Intensive Care Nursery House Staff Manual

69
Copyright © 2004 The Regents of the University of California

Intrauterine Growth Retardation

CLINICAL SIGNIFICANCE: Intrauterine growth retardation (IUGR) affects 3-10% of
pregnancies; 20% of stillborn infants have IUGR. Perinatal mortality rates are 4-8 times
higher for growth retarded infants, and morbidity is present in 50% of surviving infants.
DEFINITIONS and CLASSIFICATION:
-AGA, appropriate for gestational age: Birth weight is between 10th and 90th percentile
for infant’s gestational age (GA).
-LGA, large for gestational age: Birth weight >90th percentile for GA.
- SGA, small for gestational age: Birth weight <10th percentile for GA. Other definitions
are sometimes used for SGA, including <3rd percentile for GA or more than 2 S.D.
below the mean.
-IUGR vs. SGA: IUGR refers to deviation and reduction in expected fetal growth
pattern. Multiple adverse conditions inhibit normal fetal growth potential. Not all
IUGR infants are SGA.
ASYMMETRIC vs. SYMMETRIC GROWTH RETARDATION: Most growth
retarded infants have asymmetric growth restriction. First there is restriction of weight
and then length, with a relative “head sparing” effect. This asymmetric growth is more
commonly due to extrinsic influences that affect the fetus later in gestation, such as
preeclampsia,
chronic hypertension, and uterine anomalies. Postnatal growth after IUGR
depends on cause of growth retardation, postnatal nutritional intake, and social
environment. Symmetric growth retardation affects all growth parameters. In the human
brain, most neurons develop prior to the 18th week of gestation. Early gestational growth
retardation would be expected to affect the fetus in a symmetric manner, and thus have
permanent neurologic consequences for the infant. Examples of etiologies for symmetric
growth retardation include genetic or chromosomal causes, early gestational intrauterine
infections (TORCH) and maternal alcohol use.
CAUSAL FACTORS:
A. Maternal
-Before pregnancy:
• Prepregnancy weight influences fetal size
• Periconceptual nutritional status can affect embryogenesis (e.g., folate deficiency).
-During pregnancy: Factors that may adversely affect fetal growth include:
• Low pre-pregnancy weight and small maternal size
• Recent pregnancy and/or high parity
• Poor weight gain during pregnancy, especially in latter half
• Chronic illness - such as malabsorption, diabetes, renal disease
• Inadequate or poorly balanced intake associated with alcoholism, drug abuse,
poverty, adolescence, anorexia nervosa, food faddism
• Maternal drug and alcohol use also influence maternal nutrition.
• Decreased O2 availability to fetus (e.g., high altitude, severe maternal anemia)
Intrauterine Growth Retardation
70
Copyright © 2004 The Regents of the University of California
B. Uterine and placental factors that can adversely affect fetal growth include
inadequate placental growth, uterine malformations, decreased utero-placental blood
flow (e.g., toxemias of pregnancy, diabetic vasculopathy) and multiple gestations
C. Fetal causes are unusual, include familial genetic and chromosomal abnormalities and
intrauterine infections (i.e., TORCH), and usually have a poor long term prognosis.
PATHOPHYSIOLOGY: With maternal or placental causes of IUGR, there is decreased
placental transfer of nutrient (including oxygen) resulting in reduced fetal body stores of
lipids and glycogen resulting in neonatal hypoglycemia; chronic hypoxemia stimulates
erythropoietin production leading to polycythemia. These infants are also at increased
risk for perinatal asphyxia. Other associated problems include hypocalcemia, pulmonary
hemorrhage, hypothermia and, with IUGR associated with toxemia, thrombocytopenia
and leukopenia. With fetal causes, decreased growth is constitutive (due to genetic
factors) or secondary to infection.
ASSESSMENT and MANAGEMENT:
-Treat asphyxia if present.
-Measure weight, head circumference and length to categorize the type of IUGR.
-Careful physical examination for anomalies and dysmorphic features.
-Blood glucose and hematocrit to detect hypoglycemia and polycythemia. See
sections on Hypoglycemia (P. 153) and on Polycythemia (P. 112).
-Serum Ca++, WBC count with differential and platelet count.
-Infants with IUGR due to placental factors have ↑ O2 consumption. This ↑ insensible
water loss to a variable degree (as much as 20-30%). Compensate for this by
increasing IV fluid intake. These infants may also need greater intake (>150 mL/kg/d
and >100 kcal/kg/d) to achieve adequate growth.
-Further workup and treatment depends on abnormalities identified on history and
physical examination.
OUTCOME:
-Perinatal mortality for IUGR infants is 5-20 times greater than for AGA, mainly due
to intrauterine death, perinatal asphyxia, and congenital anomalies.
-Neurologic morbidity is 5-10 times higher than for AGA infants, especially for
infants with ↓ head circumference at birth. Intellectual and motor function (excluding
those with congenital infections, chromosomal abnormalities) depends on adverse
perinatal events and on the specific cause of growth restriction. Early identification
and treatment of hypoglycemia and polycythemia improves outcome. Neurologic
abnormalities are usual with genetic and infectious causes of IUGR.
-Retarded growth: With placental causes of IUGR, catch-up growth occurs after birth,
but these patients usually remain smaller than expected.
-Fetal “programming” of cardiovascular disease: Recent studies implicate IUGR
with adult onset of hypertension, coronary heart disease, hypercholesterolemia, and
diabetes. These studies suggest that IUGR has long term affects on endocrine
development and homeostasis.
 [Hide]
Please help with the Wikimedia strategic planning process! [Help us with
Discuss the Strategy Task Forces' recommendations. translations!]

Small for gestational age

From Wikipedia, the free encyclopedia
Jump to: navigation, search

Small for gestational age

Classification and external resources

ICD-10 P05., P07.

ICD-9 764, 765

DiseasesDB 31952

MeSH D007230

Small for gestational age (SGA) babies are those whose birth weight lies below the 10th
percentile for that gestational age.
Appropriate for gestational age (AGA) are those whose birth weight lies above the 10th
percentile for that gestational age and below the 90th percentile for that gestational age.
Small for gestational age babies have usually been the subject of intrauterine growth
restriction (IUGR), formerly known as intrauterine growth retardation.[1]

Gestational age and birth weight of infants born at 24 to 46 weeks' gestation. Infants are
classified as large for gestational age (LGA), appropriate for gestational age (AGA), or small for
gestational age (SGA). Another classification which takes in consideration only the weight and
not the gestational age, is low body weight (LBW), VLBW and ELBW.
Low birth weight (LBW) is defined as a fetus that weighs less than 2500 g (5 lb 8 oz) regardless
of gestational age. Other definitions include Very Low Birth Weight (VLBW) which is less than
1500 g, and Extremely Low Birth Weight (ELBW) which is less than 1000 g.[2] Normal Weight
at term delivery is 2500 g - 4200 g.
SGA is not a synonym of LBW, VLBW or ELBW. Example: 35 week gestational age delivery,
2250g weight is appropriate for gestational age but is LBW. One third of low-birth-weight
neonates-infants weighing less than 2500g - are small for gesational age.
There is a 8.1% incidence of low birth weight in developed countries, and 6–30% in developing
countries. Much of this can be attributed to the health of the mother during pregnancy. One third
of babies born with a low birth weight are also small for gestational age.

