Is intrauterine growth retardation a risk factor for child abuse?

A case-control study was conducted to determine whether infants with intrauterine growth retardation are at an increased risk of child abuse. Case children were those who had been born at Yale-New Haven Hospital and were reported to the hospital's child abuse committee because they had been physically abused. For each case, one control child was chosen from the hospital's log of births and matched to the case child by age, gender, race of the mother, method of payment for the hospitalization, and the provider of the child's health care at the time of birth. Infants were defined as having intrauterine growth retardation if they had either a ponderal index or a birth weight that was less than the tenth percentile for gestational age using the Kansas City or Denver growth standards. We identified 117 case-control pairs that met those criteria. The matched odds ratios for each of the four definitions of intrauterine growth retardation were less than one, indicating that infants with intrauterine growth retardation are at a decreased risk of abuse. The matched odds ratio for a low ponderal index according to the Kansas City standard was 0.4 (95% confidence interval 0.19, 0.83). This result was not affected by such possible confounding factors as the mother's age. We conclude that infants with intrauterine growth retardation are not at an increased risk and may be at a decreased risk of physical abuse.     

Heterogeneous growth and mental development of intrauterine growth-retarded infants during the first 3 years of life

Postnatal growth and development were studied in two groups of term infants with intrauterine growth retardation (IUGR) and one group of infants with normal birth weight up to 3 years of age (total sample, 205 infants). Infants with IUGR were classified as having low ponderal index (IUGR-LPI) or adequate ponderal index (IUGR-API). At birth, the two groups of infants with IUGR had similar birth weight, but length and head circumference measurements were significantly different. Overall, the IUGR-API infants remained lighter and shorter and had smaller head circumferences up to 30 months of age. The IUGR-LPI infants experienced catch-up growth in weight during the first months, because of greater fat deposition. At 24 months of age, the IUGR-API infants scored below the others on mental items. At 3 years of age the IUGR-API infants had the lowest values on seven of eight developmental measures and on the composite score; at these two time periods, the group with normal birth weight scored the highest, and the IUGR-LPI infants obtained intermediate values. It is concluded that infants with IUGR tend to follow postnatal growth and developmental patterns that are associated with their physical characteristics at birth.     

The relationship between intrauterine and postnatal growth on the subsequent psychomotor development of very low birthweight (VLBW) infants

ABSTRACT. The aim of this study was to demonstrate the relationship between intrauterine and postnatal growth and subsequent neurological and intellectual development of very low birth weight (VLBW) infants. The effect of intrauterine growth was assessed by comparing the developmental outcomes of the 131 appropriate weight for gestational age (AGA) infants with the 33 small for gestational age (SGA) infants. No significant differences were found between the two groups with respect to head circumference, neurological, intellectual or sensory handicap rates. The mean General Quotient (GQ) at the last clinic assessment for the AGA infants was 101.2 and 97.2 for the SGA infants. The effect of extra-uterine growth on subsequent development was assessed in the AGA and SGA infants separately, at the time of discharge and again at 12 months. The 31 AGA infants who failed to grow adequately in the nursery had more neonatal risk factors than the 100 AGA infants who continued to grow adequately after birth. This early postnatal growth failure was not predictive of developmental outcome. At 12 months of age, 26 infants (20%) who were initially appropriately grown at birth were failing to thrive. These infants had sustained more chronic diseases and caretaking disorders in the first year of life than their appropriately grown counterparts. They also had lower GQ and head circumference measurements (p<.05). The SGA infants who exhibited “catch up'’growth between birth and term had larger head circumference measurements at 1 year than those with persistent growth failure. Growth assessment at 12 months of age was not predictive of developmental outcome in SGA infants. We failed to show a relationship between intrauterine growth of VLBW infants and their subsequent development. AGA infants whose weights had dropped to the 3rd percentile by 12 months of age had a poorer outcome than their appropriately grown counterparts. Furthermore, early postnatal growth failure before term had no additional effects if catch up growth occurred thereafter. In the SGA group neither failure to reach the 3rd percentile by term or 12 months affected outcome.     

