 had BW 3rd–10th percentile, were examined prospectively by brain MRI at the corrected age of 5 months. The total volume of the brain, ventricles and cerebellum, the area of vermis and corpus callosum, and the height of the pituitary, mesencephalon and pons were estimated on MRI.

Results: Brain volume was smaller in the SGA?<?3rd percentile infants, independent of other perinatal factors. Chronic lung disease was an independent predictor of low brain volume. Pituitary height was greater in SGA?<?3rd percentile than in AGA infants. The corpus callosum area was less in SGA?<?3rd percentile than in SGA of 3rd–10th percentile infants.

Conclusions: Preterm infants born SGA with BW?<?3rd percentile had differences in brain structural measurements at the corrected age of 5 months, compared with preterm AGA infants, which could have implications for their neurocognitive development.     

Blunted heart rate circadian rhythms in small for gestational age infants during the early neonatal period

Infants born with intrauterine growth restriction are at increased risk for adverse cardiovascular outcomes in neonatal and later life. Although circadian rhythm is a prognostic marker of cardiovascular health, the concern over the circadian rhythm of these infants is rarely observed. To determine the influence of intrauterine growth retardation on the pattern of circadian rhythm, heart rate (HR) circadian rhythmicity was analyzed in 39 small for gestational age (SGA; birth weight and height below <-2.0 standard deviation score [SDS]) and 117 appropriate for gestational age (AGA; >-1.5 to <1.5 SDS) infants within 72 hours of birth using spectral analysis and cosinor analysis. Amplitude, midline estimating statistic of rhythm, and acrophase calculated from circadian rhythm were analyzed with clinical variables. A significant HR circadian rhythm was observed in 23.1% of the SGA and 24.8% of the AGA group without significant differences; however, SGA infants exhibited remarkable smaller amplitudes compared with AGA in all gestational age (GA) groups (p < 0.001). Amplitudes in AGA infants were positively correlated with the GA or body composition relevant variables (p < 0.001, respectively), but not SGA infants. The blunted HR circadian rhythmicity in SGA infants showed in this study might indicate the vulnerability to pathophysiological condition and could potentially refer to cardiovascular disease in later life.     

Relation between placental morphometry and fetal growth]

Forty-eight placentae of full term infants, 21 placentae from appropriate for gestational age infants (AGA) and 27 placentae from small for gestational age infants (SGA) were measured by morphometric technic using the automatic image analyzer, in order to find out the extent of fetomaternal exchange which determines the transfer of oxygen and nutrition from mother to fetus and fetal growth. The results of measurement correlated well both with infant birth weight and placental weight. They demonstrated striking quantitative differences when the placentae of SGA were compared with those of AGA. The placenta weights in the group of SGA were notably less than those in the group of AGA. It seems that low birth weight relates to low functional tissue mass of placenta. This reduction of functional tissue is accompanied by diminution of the area for exchange between mother and fetus, both at the villous surface area and at fetal capillary surface area. Thus, the ability of transferring oxygen and nutrition from mother to fetus is curtailed. The results show that the rate of fetal growth is limited by placental function as well as its weight.     

Association between early postnatal weight loss and death or BPD in small and appropriate for gestational age extremely low-birth-weight infants.