Contents
[hide]
• 1 Diagnosis
• 2 Predetermining factors
• 3 Categories of growth restriction
○ 3.1 Symmetrical
○ 3.2 Asymmetrical
• 4 Treatment
 • 5 Support
• 6 References

[edit] Diagnosis
The condition is generally diagnosed by measuring the mother's uterus, with the fundal height
being less than it should be for that stage of the pregnancy. If it is suspected, the mother will
usually be sent for an ultrasound to confirm.
[edit] Predetermining factors
The risk factor/etiology can be broadly divided into 3 categories-
• Fetal
• Maternal
• Placental
The primary risk factor is that development of the placenta is insufficient to meet the demands of
the fetus, resulting in malnutrition of the developing fetus. There are numerous contributing
factors, of both environmental and genetic origin:
• Environmental factors such as poor nutrition, tobacco smoking, drug addiction or
alcoholism
• Severe anaemia (although hydrops may also occur)
• Thrombophilia (tendency for thrombosis)
• Prolonged pregnancy
• Pre-eclampsia
• Chromosomal abnormalities
• Damaged or reduced placental tissue due to:
○ Chronic renal failure
○ Sickle cell anemia
○ Phenylketonuria
• Infections such as rubella, cytomegalovirus, toxoplasmosis or syphilis
• Twins and multiple births.
[edit] Categories of growth restriction
There are two distinct categories of growth restriction, indicating the stage at which the
development was slowed. Small for gestational age babies can be classified as having
symmetrical or asymmetrical [asymmetrical] growth restriction.[3][4]
[edit] Symmetrical
Symmetrical growth restriction, less commonly known as global growth restriction, indicates
that the fetus has developed slowly throughout the duration of the pregnancy and was thus
affected from a very early stage. The head circumference of such a newborn is in proportion to
the rest of the body. Common causes include:
 • Early intrauterine infections, such as cytomegalovirus, rubella or toxoplasmosis
• Chromosomal abnormalities
• Chronic high blood pressure
• Severe malnutrition
• Anemia
• Maternal substance abuse (prenatal alcohol use can result in Fetal alcohol syndrome)
[edit] Asymmetrical
Asymmetrical growth restriction occurs when the embryo/fetus has grown normally for the
first two trimesters but encounters difficulties in the third, usually pre-eclampsia. Such babies
have a disparity in their length and head circumference when compared to the birth weight. A
lack of subcutaneous fat leads to a thin and small body out of proportion with the head. Other
symptoms include dry, peeling skin and an overly-thin umbilical cord, and the baby is at
increased risk of hypoxia and hypoglycaemia.
[edit] Treatment
Possible treatments include the early induction of labour, though this is only done if the
condition has been diagnosed and seen as a risk to the health of the fetus.
[edit] Support
The MAGIC Foundation for Children's Growth[1]
[edit] References
1. ^ "eMedicine - Intrauterine Growth Retardation : Article by Vikram S Dogra, MD".
http://www.emedicine.com/radio/topic364.htm. Retrieved 2007-11-28.
2. ^ "eMedicine - Extremely Low Birth Weight Infant : Article by KN Siva Subramanian, MD".
http://www.emedicine.com/ped/topic2784.htm. Retrieved 2007-11-28.
3. ^ "Intrauterine Growth Restriction".
http://www.obgyn.ufl.edu/ultrasound/MedinfoVersion/sec7/7_3.html. Retrieved 2007-11-28.
4. ^ "Intrauterine Growth Restriction: Identification and Management - August 1998 - American
Academy of Family Physicians". http://www.aafp.org/afp/980800ap/peleg.html. Retrieved 2007-
11-28.
[hide]
v•d•e
Certain conditions originating in the perinatal period / fetal disease (P, 760-
779)

placenta: Placenta praevia · Placental insufficiency · Twin-to-

Maternal factors and twin transfusion syndrome
complications of
pregnancy, chorion/amnion: Chorioamnionitis
labour and delivery umbilical cord: Umbilical cord prolapse · Nuchal cord ·
Single umbilical artery
Length of gestation Small for gestational age/Large for gestational age · Preterm
and fetal growth birth/Postmature birth

Cephalhematoma · Brachial plexus lesion (Erb's palsy,

Birth trauma
Klumpke paralysis)

Intrauterine hypoxia · Infant

respiratory distress syndrome ·
Transient tachypnea of the
newborn · Meconium aspiration
Respiratorysyndrome · pleural disease
(Pneumothorax,
Pneumomediastinum) · Wilson-
Mikity syndrome ·
Bronchopulmonary dysplasia

Pneumopericardium · Persistent fetal

Cardiovascular
circulation

Vitamin K deficiency
(Haemorrhagic disease of the
newborn) · Hemolytic disease of the
newborn (ABO HDN • Anti-Kell
Haemorrhagic and
By system HDN • Rhesus c HDN • Rhesus D
haematological/
HDN • Rhesus E HDN) · Rh
hematologic disease
disease · Hydrops fetalis ·
Hyperbilirubinemia (Kernicterus,
Neonatal jaundice)
Velamentous cord insertion

Ileus · Necrotizing enterocolitis ·

Digestive system
Meconium peritonitis

Integument and
Erythema toxicum
temperature regulation

Nervous systemPeriventricular leukomalacia

Gray baby syndrome · muscle tone

Musculoskeletal
(Congenital hypertonia, Congenital
system
hypotonia)

Perinatal infection (Congenital rubella syndrome, Neonatal

herpes simplex) · Omphalitis · Neonatal sepsis (Group B
Other disorders
streptococcal infection)
Stillbirth/Perinatal mortality
 obstetric navs: pregnancy, conditions of mother/fetus/maternal transmission, eponymous
signs, proc
Retrieved from "http://en.wikipedia.org/wiki/Small_for_gestational_age"
Categories: Obstetrics | Pediatrics
Views
• Article
• Discussion
• Edit this page
• History
Personal tools
• Try Beta
• Log in / create account
Navigation
• Main page
• Contents
• Featured content
• Current events
• Random article
Search
Top of Form

Special:Search Go Search

Bottom of Form
Interaction
• About Wikipedia
• Community portal
• Recent changes
• Contact Wikipedia
• Donate to Wikipedia
• Help
Toolbox
• What links here
• Related changes
• Upload file
• Special pages
• Printable version
 • Permanent link
• Cite this page
Languages
• Deutsch
• Español
• ‫עברית‬
• This page was last modified on 14 January 2010 at 12:20.
• Text is available under the Creative Commons Attribution-ShareAlike License;
additional terms may apply. See Terms of Use for details.
Wikipedia® is a registered trademark of the Wikimedia Foundation, Inc., a non-profit
organization.
• Contact us
• Privacy policy
• About Wikipedia
• Disclaimers