Classification schemes of small-for-gestational age and type of intrauterine growth retardation and its implications to early neonatal mortality

Classification of small-for-gestational age (SGA) and pattern of intrauterine growth retardation (IUGR) and their relationship to early neonatal mortality (first 3 days) were studied in a population of 9201 full-term infants in a maternal and child center in Mexico City. SGA infants were classified on the basis of two methods: one, using the tenth percentile of a birth weight (BW) by gestational age reference growth distribution, and the other, using a cut-off point of birth weight of 2900 g. Crown-heel length (CHL) and Rohrer's ponderal index (PI = BW/CHL3) were used to classify patterns of proportionate and disproportionate IUGR. Overall, infants classified as SGA and type of IUGR had an increased risk of death in comparison to full-term appropriate-weight infants. IUGR proportionate infants with short CHL had a significantly greater mortality than disproportionate IUGR infants with normal CHL. A slightly but not significantly greater mortality was observed for IUGR disproportionate versus proportionate using PI regardless of the method of SGA used. The combination of misclassification for SGA and for type of IUGR were examined relative to the availability of gestational age and the uses of data for clinical management versus research. It is concluded that hospitals may tolerate misclassification of SGA but should pay close attention in assessing the pattern of IUGR when evaluating the mortality of newborn term infants.     

Activities of lipase and trypsin in duodenal juice of infants small for gestational age

In 18 low birth weight infants, small for gestational age, with different degrees of intrauterine growth retardation the activities of pancreatic lipase and trypsin and the concentrations of bile acids were measured in preprandially aspirated duodenal juice. The results were compared to those of 24 low birth weight infants, appropriate for gestational age, with comparable birth weights and postnatal ages. The activities of both measured pancreatic enzymes were negatively correlated with the degree of intrauterine growth retardation, expressed as the difference between the individual birth weight and the weight of the 10th percentile of the intrauterine growth curve (lipase: r = -0.697, p less than 0.001; trypsin: r = -0.739, p less than 0.001). The activity of trypsin in the small for gestational age infants was within the range of that found in the infants appropriate for gestational age. However, the lipase activity was decreased in infants who presented with growth retardation of greater than 400 g/kg birthweight. The concentrations of bile acids were similar in both groups (4.60 +/- 2.51 and 4.55 +/- 2.26 mmol/L, respectively) and sufficient for activating the bile salt stimulated lipase in human milk. The data suggest that in intrauterine growth retarded infants the lipase activity in the duodenal juice can be a limiting factor for optimal fat digestion. This should be considered in the nutritional management of such infants.     

Determinants of fetal growth and body proportionality

Previous studies of fetal growth and body proportionality have been based on error-prone gestational age estimates and on inappropriate comparisons of infants with dissimilar birth weights. Based on a cohort of 8719 infants with validated (by early ultrasonography) gestational ages and indexes of body proportionality standardized for birth weight, potential maternal and fetal determinants of fetal growth and proportionality were assessed. Maternal history of previous low birth weight infants, pregnancy-related hypertension (particularly if severe), diabetes, prepregnancy weight, net gestational weight gain, cigarette smoking, height, parity, and fetal sex were all significantly associated with fetal growth in the expected directions. Consistent with previous reports, maternal age, marital status, and onset or total amount of prenatal care had no significant independent effects. Fetal growth ratio (relative weight for gestational age), pregnancy-related hypertension, fetal sex, and maternal height were the only significant determinants of proportionality. Infants who were growth-retarded, those with taller mothers, those whose mothers had severe pregnancy-related hypertension, and males tended to be longer and thinner and had larger heads for their weight, although these variables explained only a small fraction of the variance in the proportionality measures. Among infants with intrauterine growth retardation, gestational age was not independently associated with proportionality (in particular, late term and post-term infants did not tend to be more disproportional), a finding that does not support the hypothesis that earlier onset of growth retardation leads to more proportional growth retardation. The results raise serious questions about previous studies of proportionality, particularly those suggesting a nutritional etiology for proportional intrauterine growth retardation.(ABSTRACT TRUNCATED AT 250 WORDS)     

Catch-up growth, muscle and fat accretion, and body proportionality of infants one year after newborn intensive care