OBJECTIVE: To examine the association between weight loss during the first 10 days of life and the incidence of death or bronchopulmonary dysplasia (BPD) in small for gestational age (SGA) and appropriate for gestational age (AGA) extremely low-birth-weight infants. DESIGN/METHODS: This is a retrospective analysis of a cohort of ELBW (birth weight <1000 g) infants from the NICHD Neonatal Research Network's database. The cohort consisted of 9461 ELBW infants with gestational age of 24-29 weeks, admitted to Network's participating centers during calendar years 1994-2002 and surviving at least 72 h after birth. The cohort was divided into two groups, 1248 SGA (with birth weight below 10th percentile for gestational age) and 8213 AGA (with birth weight between 10th and 90th percentile) infants. We identified infants with or without weight loss during the first 10 days of life, which we termed as 'early postnatal weight loss' (EPWL). Univariate analyses were used to predict whether EPWL was related to the primary outcome, death or BPD, within each birth weight/gestation category (SGA or AGA). BPD and death were also analyzed separately in relation to EPWL. Logistic regression analysis was done to evaluate the risk of death or BPD in SGA and AGA groups, controlling for maternal and neonatal demographic and clinical factors found to be significant by univariate analysis. RESULTS: SGA ELBW infants had a lower prevalence of EPWL as compared with AGA ELBW infants (81.2 vs 93.7%, respectively, P<0.001). In AGA infants, univariate analysis showed that death or BPD rate was lower in the group of infants with EPWL compared with infants without EPWL (53.4 vs 74.3%, respectively, P<0.001). The BPD (47.2 vs 64%, P<0.001) and death (13.8 vs 32.9%, P<0.001) rate were similarly lower in the EPWL group. The risk-adjusted odds ratios (ORs) showed that EPWL was associated with lower rate of death or BPD (OR 0.47, 95% CI: 0.37-0.60). In SGA infants, on univariate analysis, a similar association between EPWL and outcomes was seen as shown in AGA infants: death or BPD (55.9 vs 75.2%, P<0.001), BPD rate (48.3 vs 62.1%, P=0.002) and rate death (19 vs 40.8%, P<0.001) for those with or without EPWL, respectively. Multiple logistic regression showed that as in AGA ELBW infants, EPWL was associated with lower risk for death or BPD (OR 0.60, 95% CI: 0.41-0.89) among SGA infants. CONCLUSIONS: SGA infants experienced less EPWL when compared with their AGA counterparts. EPWL was associated with a lower risk of death or BPD in both ELBW AGA and SGA infants. These data suggest that clinicians who consider the association between EPWL and risk of death or BPD should do so independent of gestation/birth weight status.     

The relationship among intrauterine growth, insulinlike growth factor I (IGF-I), IGF-binding protein-3, and bone mineral status in newborn infants

Insulinlike growth factors (IGFs) exert profound effects on somatic growth and cellular proliferation of many tissues and play an essential role in bone metabolism. The aim of this study was to investigate how fetal growth and bone mineralization correlate with IGF-I and IGF-binding protein-3 (IGFBP-3) levels of newborn infants and their mothers. In addition, we aimed to determine the predictive value of anthropometric measurements on variability in bone mineral status. Umbilical cord venous blood samples were obtained at delivery from 100 term newborn infants. Forty of the newborn infants had birthweights appropriate for gestational age (AGA), 30 were small for gestational age (SGA), and 30 were large for gestational age (LGA). Data were acquired using whole-body dual-energy X-ray absorptiometry scanner with a pediatric platform. Umbilical cord serum IGF-I concentrations were higher in LGA newborns ( P < 0.01), but lower in SGA newborns ( P < 0.01) than in AGA newborns. Umbilical cord serum IGFBP-3 concentrations in LGA newborns were significantly greater than in SGA and AGA newborns ( P < 0.01 and P < 0.01, respectively). Whole-body bone mineral density (WB BMD) was higher in LGA babies (0.442 +/- 0.025 g/cm2 [SD]; P < 0.01) but lower in SGA (0.381 +/- 0.027 g/cm 2; P < 0.0001) than in AGA babies (0.426 +/- 0.022 g/cm2). WB BMD and content (WB BMC) were correlated significantly with birthweight, birth height, head circumference, body mass index (BMI) of the infants; ponderal index and triceps skinfold thickness (reflecting fat stores) of the infants; cord serum IGF-I concentration, serum IGF-I concentration of the mothers; and fat mass, proportionate fat mass, weight, and BMI of the mothers. In contrast, WB BMC was also correlated positively with cord serum IGFBP-3 concentration and gestational age, and WB BMD was positively correlated with serum IGFBP-3 levels of the mothers. Umbilical cord serum IGF-I concentration of the infants was correlated significantly with the concentration of the mothers ( R = 0.232; P = 0.020). Umbilical cord serum IGF-I and IGFBP-3 concentrations were correlated significantly with the fat mass, gestational age, birthweight, birth height, head circumference, and BMI of the infants. Umbilical cord IGF-I concentration was also correlated with ponderal index and triceps skinfold thickness of the infants, maternal weight, BMI, and proportionate fat mass of the infants. Stepwise multiple regression analyses showed no significant relation between bone indices (WB BMD, WB BMC) and the infant's or mother's variations including serum IGF-I and IGFBP-3 concentrations. Birthweight and gestational age are related to bone indices. However, the present study does not provide support for the hypothesis that serum IGF-I and IGFBP-3 levels of infants and their mothers may play a major role in the regulation of bone metabolism in the developing skeleton.     