AIIMS- NICU protocols 2007

Management of infants with intra-uterine
growth restriction
Ashok K Deorari, Ramesh Agarwal , Vinod K Paul
Division of Neonatology, Department of Pediatrics
All India Institute of Medical Sciences
Ansari Nagar, New Delhi –110029
Address for correspondence:
Dr Ashok Deorari
Professor
Department of Pediatrics
All India Institute of Medical Sciences
Ansari Nagar, New Delhi 110029
Email: sdeorari@yahoo.com
Downloaded from www.newbornwhocc.org 1
AIIMS- NICU protocols 2007
Abstract
Intra-uterine growth restriction (IUGR) contributes to almost two-thirds of
LBW infants born in
India. Poor nutritional status and frequent pregnancies are common pre-
disposing conditions in
addition to obstetric and medical problems during pregnancy. Growth
restriction may be
symmetrical or asymmetrical depending on the time of insult during
pregnancy. The pathological
insult in an asymmetrical IUGR occurs during the later part of the pregnancy
and has a brainsparing
effect. Common morbidities are more frequent in <3rd percentile group as
compared to 3rd–
10th percentile group. Guidelines for management of IUGR neonates in these
two groups have been
provided in the protocol.
Downloaded from www.newbornwhocc.org 2
AIIMS- NICU protocols 2007
Introduction
Nearly one third of neonates born in India are low birth weight (LBW),
weighing less than 2500
grams at birth. A baby’s low birth weight is either the result of preterm birth
(before 37 completed
weeks of gestation) or due to intrauterine growth restriction (IUGR). Later
condition is akin to
malnutrition and may be present in both term and preterm infants. Neonates
affected by IUGR are
usually undernourished, undersized and therefore, low birth weight. Two-
third LBW neonates
born in India fall in this category1. Since IUGR neonates are more likely to
suffer complications
including cold stress and hypoglycemia, it is important that these infants are
identified and
managed appropriately at birth2. Even after recovering from neonatal
complications, they remain
more prone to poor physical growth, poor neurodevelopmental outcome,
recurrent infection and
chronic diseases (hypertension, hyperlipidemia, diabetes mellitus, coronary
heart disease) later in
life3.
IUGR and SGA (Small-for-gestational age)
Although both the terms are used inter-changeably and both denote
malnutrition, there is a minor
difference in the terminology. SGA a statistical definition, is used for
neonates whose birth weight
is lower than (less than 10th percentile for that particular gestational age)
population norms. IUGR
is a clinical definition and includes neonates with clinical evidence of
malnutrition. This may be in
the form of loose skin folds on the face and in the gluteal region, absence of
subcutaneous fat and
peeling of skin. Although most IUGR infants would also be SGA, it is possible
that a small
minority of IUGR infants may have birth weights above the 10th percentile.
These morphological
IUGR infants would behave like SGA infants and should be managed along
the same lines as SGA
infants. For purposes of discussion in this paper, the term IUGR would include
both the groups of
infants .
Downloaded from www.newbornwhocc.org 3
AIIMS- NICU protocols 2007
Etiology
Poor nutritional status of the mother and frequent pregnancies are the major
cause of IUGR.
Mothers with a weight of less than 40 kg and a height of less than 145 cm
often give birth to SGA
infants. Insufficient nutritional intake during pregnancy also has an adverse
effect on fetal weight.
Maternal hypertension, pre-eclampsia, post-maturity, frequent pregnancies,
multiple pregnancy,
anemia, malaria and tobacco use are other causes of IUGR4-6. Chronic
maternal diseases of heart,
kidneys, lungs or liver may also lead to IUGR.
Types of IUGR
Infants with IUGR are often classified as having symmetrical (head
circumference, length and
weight equally affected) or asymmetrical (with relative head growth sparing)
growth restriction.
Infants with symmetric IUGR often have an earlier onset and are associated
with causes that affect
total fetal cell number including chromosomal, genetic, teratogenic, intra-
uterine infections and
severe hypertensive etiologies. Asymmetric IUGR is often of a later onset,
demonstrates
preservation of blood flow to brain and is associated with poor maternal
nutrition or late onset
exacerbation of maternal vascular disease (pre-eclampsia, chronic
hypertension)7.
Clinical features
IUGR or SGA infants are often term or near-term in gestation. Their birth
weight usually falls
below the 10th percentile8 The neonate has an emaciated look and loose skin
because of lack of
subcutaneous tissue. These are particularly prominent over the buttocks and
the thighs. They look
alert and are often plethoric. Comparison of the head circumference with
chest circumference is
helpful in the identification of a SGA infant. In infants with appropriate
growth, the head size is
usually bigger than the chest by about 2-cm. In SGA infants, the head
circumference usually
Downloaded from www.newbornwhocc.org 4
AIIMS- NICU protocols 2007
exceeds the chest circumference by more than 3 cm. A preterm SGA infant
would have a
combination of clinical features suggestive of both, prematurity and IUGR9.
Problems of SGA infants
Common neonatal morbidities encountered in SGA infants born in our
hospital are given in Table
1. The common morbidities encountered in IUGR neonates include: (a)
perinatal asphyxia, (b)
hypothermia, (c) hypoglycemia and (d) polycythemia. These morbidities are
commoner in the
more severely gr
owth restricted babies (<3rd percentile) as compared to babies in the 3rd to
10th percentile category.
From August 2004 to July 2005, 144 SGA babies were born in our hospital. 24
(17%) developed
hypoglycemia and 14 (10%) had polycythemia requiring partial exchange
transfusion. Amongst 24
babies with hypoglycemia 50% of the total episodes occurred at 2 h, 22% at
48 h, 11% each at 6
and 12 h and only 4% each at 24 and 72 h of age. 12 (50%) had multiple
episodes of
hypoglycemia. 3 babies were symptomatic and required intravenous fluid
therapy. Rest were
managed with supplementary oral feeds. Of 14 babies with polycythemia,
only 3 were
symptomatic. Polycythemia was detected at 2 h in 50%, at 6 h in 29%, at 12
h in 14% and only 7%
at 24 h of life. No cases of polycythemia were detected at 48 and 72 h of life.
Management
Early delivery is indicated if there is arrest of fetal growth and pulmonary
maturity is satisfactory.
Fetal hypoxia may necessitate emergency cesarean section and one should
be prepared to receive
an asphyxiated infant. If liquor is meconium stained and the neonate is
depressed, endotracheal
suctioning is essential10. Infant should be screened for any congenital
malformations. Based on
initial assessment, decision is taken to either keep the infant in nursery or
with mother.
Birth weight 3rd – 10th percentile
Downloaded from www.newbornwhocc.org 5
AIIMS- NICU protocols 2007
In the absence of complications including perinatal asphyxia and respiratory
distress, these
neonates may be managed with the mother (Table 2). Skin-to-skin care helps
in maintaining
temperature and facilitates breast-feeding. Early initiation of breastfeeding
and/ or assisted feeding
helps in averting hypoglycemia. Term SGA infants usually do not pose any
serious difficulties
because they have no problems in direct breast-feeding. To avoid
hypoglycemia, they should be put
to breast within one hour of birth. However these infants are at risk of
morbidities and should be
monitored regularly for hypoglycemia and polycythemia in the first 48-72
hours.
Neonates with asymptomatic hypoglycemia should be supplemented with
sugar fortified formula
feeds. This may be given with the help of a cup and spoon/ paladai.
Neonates with normoglycemia
on regular feeds should be gradually weaned to exclusive breast-feeding
within the next 3-4 days.
Failure to maintain normoglycemia despite regular oral feeds should be
treated with IV fluids.
Neonates with symptomatic hypoglycemia should be shifted to a special care
nursery and managed
appropriately with a glucose bolus followed by a continuous glucose infusion
at 6-8 mg/kg/min.
Neonates with asymptomatic polycythemia and a hematocrit <75 maybe
managed conservatively
by increasing fluid intake. The infant should receive regular (2-3 hourly)
breast feeds with extra
supplementation. Infants with symptomatic polycythemia or hematocrit >75
should be managed by
partial exchange transfusion in the neonatal intensive care unit11.
Birth weight <3rd percentile, gestation <35 weeks
Neonates with severe growth restriction (<3rd percentile) or with presence of
complications should
be managed in the intensive care unit (Table 2). This group would include
infants with perinatal
asphyxia, symptomatic hypoglycemia, symptomatic polycythemia,
prematurity (<35 weeks),