We studied catch-up growth, muscle and fat accretion, and body proportionality at 4 and 12 months of age corrected for prematurity in 30 very low birth weight (VLBW) (less than 1500 gm), 30 low birth weight (LBW) (1500 to 2499 gm) and 30 normal birth weight (greater than or equal to 2500 gm) infants who required newborn intensive care. At 4 and 12 months, the VLBW infants had significantly lower mean weight and length (p less than 0.01), but not lower occipitofrontal circumference percentiles, than the LBW and normal birth weight groups, and showed no catch-up weight or length growth between 4 and 12 months. All three groups had significant increases in mean upper mid-arm circumferences, mid-arm muscle circumferences, and arm muscle areas between 4 and 12 months. Mean mid-arm muscle circumferences and arm muscle areas were similar among the three groups at 4 months but became significantly stratified by birth weight groups by 12 months, with VLBW infants having the lowest mean value. In contrast, analysis of fat stores by triceps skin-fold thickness and arm fat area demonstrated no significant increases in any group between 4 and 12 months, except for arm fat area in the LBW group. The VLBW infants had significantly less fat than normal birth weight infants at 4 and 12 months. All three groups had proportional growth at both visits, as assessed by mid-arm circumference/head circumference ratio and weight-length percentile for age. The VLBW infants were significantly lighter for their length than normal birth weight infants. We conclude that VLBW infants have no first-year catch-up growth, remaining smaller than higher birth weight infants, although appropriately proportional. Somatic growth during the first year is due more to muscle than to fat accretion, especially in VLBW infants.     

Growth and development of term disproportionate small-for-gestational age infants at the age of 7 years

Twenty-four term infants with disproportionate intrauterine growth retardation (SGA group) and 24 normally grown term infants matched for age, sex, birth rank and social class were followed from birth until 7 years of age. Both groups were free from perinatal complications and chronic diseases. The children in the SGA group continued to be underweight-for-height with a low ponderal index and a relatively small head circumference at the age of 7 years. Only minor shifts occurred in the individual growth curves since the age of 3 years. In 12 SGA children and 1 control multiple 'soft' neurological signs were found. Their grammar school teachers observed problematic behavior (hyperactivity, poor concentration and clumsiness) in 9 and academic problems in 5 of the 12 SGA children with neurological dysfunction. These findings indicate that disproportionate intrauterine growth retardation at term can have long-term effects on growth and development.     

Serum insulin-like growth factor 1 and serum growth-promoting activity during the first postnatal year in infants with intrauterine growth retardation

Follow-up from birth to age 12 months was obtained in 21 infants born with intrauterine growth retardation. Serum insulin-like growth factor 1 was measured by radioimmunoassay. The bioassayable growth-promoting activity of the serum was measured as the "thymidine activity" on lectin-activated lymphocytes at 5 days and 1, 3, 6, 9, and 12 months, and was compared with control values. Depending on their length at age 12 months, the intrauterine growth retardation infants were divided into three groups: at or above the average (n = 8, group A), between the mean and -2 SD (n = 7, group B), or less than -2 SD (n = 6, group C). No differences in nutritional indexes or in head circumference were found between the three groups. Insulin-like growth factor 1 was significantly lower at age 5 days in intrauterine growth retardation than in control infants. It increased slowly in groups A and B to reach the control values at age 9 and 12 months. In group C it remained significantly subnormal at 1 yr of age. Thymidine activity was also significantly lower at age 5 days in intrauterine growth retardation compared with control infants. It increased sharply at age 1-3 months in groups A and B but remained significantly lower in group C up to 1 yr of age. Although individual values of insulin-like growth factor 1 and thymidine activity were closely correlated, the increase of length during the first postnatal year correlated significantly with the thymidine activity levels at 1 and 3 months but not with the insulin-like growth factor 1 levels at 1, 3, and 6 months.(ABSTRACT TRUNCATED AT 250 WORDS)     

Growth of 519 Small for Gestational Age Infants during the First Two Years of Life