Significance of high and normal neonatal nucleated red blood cell count in small-for-gestational-age newborns

The objective of this study was to evaluate the obstetrical and neonatal outcome in small-for-gestational age (SGA) and appropriate-for-gestational-age (AGA) fetuses with normal and elevated neonatal nucleated red blood cell counts. Therefore the nucleated red blood cell count was assessed immediately after birth in 906 neonates delivered at our institution and the perinatal and neonatal data were compared. Postnatally, infants were classified as SGA if they had a birth weight for given gestational age below the 10th percentile. Neonates were allocated to four groups according to their nucleated red blood cell count: SGA neonates with normal and high nucleated red blood cell count and appropriate-for-gestational-age newborns (AGA) with normal and high nucleated red blood cell count. Statistical analysis included the Mann-Whitney U-Test, Student's t-test, chi2 analysis of variance and stepwise regression analysis. SGA newborns with high nucleated red blood cell count had a significantly lower birth weight, a lower gestational age at delivery, lower arterial and venous pH values, lower Apgar scores at 1 min, 5 min and 10 min as well as lower base excess values compared to the other groups. They had to be transferred significantly more often and stayed longer in the neonatal intensive care unit. Three cases of intraventricular hemorrhage, four cases of necrotizing enterocolotis and two neonatal deaths occurred all in the SGA group with high neonatal nucleated red blood cell counts. Neonatal outcomes of SGA and AGA newborns with normal nucleated red blood cell counts were comparable. Our data do therefore underline the possible value of neonatal nucleated red blood cell counts to differentiate the healthy small-for-gestational age newborn from the truely growth retarded newborn.     

Total body water in small- and appropriate- for gestational age newborns

OBJECTIVES: To ascertain total body water in small for gestational age (SGA) and appropriate for gestational age (AGA) newborns. METHODS: SGA and AGA babies were matched by gestational age and studied from birth to term age. Criteria for exclusions were genetic syndromes, malformations, and congenital infections. Bioelectrical impedance was performed at two days of life (term infants), or at seven days of life and term age (preterm infants). Weight and length were measured by trained interviewers, and Z-score, weight/length ratio and Rohrer ponderal index was calculated. RESULTS: Of the 54 infants evaluated, 28 were SGA (17 preterm) and 26 were AGA (15 preterm). Total body water was greater in SGA preterm babies at seven days of age (P=0.058) and at term age (P<0.0001). Weight/length ratio and Rohrer ponderal index increased towards term. Weight Z-score and anthropometric measures at term were significantly smaller in SGA babies. Being SGA and variation in Rohrer ponderal index influenced the variations in total body water. CONCLUSIONS: SGA babies had greater total body water, and both groups presented insufficient increase in body solid mass, stressing the importance of nutritional support during neonatal care.     

The cardiothoracic ratio in AGA and SGA very low birth weight newborn infants.

BACKGROUND: Cardiothoracic (CT) ratio is a common measurement used to assess heart size in chest radiographs of pediatric patients, but no recent studies have analyzed the standards for CT ratios in very low birth weight (VLBW) infants. OBJECTIVE: The aim of this study was to provide improved standards for CT ratios measured from chest radiographs of VLBW (<1500 g) infants, and to compare CT ratios between small for gestational age (SGA) and appropriate for gestational age (AGA) infants in this population. DESIGN/METHODS: Among VLBW infants admitted to the Jacobi Medical Center NICU from 2002 to 2004, CT ratios were calculated from anteroposterior supine chest radiographs taken of 54 VLBW infants (18 SGA and 36 AGA group-matched on the basis of birthweight and sex) during the first 24 h of life. RESULTS: There were no significant differences between the two groups with respect to birthweight, sex, 1-min Apgar score, 5-min Apgar score, intubation status and degree of inspiration. Median GA of the SGA infants was significantly greater than the AGA infants (30 and 27 weeks, respectively; P<0.001). CT ratios among SGA infants were significantly larger than those among AGAs. Using the widest internal width of the bony thorax, the mean CT ratio among SGA and AGA infants was 0.523 and 0.479, respectively (P=0.00102). CONCLUSIONS: VLBW SGA infants have larger CT ratios than VLBW AGA infants, suggesting that existing standards for normal CT ratios may be inappropriate for use among SGA infants.