respiratory distress and hypothermia. They should be monitored for
hypoglycemia, polycythemia
and feed intolerance in the initial few days.
Downloaded from www.newbornwhocc.org 6
AIIMS- NICU protocols 2007
Infants with gestation <30 weeks (birth weight <1200 grams) should be
started on IV fluids
initially and gradually weaned to oral feeds over the next few days. In the
absence of other
complications, oro-gastric feeds should be started for neonates >30 weeks
(>1200 grams) and
gradually shifted to katori-spoon/ paladai feeding. An infant on full oral feeds
with spoon-feeding
may be tried on direct breast-feeding. These high-risk infants need to be
observed for a minimum
of 72 hours for hypoglycemia. Infants on full katori-spoon feeding and/ or
breast-feeding may be
shifted to the mother after 72 hours if she is confident of on going-care.
Paladai/ spoon feeding
Feeding with a spoon (or a similar device such as ‘paladai’) and katori (or
any other receptacle
such as cup) has been found to be safe in SGA infants8. This mode of feeding
is a bridge between
gavage feeding and direct breast-feeding. It is based on the premise that
neonates with a gestation
of 30-32 weeks or more are in a position to swallow the feeds satisfactorily
even though they may
not be good at sucking or coordinated sucking and swallowing. A medium
sized katori and a small
(1-2 ml size) spoon should be used. The spoon should be filled just short of
the brim with
expressed milk, should be placed at the corner of mouth and milk should be
allowed to flow into
the infant’s mouth slowly, avoiding any spillage. The infant would actively
swallow the milk. This
process should be repeated till the required amount has been fed. If the
infant does not actively
accept and swallow the feed, an attempt should be made to wake the infant
with gentle stimulation.
If he is still sluggish, do not insist on this method. It is better to switch back
to gavage feeds till the
infant is ready.
SGA/IUGR babies with absent or reversed end-diastolic flow (AREDF)
in umbilical artery
In the IUGR fetus, hypoxaemia produces circulatory redistribution towards
the brain and away
from the viscera and placenta, culminating in umbilical artery or aortic
AREDF in the most
Downloaded from www.newbornwhocc.org 7
AIIMS- NICU protocols 2007
severely affected fetuses. The combination of antenatal and persisting
postnatal disturbances of gut
perfusion, interacting with the metabolic demands of feeding, may adversely
affect intestinal tissue
oxygenation, combining with stasis and immunological factors to contribute
to the development of
NEC. A review by Dorling et al including 14 studies and 1178 neonates found
higher risk of NEC
in IUGR babies with AREDF (odds ratio: 2.13; 95% CI: 1.49 to 3.03).12
Although evidence for
feeding strategy to be adopted in these babies is limited, it may be prudent
to start and persist with
minimal enteral nutrition for first 48-72 h of life.
Long-term outcome and follow-up
IUGR babies are at risk for poor growth and neuro-developmental outcome.3
We routinely follow
IUGR babies with birthweight below <3rd percentile and those with
birthweight 3-10th percentile if
they develop significant morbidities (e.g. hypoglycemia, polycythemia, birth
asphyxia) during
hospital stay.
Downloaded from www.newbornwhocc.org 8
AIIMS- NICU protocols 2007
References
1. United Nations Childrens Fund and World Health Organization, Low
Birthweight:
Country,regional and global estimates. UNICEF, New York, 2004.
2. Arora NK, Paul VK, Singh M. Morbidity and mortality in term infants with
intrauterine growth
retardation. J Trop Pediatr 1987;33: 186-9.
3. Teberg AJ, Walther FJ, Pena IC. Mortality, morbidity, and outcome of the
small-for-gestationalage
preterm infant. Semin Perinatol 1988;12: 84-94.
4. Mavalankar DV, Gray RH, Trivedi CR, Parikh VC. Risk factors for small for
gestational age
births in Ahmedabad, India. J Trop Pediatr 1994;40:285-90.
5. Arora NK, Singh M, Paul VK, Bhargava VL. Etiology of fetal growth
retardation in hospital
born infants. Indian J Med Res 1987;85:395-400.
6. Bhatia BD, Agarwal KN, Jain NP, Bhargava V. Growth pattern of
intrauterine growth retarded
(IUGR) infants in first nine months of life. Acta Pediatr Scand 1984;73:189-96.
7. Singh M. Disorders of weight and gestation. In Care of the Newborn (Ed)
Singh M. 5th Ed,
1999, Sagar Publications, New Delhi pp 224-45.
8. Singh M, Giri SK, Ramachandran K. Intrauterine growth curves of live-born
infants. Indian
Pediatr 1974;11: 475-9.
9. Paul VK. Management of LBW babies. In NNF Teaching Aids on Newborn
Care. Ed Deorari
AK. 2nd Ed, 1998, Noble Vision, New Delhi pp 25-36
10. Niermayer S, Kattwinkel J, Van Reempts P, Nadkarni V, Phillips B,
Zideman D et al.
International guidelines for neonatal resuscitation. An excerpt from the
guidelines 2000 for
cardiopulmonary resuscitation and emergency cardiovascular care.
International consensus on
Downloaded from www.newbornwhocc.org 9
AIIMS- NICU protocols 2007
Science. Contributors and reviewers for the neonatal resuscitation
guiidelines. Pediatrics
2000;106:E29.
11. Deorari AK, Paul VK, Shrestha L, Singh M. Symptomatic neonatal
polycythemia: comparison
of partial exchange transfusion with saline versus plasma. Indian Pediatr
1995;32: 1167-71
12. Dorling J, Kempley S, Leaf A. Feeding growth restricted preterm infants
with abnormal
antenatal Doppler results. Arch Dis Child Fetal Neonatal Ed. 2005;90:F359-
63.
Downloaded from www.newbornwhocc.org 10
AIIMS- NICU protocols 2007
Table 1: Common morbidities in SGA neonates
Period: Jan 1999 to Dec 00
(n=156)
Period: Aug 04 to Jul 05
(n=144)
Weight <3rd
percentile
(n=47)
Weight 3rd-10th
percentile
(n=109)
Weight <10th
percentile
(n=144)
Birth asphyxia
Total
Moderate
Severe
4 (8.5%)
22
10 (9.2%)
82
25 (17%)
--
Hypoglycemia
Total
Symptomatic
Asymptomatic
12 (25.5%)
66
14 (12.8%)
3
11
24 (17%)
3
21
Polycythemia
Total
Symptomatic
Asymptomatic
14 (29.8%)
3
11
17 (15.6%)
89
14 (10%)
3
11
Hypothermia 0 4 (3.7%) 19* (13.2%)
*Includes 1 baby with hypothermia and 18 babies with cold stress
Downloaded from www.newbornwhocc.org 11
AIIMS- NICU protocols 2007
Table 2: Management of SGA infants
Criteria for admission to Nursery
- All SGA infants < 2 SD (3rd percentile)
- Infants with gestational age < 35 wks
- Infants with birth asphyxia, respiratory distress etc.
Care of SGA infants with mothers (birth weight between 3rd and
10th percentile,
gestation >35 wks)
• Early initiation of breast feeding (within 1 hour)
• Skin-to-skin care to maintain temperature, monitoring of cold
stress by mother
and health professionals.
• Monitor blood sugar, hematocrit
• Prevent infections
Care of SGA infants in Nursery (birth weight <3rd percentile or
gestation <35 wks)
• Nurse in thermo neutral environment
• It stable, early initiation of feeds ( EBM).
- Feed by orogastric tube or katori-spoon /paladai if gestation >32
wks
- Initial intravenous fluids followed by orogastric or katori-
spoon /paladai if
gestation <32 wks
• Monitor blood sugar, hematocrit
Care of SGA infants with absent or reversed en-diastolic blood
flow
• At higher risk of development of NEC
• If preterm (gestation <32 weeks): Nil per oral or on minimal
enteral nutrition
for first 48-72 h of life followed by gradual advancement of feed
volume
Downloaded from www.newbornwhocc.org 12
AIIMS- NICU protocols 2007
Figure 1: Algorithm for management of SGA infants
SGA*
Term (borderline) <35 wk
<3rd percentile 3rd –10th percentile
Admit nursery Monitor with mother Admit nursery
Breastfeeding or katori-spoon Breastfeeding <30 wk – initial on IV
30 – 34 wk orogastric or katori-spoon
*Blood sugar, hematocrit, temperature monitoring
Downloaded from www.newbornwhocc.org 13
 PREMATURITY AND IUGR
The causes of neonatal hypoglycemia can be categorized according to associated
disturbances in one or more of the processes required for normal hepatic glucose
production that may lead to transient or prolonged episodes of hypoglycemia (Table
1 ). Hepatic glycogen stores are limited in both preterm infants, who have not
experienced the period of rapid glycogen accumulation during late gestation, and
small-for-gestational age (SGA) infants, who have not had adequate substrate
supply available for glycogen synthesis, which puts these newborns at risk for
hypoglycemia. IUGR due to placental insufficiency with preservation of normal head
size puts an added demand on the infant's already low glycogen stores because of
the increased brain-to-bodyweight ratio. Postterm infants and infants of multiple
gestations also may be at risk because of the presence of relative placental
insufficiency. In addition to decreased glycogen availability, studies in preterm and
IUGR infants have found altered patterns of insulin secretion, substrate metabolism,
and hormonal responses to changes in blood glucose concentration compared with
appropriate-for-gestational age (AGA) term infants.