ABSTRACT. The physical growth of 519 small for gestational age infants (SGA), with a birth weight below the 10th percentile on our own growth curve, born in the region of University Central Hospital of Turku during the period June 1,1981-May 31, 1982, was studied. The study population consists of 4 517 term, appropriate for gestational age (AGA) infants, 488 term SGA infants, 320 preterm AGA infants and 31 preterm SGA infants. The degree of intrauterine growth retardation (IUGR) seemed to have an effect on physical growth in term SGA infants. Those term SGA infants with a low Ponderal Index (PI) (type II) were taller and had a larger head circumference at the age of 24 months than term SGA infants with adequate PI (type I). Among the preterm SGA infants the degree of IUGR seemed to have no effect on later growth. Smoking is still one of the main risk factors associated with poor intrauterine growth. In this study we also found that smoking has an effect on later growth; the children of smoking mothers were smaller than those of non-smoking mothers in the AGA group. Among the SGA infants the infants of non-smoking mothers were bigger than those of smoking mothers. This difference could be explained by other factors associated with SGA. We found that in spite of the catch-up growth during the first months, 26% of the severely SGA infants (birth weight below the 2.5th percentile) still had a weight below the 2.5th percentile at the age of 24 months.     

Infants born to narcotic dependent mothers: Physical growth patterns in the first 12 months of life

Objectives: To describe the physical growth patterns of infants born to narcotic dependent mothers (INDM) over a 12 months period and, if possible, to relate the growth to drug taking patterns during pregnancy.
Methodology: The growth of a cohort of 43 INDM was measured during the first 12 months of life. Weight and length measurements were compared with percentile charts and converted to Z scores. Questionnaire data about drug taking practices, demographic variables and the neonatal period (including withdrawal scores) were obtained.
Results: Twenty-four (55.8%) of INDM had evidence of neonatal drug withdrawal requiring treatment with phenobarbitone. At birth, Z scores for weight and length indicated relative intrauterine growth retardation. By 12 months, there had been some catch up growth, but Z scores for weight and length were still below zero. Persistent weight retardation at 12 months was correlated with methadone dosage during pregnancy, but not the need for phenobarbitone therapy.
Conclusions: The growth patterns of INDM in the first 12 months of life indicated that at birth there was evidence of intrauterine growth retardation, but by 12 months the growth was little different from the rest of the community. There appears to be some influence of narcotic agents taken while pregnant on subsequent growth of INDM.     

Early feeding advancement in very low-birth-weight infants with intrauterine growth retardation and increased umbilical artery resistance

BACKGROUND: To investigate whether intrauterine growth retardation (birth weight <10th percentile), increased umbilical artery resistance (resistance index >90th percentile measured by Doppler velocimetry), or brain sparing (increased umbilical artery resistance and decreased middle cerebral artery resistance index <5th percentile) were associated with early feeding intolerance in very low-birth-weight (VLBW, <1,500 g) infants. METHODS: From July 1999 to December 2000, 124 inborn VLBW infants were enrolled in a prospective trial evaluating early enteral nutrition after a standardized feeding protocol (daily feeding advancement, 16 mL/kg birth weight). Feeding tolerance was assessed as the age at which full enteral feeds (150 mL/kg daily) were achieved. Data are shown as median, 25th, and 75th percentiles. RESULTS: Full enteral feeds were achieved at 15 days (range, 12-21 days) of age for all infants. Intrauterine growth retardation (full enteral feeding achieved at 14 days; range, 12-21 days), increased umbilical artery resistance (full enteral feeding achieved at 14 days; range, 11-16 days), and brain sparing (full enteral feeding achieved at 15 days; range, 14-20 days) were not associated with early feeding intolerance. CONCLUSION: Very low-birth-weight infants with intrauterine growth retardation, increased umbilical artery resistance, and brain sparing tolerated enteral feeding as well as appropriate-for-gestational-age VLBW infants.     

The premature small-for-gestational-age infant during the first year of life: comparison by birth weight and gestational age

To determine the effect of intrauterine growth retardation on the outcome of the premature infant, we compared a group of 35 premature, small-for-gestational-age (SGA) infants with two groups of premature, appropriate-for-gestational-age (AGA) infants: one with similar birth weight (AGA-BW group) and the other with similar gestational age (AGA-GA group). Groups were matched by year of birth, race, gender, and socioeconomic status. Infants were free of major congenital anomalies and intrauterine infection. They were evaluated at term, at 20 and 40 weeks, and at 1 year corrected age. The SGA infants had a lower mean developmental quotient than the two groups of AGA infants. The SGA infants had significantly smaller body dimensions at birth, more nursery complications, and a higher incidence of major neurologic problems than their AGA-GA matches but were comparable to the AGA-BW matches. Poor growth constitutes an additional risk factor to prematurity. The results highlight the importance of comparing premature SGA infants with premature AGA infants of similar gestational age rather than similar birth weight.     