University of Virginia Health System Skip Navigation

• Health System

• Calendars

• Maps

• A-Z Index

• UVa

Top of Form

Keyw ord or Nam HS Web Submit

Bottom of Form
• Home

• Why Choose UVa

• Make an Appointment

• Patients & Visitors

• Health Professionals

• Careers

UVa Health.com... where Answers are found

• Newsletters
• Breast Health
• Diabetes Health
• Heart Health
• Men's Health
• Women's Health
• Parenting
• Mind & Body
• Find a Doctor
○ Adult Congenital Heart and Pregnancy
○ Diabetes and Pregnancy
○ High-Risk Obstetrics
○ Reproductive Genetics
○ Teen Health

• Maps & Directions

• Calendar of Events
• Clinical Trials
• Why Choose UVa

Top of Form

Adolescent Medicine
Allergy/Asthma/Immunology
Arthritis & Rheumatology
Blood Disorders
Burns
Cancer
Topics

go

Bottom of Form
Top of Form

USSEARCH /UVAHealth/peds Go

Search This Site

Bottom of Form
En Español
High-Risk Pregnancy

Intrauterine Growth Restriction (IUGR)

What is intrauterine growth restriction (IUGR)?
Intrauterine growth restriction (IUGR) is a term used to describe a condition in which the fetus is
smaller than expected for the number of weeks of pregnancy. Another term for IUGR is fetal
growth restriction. Newborn babies with IUGR are often described as small for gestational age
(SGA).
A fetus with IUGR often has an estimated fetal weight less than the 10th percentile. This means
that the fetus weighs less than 90 percent of all other fetuses of the same gestational age. A
fetus with IUGR also may be born at term (after 37 weeks of pregnancy) or prematurely (before
37 weeks).
Newborn babies with IUGR often appear thin, pale, and have loose, dry skin. The umbilical cord
is often thin and dull-looking rather than shiny and fat. Babies with IUGR sometimes have a
wide-eyed look. Some babies do not have this malnourished appearance but are small all-over.
What causes intrauterine growth restriction (IUGR)?
Intrauterine growth restriction results when a problem or abnormality prevents cells and tissues
from growing or causes cells to decrease in size. This may occur when the fetus does not receive
the necessary nutrients and oxygen needed for growth and development of organs and tissues,
or because of infection. Although some babies are small because of genetics (their parents are
small), most IUGR is due to other causes. Some factors that may contribute to IUGR include the
following:
• Maternal factors:

○ high blood pressure

○ chronic kidney disease
○ advanced diabetes
○ heart or respiratory disease
○ malnutrition, anemia
○ infection
○ substance abuse (alcohol, drugs)
○ cigarette smoking

• Factors involving the uterus and placenta:

○ decreased blood flow in the uterus and placenta

○ placental abruption (placenta detaches from the uterus)
○ placenta previa (placenta attaches low in the uterus)
○ infection in the tissues around the fetus

• Factors related to the developing baby (fetus):

○ multiple gestation (twins, triplets, etc.)

○ infection
○ birth defects
 ○ chromosomal abnormality
Why is intrauterine growth restriction (IUGR) a concern?
IUGR can begin at any time in pregnancy. Early-onset IUGR is often due to chromosomal
abnormalities, maternal disease, or severe problems with the placenta. Late-onset growth
restriction (after 32 weeks) is usually related to other problems.
With IUGR, the growth of the baby's overall body and organs are limited, and tissue and organ
cells may not grow as large or as numerous. When there is not enough blood flow through the
placenta, the fetus may only receive low amounts of oxygen. This can cause the fetal heart rate
to decrease placing the baby at great risk.
Babies with IUGR may have problems at birth including:
• decreased oxygen levels

• low Apgar scores (an assessment that helps identify babies with difficulty adapting after
delivery)

• meconium aspiration (inhalation of the first stools passed in utero), which can lead to
difficulty breathing

• hypoglycemia (low blood sugar)

• difficulty maintaining normal body temperature

• polycythemia (too many red blood cells)

Severe IUGR may result in stillbirth. It may also lead to long-term growth problems in babies
and children.
How is intrauterine growth restriction (IUGR) diagnosed?
During pregnancy, fetal size can be estimated in different ways. The height of the fundus (the
top of a mother's uterus) can be measured from the pubic bone. This measurement in
centimeters usually corresponds with the number of weeks of pregnancy after the 20th week. If
the measurement is low for the number of weeks, the baby may be smaller than expected.
Other diagnostic procedures may include the following:
• ultrasound
Ultrasound (a test using sound waves to create a picture of internal structures) is a more
accurate method of estimating fetal size. Measurements can be taken of the fetus' head
and abdomen and compared with a growth chart to estimate fetal weight. The fetal
abdominal circumference is a helpful indicator of fetal nutrition.

• Doppler flow
Another way to interpret and diagnose IUGR during pregnancy is Doppler flow, which use
sound waves to measure blood flow. The sound of moving blood produces wave-forms
that reflect the speed and amount of the blood as it moves through a blood vessel. Blood
vessels in the fetal brain and the umbilical cord blood flow can be checked with Doppler
flow studies.

• mother's weight gain

A mother's weight gain can also indicate a baby's size. Small maternal weight gains in
pregnancy may correspond with a small baby.
How is intrauterine growth restriction (IUGR) managed?
Management of IUGR depends on the severity of growth restriction, and how early the problem
began in the pregnancy. Generally, the earlier and more severe the growth restriction, the
greater the risks to the fetus. Careful monitoring of a fetus with IUGR and ongoing testing may
be needed.
Some of the ways to watch for potential problems include the following:
• fetal movement counting - keeping track of fetal kicks and movements. A change in
the number or frequency may mean the fetus is under stress.

• nonstress testing - a test that watches the fetal heart rate for increases with fetal
movements, a sign of fetal well-being.

• biophysical profile - a test that combines the nonstress test with an ultrasound to
evaluate fetal well-being.

• ultrasound - a diagnostic imaging technique which uses high-frequency sound waves

and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are
used to view internal organs as they function, and to assess blood flow through various
vessels. Ultrasounds are used to follow fetal growth.

• Doppler flow studies - a type of ultrasound which use sound waves to measure blood
flow.
Treatment for IUGR:
Although it is not possible to reverse IUGR, some treatments may help slow or minimize the
effects. Specific treatments for IUGR will be determined by your physician based on:
• your pregnancy, overall health, and medical history
• the extent of the disease
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference
Treatments may include:
• nutrition
Some studies have shown that increasing maternal nutrition may increase gestational
weight gain and fetal growth.

• bedrest
Bedrest in the hospital or at home may help improve circulation to the fetus.

• delivery
If IUGR endangers the health of the fetus, then an early delivery may be necessary.
Prevention of intrauterine growth restriction:
Intrauterine growth restriction may occur, even when the mother is in good health. However,
some factors may increase the risks of IUGR, such as cigarette smoking and poor maternal
nutrition. Avoiding harmful lifestyles, eating a healthy diet, and getting prenatal care may help
decrease the risks for IUGR. Early detection may also help with IUGR treatment and outcome.
Click here to view the
Online Resources page of this Web Site.