Part 1. Outcome for Small-for-Gestational-Age Infants with Very Low Birth Weight (<1,500g)

Mortality and morbidity of small-for-gestational-age (SGA) infants with very low birth weight (VLBW) (less than 1,500 g at birth) are reported. Survival rate of 47 VLBW infants was 92%, with no statistical difference between SGA and appropriate-for-gestational-age (AGA) groups. Thirty-nine VLBW infants were watched in our follow-up clinic for more than seven months. Overall incidence of major neurologic defects (cerebral palsy, epilepsy or psychomotor retardation) was 12.8%. Handicap was significantly different for SGA and AGA groups, that is, four out of 12 SGA infants (33%), compared with one out of 27 AGA infants (3.3%). Major neurologic defects in VLBW infants were strongly associated with intrauterine growth retardation (IUGR) related to toxemia of pregnancy with onset in the 2nd trimester. Although most of the VLBW SGA infants were IUGR due to noxious intrauterine environments, head sizes of all, with one exception, were growth-restricted in utero. If IUGR, especially retardation of head growth, is detected in utero during the 2nd trimester, discussion between obstetrician and neonatologist about optimal neurological outcome for the infant is mandatory.     

Body proportionality and head and length 'sparing' in growth-retarded neonates: a critical reappraisal

Despite the popular current distinction between "proportional" and "disproportional" intrauterine growth retardation, it has never been shown that variation in body proportions is greater among growth-retarded than nongrowth-retarded infants of the same birth weight, nor that proportionality is distributed bimodally among growth-retarded infants. Based on a cohort of 8719 neonates born between 1980 and 1986 of mothers with concordant (+/- 7 days) menstrual dating and early ultrasound estimates of gestational age, we used a continuous measure of birth weight for gestational age to define four study groups: nongrowth retarded (n = 5163) and mild (n = 411), moderate (n = 226), and severe (n = 147) intrauterine growth retardation. Compared with non-growth-retarded infants of the same gestational age, growth-retarded infants had substantially lower lengths, head circumferences, and proportionality ratios, and the magnitude of the deficits increased significantly with increasing degrees of growth retardation. When the comparison was based on birth weight rather than gestational age, however, growth-retarded infants had slightly but significantly greater lengths and head circumferences, with increased variability in body proportions, but no evidence of the bimodality that would characterize two distinct subtypes. The analysis suggests that proportionality among intrauterine growth-retarded infants represents a continuum, with progressive disproportionality as severity of growth retardation increases. Moreover, despite evidence of some "sparing," the absolute magnitudes of the deficits in length and head growth remain substantial.     

出生早期体重增长速率对早产儿矫正12月龄时神经发育的影响

目的 研究早产儿出生早期的体重增长速率对矫正12月龄时神经发育的影响.方法 收集2015年7月1日至2019年12月31日期间在广州医科大学附属第三医院新生儿科出院,且在该院高危儿门诊随访的早产儿的相关资料,根据其出生至矫正胎龄40周时的体重增长速率分为低速率组[<10 g/(kg·d);21例]和高速率组[≥10 g...     

Pre- and postoperative growth in persistent ductus arteriosus

Children with a persistent ductus arteriosus requiring ligation under 6 months of age show evidence of intrauterine growth retardation. By the time of operation the weight centile of 17 (71%) of 24 such infants had fallen, but 20(84%) of the 24 gained weight postoperatively. Those who did not so were either large-for-dates infants growing towards the normal or small-for-dates infants who remained small postoperatively.     