High-Risk Pregnancy Home

• High-Risk Pregnancy Home Page

• Pregnancy Complications
 • Glossary

• Online Resources

• Site Index
Last modified on: February 12, 2004

• Text Only
• Print this Page

• E-mail this Page

High-Risk Pregnancy
PO Box 800224
Charlottesville, VA 22908
434-924-3627
Maintained by Health Topics Contact
© 2008 by the Rector and Visitors of the University of Virginia
Disclaimer | Privacy Policy | About this Site

Abnormal size at birth

D: SGA: birth weight < 20th percentile for gestational age or < 2.5 kg.
LGA: birth weight > 90th percentile for gestational age or > 4 kg.
A: SGA: may be familial, constitutional, or due to IUGR.
IUGR is defined as either symmetrical or asymmetrical:
Asymmetrical IUGR: relative sparing of head circumference in relation to
weight and length:
. Due to impaired uteroplacental function 28 to maternal pre-eclampsia, DM
or nutritional deficiency during the 3rd trimester.
. Occurs when foetal growth rate in 3rd trimester exceeds maximal supply
from the placenta.
. There is preferential sparing of the cerebral perfusion at times of foetal
distress.
Symmetrical IUGR: head circumference, weight, and length are all proportionally
affected to equivalent degrees:
. Indicative of a prolonged period of poor intrauterine growth.
. Caused by congenital intrauterine infections (TORCH) in the 1st trimester,
genetic factors such as single gene deletions and chromosomal disorders,
maternal smoking, drug and alcohol abuse, chronic medical conditions (e.g.
CRF), malnutrition, or multiple pregnancies.
LGA: macrosomia is a feature of infants of mothers with either gestational or
poorly controlled/undiagnosed DM.
A/R: IUGR: previous SGA infant, low pre-pregnancy weight and poor pregnancy
weight gain.
E: SGA: affects by definition 20% of the population and varies with ethnic background.
IUGR: 2/200 neonates; asymmetrical > symmetrical IUGR.
LGA: affects by definition 20% of live births; is more common in developed
countries where there is a higher prevalence of DM.
H&
E:
Antenatal: maternal examination and accurate dating aid diagnosis. Oligohydramnios
and poor foetal movements are indications of placental insufficiency.
Perinatal monitoring: foetal tachycardia, loss of variability of the baseline in
the foetal heart trace, and late decelerations may indicate foetal distress on
CTG.
Postnatal measurements: birth weight, length, and head circumference on
centile chart.
P: See A.
I: Radiology: USS is the 18 method of diagnosing IUGR or macrosomia antenatally.
Cordocentesis: percutaneous umbilical blood sampling may be used for detection
of hypoxia, lactic acidosis, hypoglycaemia, chromosomal analysis, and
DNA diagnosis of congenital intrauterine infections.
M: Antenatal: maternal bedrest and limitation of activity for severe IUGR.
Perinatal: maternal administration of O2, continuous assessment of foetal
well-being.
Delivery (IUGR): if foetus becomes hypoxic in utero, an emergency
Caesarean section is required.
Macrosomia: induce at 38/40 to prevent complications in a unit with good
neonatal facilities.
3

CONDITIONS
Abnormal size at birth continued
C: IUGR foetus: intrauterine hypoxia, birth asphyxia, and death.
IUGR infant: hypothermia (relatively large surface area), hypoglycaemia
(poor fat and glycogen stores), hypocalcaemia, polycythaemia, and meconium
aspiration.
LGA: birth asphyxia due to prolonged/difficult delivery, birth trauma, especially
shoulder dystocia, hypoglycaemia in the neonatal period due to hyperinsulinism,
and polycythaemia.
P: Depends on the cause of abnormal size at birth. Infants with asymmetrical
IUGR will rapidly put on weight in the postnatal period; symmetrical IUGR
infants are more likely to remain small permanently. Studies have shown that
IUGR infants are at "risk of developing "BP, Type II DM, and coronary heart
disease.
4

CONDITIONS
Acne vulgaris
D: Inflammation of the pilosebaceous duct. Classified as mild, moderate, and
severe.
A: Adolescent acne:
. "Sebum production: androgenic stimulation of hyper-responsive pilosebaceous
units.
. Impaired normal flow of sebum: obstruction of the pilosebaceous duct by
hyperkeratosis.
. Propioni acne bacteria: may play a role by producing cytokines and lipolytic
enzymes.
Infantile acne: <3 months of life; transient and usually due to maternal
androgens.
A/R: Puberty, may " premenstrually, POS, excess cortisol (Cushing syndrome).
E: Developed world: affects 79–95% of the adolescent population, peaking at
14–18 years; tends to recede by early twenties.
Developing world: acne incidence is considerably lower; likely combination
of environmental and genetic factors.
H: Usually self-diagnosed, acute onset, greasy skin, may be painful.
E: Open comedones: whiteheads; flesh-coloured papules.
Closed comedones: blackheads; black colour is due to oxidation of the melanin
pigment.
Other features: pustules, nodules, cysts, scarring, and seborrhoea.
Distribution: primarily affects the face, neck, chest, and back (where sebaceous
glands are most numerous).
P: Gross distension of the pilosebaceous follicle with neutrophil infiltration.
Closed comedones may contain serous fluid. Severe acne can create fistulae
between inflamed glands.
I: Normally none required. Investigate for endocrine disorder if acne develops
during 2–10 years of age.
Bloods: FSH, LH (if female, suspect POS).
Urine: 24-h-urinary cortisol (if Cushing syndrome is suspected).
M: Many cases may not need treatment. Indication for treatment based on classification
and degree of psychosocial impact. In severe acne, therapy should be
commenced early to prevent scarring.
Topical preparations:
(1) Benzoyl peroxide; keratolytic agent, encourages skin peeling, and # number
of P. acnes (S/E: irritation and bleaching of clothes).
(2) Vitamin A derivatives; tretinoin, may take 3–4 months to work.
(3) Azelaic acid.
Antibiotics:
(1) Topical: clindamycin, erythromycin.
(2) Systemic: tetracycline only in > 16 years. (S/E: discolours teeth and may
soften bones in children.)
A gradual " in P. acne resistance to many antibiotics has been documented;
growing need to use either appropriate antibiotics or change the therapeutic
strategy in favour of other regimens.
Isotretinoin (Roaccutane P.O.): vitamin A derivative, 4–6-month course only
by specialist prescription for severe acne (S/E: teratogenic; females require OCP,
hyperlipidaemia).
Antiandrogens: in females only; OCP or cyproterone acetate.
UVB: adjunctive therapy, but rarely used.
Advice: improvement may not be seen for at least a couple of months, use nongreasy
cosmetics, wash face daily, moderate exposure to sunshine is beneficial.
5
CONDITIONS
Acne vulgaris continued
C: Physical: facial scarring (atrophic/keloid), hyperpigmentation of scars, 28 infection
and fistulae.
Psychosocial: lack of self-confidence.
P: Generally improves spontaneously over months/years. Persists into adulthood
in 22% of women and 3% of men.
6

CONDITIONS
Acquired female genital disorders
D: Abnormalities of the female genital tract not present at birth.
A: Labial adhesions: adherence of the labia minora in the midline; may give the
appearance of absence of the vagina. A thin pale semi-translucent membrane
covers the vaginal os. Trauma causes denudation of the epithelial layer of the
labia minora mucosa and leads to fibrous tissue formation; therefore sealing
of the labia minora. Trauma can involve inflammatory conditions (vulvitis,
vulvovaginitis), sexual abuse, or straddle injuries.
Vulvovaginitis: pruritus, vulval pain, vulval erythema, vaginal discharge or
bleeding. Usually associated with poor perineal hygeine, constipation, and atopic
dermatitis caused by local irritants (bubble bath, soaps, shampoo) or by occlusive
clothing causing irritation. May be caused by trauma 28 to abuse; therefore this
should be considered if other concerns are present.
A/R: Vulvovaginitis is often misdiagnosed as a UTI due to its similar presentation.
E: Labial adhesions: peak age: 3 months to 6 years, incidence: 1–2%.
Vulvovaginitis: very common in <5-year-olds.
H: Labial adhesions: usually asymptomatic and noted on routine examination.
Some patients may leak urine when they stand after voiding.
Vulvovaginitis: history should include toilet-training, type of nappy used,
bad odour or dark discharge, scratching, history of eczema, allergic rhinitis, or
diarrhoea, tendency of child to insert objects, and any possible indication of
abuse.
E: General: should be by a skilled clinician, in a well-lit room with a relaxed and
distracted child (mother reading book).
Labial adhesions: the edges of the labia minora are sealed along the midline,
beginning at the posterior fourchette and extending anteriorly towards
the clitoris.
Vulvovaginitis: commonly, only vulvitis will be detected, although vaginal
discharge and bleeding may also be present.
P: See A.
I: Exclude other vaginal disorders such as imperforate hymen or septate vagina
prior to treatment.
Microbiology: vaginal swab if discharge present, MSU.
Radiology: indirect cystourethrogram may show urinary retention behind
the fused labia, bladder distention þ=_ hydronephrosis in labial adhesions.
M: Labial adhesions: oestrogen cream dissolves the adhesions in 90% of cases.
Once adhesions have been lysed vasoline is used as prophylaxis for 1–2
months.
Vulvovaginitis:
. Treat any underlying infection with appropriate antibiotics.
. Education of adequate perineal hygiene and removal of potential irritants.
C: Labial adhesions: without adequate treatment 20–40% will develop UTI.
P: Labial adhesions: recurrence is common, therefore good follow-up is
required.
Vulvovaginitis: outcome good with improved perineal hygiene.
7

CONDITIONS

Printer Friendly
Download our official FREE toolbar
Dictionary, Encyclo pedia and Thesaurus - The Free Dictionary
TE XT forum mailing list For webmasters

1,867,474,407 visitors Top of Form

served.
New: Language forums
 utf-8

TheFreeDictionary Google Bing

intrauterine grow th retardation

4 Search

Word / Article Starts with Ends with Text

Bottom of Form
Help the victims of the recent earthquake in Haiti
Medical
Dictionary/ dictionary Legal Financial Acronyms Idioms Encyclopedia Wikipedia
?
thesaurus dictionary dictionary encyclopedia

Also found in: Dictionary/thesaurus, Acronyms, 0.52 s

intrauterine growth Encyclopedia, Wikipedia, Hutchinson ec.
retardation
Ads by GoogleMPS VI, A Rare Disorder ?Page tools
Early signs of MPS VI Disorder often common symptoms. Learn more.
www.mpsvi.com Printer Feedback
Truth About Scientology friendly Add
Learn about beliefs, humanitarian efforts & more. Watch online videos Cite / link definition
Scientology.org Email
Meniere's Syndrome
Learn about the Latest Advances for Meniere's Disease - Yours Free. Advertisement (Bad
www.menieres-guidebook.com
banner? Please let us
Intrauterine Growth Retardation know)
Definition Related Ads
Intrauterine growth retardation (IUGR) occurs when the unborn baby is at or
▪ Baby ▪ Children
below the 10th weight percentile for his or her age (in weeks).
Shower Projects
Description Games ▪ Gas
There are standards or averages in weight for unborn babies according their ▪ Causes
age in weeks. When the baby's weight is at or below the 10th percentile for his Pregnancy ▪
or her age, it is called intrauterine growth retardation or fetal growth restriction. Website Conceiving
These babies are smaller than they should be for their age. How much a baby ▪ a Baby
weighs at birth depends not only on how many weeks old it is, but the rate at Pregnancy ▪ Newborn
which it has grown. This growth process is complex and delicate. There are Signs Clothing
three phases associated with the development of the baby. During the first ▪ ▪ Infant
phase, cells multiply in the baby's organs. This occurs from the beginning of Pregnancy Clothes
development through the early part of the fourth month. During the second
Problem
phase, cells continue to multiply and the organs grow. In the third phase (after
▪
32 weeks of development), growth occurs quickly and the baby may gain as
Flatulence
much as 7 ounces per week. If the delicate process of development and
Causes
weight gain is disturbed or interrupted, the baby can suffer from restricted
growth.
IUGR is usually classified as symmetrical or asymmetrical. In symmetrical ?My Word List
IUGR, the baby's head and body are proportionately small. In asymmetrical
Add current page to the
IUGR, the baby's brain is abnormally large when compared to the liver. In a
list
normal infant, the brain weighs about three times more than the liver. In
asymmetrical IUGR, the brain can weigh five or six times more than the liver. Advertisement (Bad
banner? Please let us
Causes and symptoms know)
Doctors think that the two types of IUGR may be linked to the time during ?Charity
development that the problem occurs. Symmetrical IUGR may occur when the
unborn baby experiences a problem during early development. Asymmetrical Feed a
IUGR may occur when the unborn baby experiences a problem during later hungry child
development. While not true for all asymmetrical cases, doctors think that - donate to
sometimes the placenta may allow the brain to get more oxygen and nutrition school feeding program
while the liver gets less. Advertisement (Bad
There are many IUGR risk factors involving the mother and the baby. A banner? Please let us
mother is at risk for having a growth restricted infant if she: know)
• Has had a previous baby who suffered from IUGR
• Is small in size
• Has poor weight gain and nutrition during pregnancy
• Is socially deprived
• Uses substances (like tobacco, narcotics, alcohol) that can cause
abnormal development or birth defects
• Has a vascular disease (like preeclampsia)
• Has chronic kidney disease
• Has a low total blood volume during early pregnancy
• Is pregnant with more than one baby
• Has an antibody problem that can make successful pregnancy difficult
(antiphospholipid antibody syndrome).
Additionally, an unborn baby may suffer from IUGR if it has:
• Exposure to an infection, including German measles (rubella),
cytomegalovirus, tuberculosis, syphilis, or toxoplasmosis
• A birth defect (like a severe cardiovascular defect)
• A chromosome defect, especially trisomy 18 (Edwards' syndrome)
• A primary disorder of bone or cartilage
• A chronic lack of oxygen during development (hypoxia)
• Placenta or umbilical cord defects
• Developed outside of the uterus.
Key terms
Preeclampsia — Hypertension (high blood pressure) during pregnancy.
Diagnosis
IUGR can be difficult to diagnose and in many cases doctors are not able to
make an exact diagnosis until the baby is born. A mother who has had a
growth restricted baby is at risk of having another during a later pregnancy.
Such mothers are closely monitored during pregnancy. The length in weeks of
the pregnancy must be carefully determined so that the doctor will know if
development and weight gain are appropriate. Checking the mother's weight
and abdomen measurements can help diagnose cases when there are no
other risk factors present. Measuring the girth of the abdomen is often used as
a tool for diagnosing IUGR. During pregnancy, the healthcare provider will use
a tape measure to record the height of the upper portion of the uterus (the
uterine fundal height). As the pregnancy continues and the baby grows, the
uterus stretches upward in the direction of the mother's head. Between 18 and
30 weeks of gestation, the uterine fundal height (in cm.) equals the weeks of
gestation. If the uterine fundal height is more than 2-3 cm below normal, then
IUGR is suspected. Ultrasound is used to evaluate the growth of the baby.
Usually, IUGR is diagnosed after week 32 of pregnancy. This is during the
phase of rapid growth when the baby should be gaining more weight. IUGR
caused by genetic factors or infection may sometimes be detected earlier.
Treatment
There is no treatment that improves fetal growth, but IUGR babies who are at
or near term have the best outcome if delivered promptly. If IUGR is caused
by a problem with the placenta and the baby is otherwise healthy, early
diagnosis and treatment of the problem may reduce the chance of a serious
outcome.
Prognosis
Babies who suffer from IUGR are at an increased risk for death, low blood
sugar (hypoglycemia), low body temperature (hypothermia), and abnormal
development of the nervous system. These risks increase with the severity of
the growth restriction. The growth that occurs after birth cannot be predicted
with certainty based on the size of the baby when it is born. Infants with
asymmetrical IUGR are more likely to catch up in growth after birth than are
infants who suffer from prolonged symmetrical IUGR. However, as of 1998,
doctors cannot reliably predict an infant's future progress. Each case is
unique. Some infants who have IUGR will develop normally, while others will
have complications of the nervous system or intellectual problems like
learning disorders. If IUGR is related to a disease or a genetic defect, the
future of the infant is related to the severity and the nature of that disorder.
Resources
Books
Cunningham, F. Gary, et al. Williams Obstetrics. 20th ed. Stamford: Appleton
& Lange, 1997.
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.