Pre- and post-natal growth in children of women who smoked in pregnancy

Pre- and post-natal growth was studied from week 17 of pregnancy until 5 years of age in children of women who reported daily smoking at the time of conception, and compared to the growth in children of non-smokers. Fetal abdominal diameter, femur length and biparietal diameter were measured in weeks 17 and 37 of pregnancy, and weight, height and head circumference were measured at birth, and at 6, 13 and 60 months of age in 185 children of smokers and 345 children of non-smokers. Cross sectional data at birth showed that infants of smokers had lower weight and length, but similar ponderal index as infants of non-smokers, and this may suggest a symmetrical growth retardation. Longitudinal growth curves indicated that the growth retardation took place in the second half of pregnancy. During the first 5 years of life, children of smokers had complete catch-up growth in weight, a partial catch-up in height, and no catch-up growth in head circumference. At 5 years, children of smokers had a higher ponderal index and skinfold thickness, suggesting that these children, on average, were more obese than children of non-smokers.     

早产儿出院后追赶生长的随访观察及宫外发育迟缓的影响因素

目的 研究早产儿纠正月龄6个月内追赶生长的情况,并分析宫外发育迟缓（EUGR）的影响因素。方法 选取在新生儿重症监护病房治疗后出院的,并建立序贯化定期随访档案且有完整随访记录的早产儿321例,按2015年“早产儿保健工作规范”出院后分组随访标准分为低危早产儿组（n=69）和高危早产儿组（n=252）。采用Z评分法对体重、身长和头围进行评估,分析早产儿纠正月龄6个月内追赶生长情况。并采用多因素logistic回归分析探讨6月龄EUGR发生的危险因素。结果 低危组和高危组两组早产儿体重、身长和头围的Z值 < -2（未达追赶生长）的百分比均随纠正月龄增加而逐渐下降,其中低危组早产儿纠正月龄6个月时体重、身长和头围未达追赶生长的比例分别降为1.4%（1/69）、2.9%（2/69）和 1.4%（1/69）,高危组早产儿相应的比例为1.2%（3/252）、1.6%（4/252）和3.6%（9/252）。高危组纠正6月龄EUGR发生率高于低危组（28.2% vs 15.9%,P=0.039）。多因素logistic回归分析显示,早产儿纠正6月龄EUGR的危险因素包括多胎（OR=2.68,P=0.010）、出生体重较低（<1 000 g：OR=14.84,P < 0.001;1 000~1 499 g：OR=2.85,P=0.005）、宫内发育迟缓（OR=11.41,P < 0.001）,而出生后营养强化可降低EUGR的风险（OR=0.25,P < 0.001）。结论 早产儿多可在纠正月龄6个月内达追赶生长;高危早产儿6月龄EUGR发生率较高;多胎、低出生体重、宫内发育迟缓为早产儿EUGR的危险因素,而出生后合理营养强化可降低早产儿EUGR的发生。     

新生儿重症监护病房中早产儿营养相关状况多中心调查974例报告

目的 了解我国早产儿在出生后早期的营养状况和影响其生长的高危因素.方法 采用回顾性调查的方法 ,收集2005年1月1日至2006年6月30日10所医院早产儿的临床资料,对影响早产儿生长的危险因素进行分析.组间行X2检验,计量资料行t检验.结果入选对象1000例,收集合格调查表974份.中位胎龄32.6周,中位出生体重1732.2 g.开始喂养时间为2(1,3)d.早产配方奶喂养占77.0%,母乳+早产配方奶喂养占13.6%.肠外营养应用氨基酸占87.3%,开始使用时间为2.5(2,3)d;平均使用时间为11(6,17)d;应用脂肪乳剂占56.9%,开始使用时间为3(2,5)d;平均使用时间为12(7,18)d.住院期间总热卡达120 kcal/(kg·d)者占74.1%,达标日龄平均为(16.3±9.4)d;口服热卡达100 kcal/(kg·d)者占84.1%,达标日龄平均为(17.0±9.4)d.早产儿平均生理性体重下降幅度为出生体重的7.54%±4.7%,恢复体重日龄(10.92±5.10)d,住院期间平均体重增长速度(13.4±6.0)g/(kg·d).对696例单胎早产儿在出院时以相应胎龄的百分位数进行评价,分别有60.0%、58.9%、29.5%的早产儿其体重、身高和头围低于第10百分位,较出生时有较大幅度的提高.结论出生体重小于第10百分位、开始喂养时间晚和体重增长速度慢是导致早产儿生后生长迟缓的危险因素.积极的营养支持策略对改善我国早产儿的营养状况及远期预后有重要意义.