intrauterine growth retardation

n. Abbr. IUGR
Birth weight that is below the tenth percentile for gestational age. Also called
intrauterine growth restriction.
The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company.
Published by Houghton Mifflin Company. All rights reserved.

intrauterine growth retardation,

an abnormal process in which the development and maturation of the fetus
are impeded or delayed more than two deviations below the mean for
gestational age, sex, and ethnicity. It may be caused by genetic factors,
maternal disease, or fetal malnutrition that results from placental insufficiency.
See also growth retardation, small for gestational age infant.
Mosby's Medical Dictionary, 8th edition. © 2009, Elsevier.

intrauterine
within the uterus.

intrauterine contraceptive device

a mechanical device inserted into the uterine cavity for the purpose of
contraception. These devices, used in human gynecology, have been used in
draft cattle in Asia for many years. Used occasionally also in dogs. Called also
IUD.
intrauterine growth retardation
failure to grow properly in utero in stature, as measured by crown to rump
measurement. Pituitary dwarfism in cattle and runting in piglets and puppies
are typical examples.
intrauterine medication
medication applied to the uterus via a cervical catheter, or manually in the
recently birthed mare, sow or cow.
intrauterine therapy
is a common practice in food animals. Infusion of fluid material or manual
placement of solid materials are the usual methods employed. The method
has the advantage of achieving maximum concentration of the medicament at
the endometrium but only low concentrations are achieved in the deeper
layers. See also infusion.
Saunders Comprehensive Veterinary Dictionary, 3 ed. © 2007 Elsevier, Inc. All rights reserved

intrauterine growth retardation

Fetal growth restriction Neonatology A generic term for any delay in achieving
intrauterine developmental milestones, most commonly related to maternal
drug, tobacco and alcohol abuse; IUGR affects high-risk infants with perinatal
asphyxia, hypoglycemia, hypothermia, pulmonary hemorrhage, meconium
aspiration, necrotizing enterocolitis, polycythemia and complications of
infections, malformations and syndromes; IUGR fetuses have weight < 10th
percentile for gestational age, abdominal circumference < 2.5th percentile
Types Symmetric–body is proportionately small; asymmetric–head is
disproportionately bigger than body, which implies undernourishment–growth
of vital organs–heart, brain is at expense of liver, muscle and fat, often due to
placental insufficiency; IUGR is the 2nd most common–after prematurity–cause
of perinatal M&M; it affects ±5% of the general obstetric population. See Low
birthweight, Small for gestational age.
Intrauterine growth restriction
Placental insufficiency
• Unexplained elevated maternal alpha- fetoprotein level
• Idiopathic
• Preeclampsia
• Chronic maternal disease
• Cardiovascular disease
• Diabetes
• Hypertension
Abnormal placentation
• Abruptio placentae
• Placenta previa
• Infarction
• Circumvallate placenta
• Placenta accretia
• Hemangioma
Genetic disorders
• Family history
• Trisomy 13, 18 and 21
• Triploidy
• Turner's syndrome (some cases)
• Malformations
Immunologic
• Antiphospholipid syndrome
Infections
• Cytomegalovirus
• Rubella
• Herpes
• Toxoplasmosis
Metabolic
• Phenylketonuria
Other
• Poor maternal nutrition
• Substance abuse (smoking, alcohol, drugs)
• Multiple gestation
• Low socioeconomic status
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.

How to thank TFD for its existence? Tell a friend about us, add a link to this
page, add the site to iGoogle, or visit webmaster's page for free fun content.
Link to this page:
<a href="http://medical-dictionary.thefreedictionary.com/intrauterine+grow

Please bookmark with social media, your votes are noticed and appreciated:

Ads by GoogleAmos Grunebaum, MD FACOG

Obstetrician & Gynecologist Maternal-Fetal Medicine
Grunebaum.com
Bilirubin Assay Kit
Colorimetric 96-well/cuvet assays Fast, convenient and reliable
www.bioassaysys.com
"Restless Leg Syndrome"
A Proven Restless Leg Syndrome Cure That Always Gives "Instant Relief"
www.AllCalm.com

? Mentioned in ? References in periodicals archive

Fetal transfusion syndrome, fetofetal transfusion
Antepartum Testing probation
syndrome, stuck twin syndrome Obstetrics
expanded rubella psychomotor
Intrauterine growth retardation in 1 twin due to an
syndrome retardation
artery-to-artery vascular shunting, which may occur
FGR restriction
in a diamnionic-dichorionic placenta
growth retardation retardation
Hemodynamics and cardiology; neonatology
High-risk pregnancy revocation
questions and controversies by SciTech Book News
Intrauterine growth small for gestational
We found evidence of associations between
restriction age
exposure to specific HAAs and term low birth weight
IUGR Turner syndrome
as well as intrauterine growth retardation and for
low birth weight twin-to-twin transfusion
exposure to the five regulated HAAs (HAAS) and
placental syndrome
term low birth weight.
insufficiency varicella embryopathy
Late pregnancy exposures to disinfection by-
preeclampsia More results
products and ... by Reif, John S. / Environmental
Health Perspectives
Every 17 parts per billion increase in daily ozone
levels during a woman's third trimester increases the
risk of intrauterine growth retardation by 20
percent.
OZONE LEVEL POSES RISK TO WOMEN BABIES
BORN UNDERWEIGHT by Daily News (Los
Angeles, CA)
More results

Medical browser ? ? Full browser

intrauterine amputation
Intrauterine devices intrauterine growth Intrauterine
intrauterine catheter
Intrauterine devices restriction insemination
intrauterine contraceptive
Intrauterine devices intrauterine growth Intrauterine
intrauterine device
Intrauterine devices restriction insemination
intrauterine fracture
Intrauterine devices intrauterine growth Intrauterine
intrauterine growth curve
intrauterine fetal death restriction insemination
Intrauterine growth
Intrauterine fetal intrauterine growth Intrauterine
restriction
growth retardation restriction insemination
intrauterine growth
Intrauterine fetal intrauterine growth Intrauterine
retardation
growth retardation restriction insemination
intrauterine insemination
Intrauterine fetal intrauterine growth intrauterine medication
intrauterine pressure
growth retardation restriction intrauterine medication
catheter
intrauterine fracture intrauterine growth intrauterine medication
intrauterine transfusion
intrauterine fracture restriction Intrauterine Pregnancy
intravasation
intravascular
intravascular
brachytherapy
intravascular coagulation
test
intrauterine fracture
intrauterine fracture
intrauterine fracture
intrauterine fracture
intrauterine growth
curve
intrauterine growth
restriction
intrauterine growth
Intrauterine Pressure
retardation
Intrauterine Pressure
Intrauterine Growth
Catheter
Retardation Low Birth
Intrauterine Pressure
Weight
Catheter
Intrauterine hypoxia
IntraUterine System
intrauterine infusion
intrauterine therapy
intrauterine infusion
intrauterine therapy
intrauterine infusion
intrauterine therapy
intrauterine infusion
intrauterine infusion
intrauterine infusion

Top of Form
4 utf-8

TheFreeDictionary Google
Medical Dictionary

Search

Word / Article Starts with Ends with Text

Bottom of Form

For surfers: Free toolbar & extensions | Word of the Day | Bookmark | Help
Free Tools: For webmasters: Free content | Linking | Lookup box | Double-click lookup | Partner with
us
Disclaimer | Privacy policy | Feedback | Copyright © 2010 Farlex, Inc.
All content on this website, including dictionary, thesaurus, literature, geography, and other reference data is for informational
purposes only. This information should not be considered complete, up to date, and is not intended to be used in place of a visit,
consultation, or advice of a legal,

medical, or any other professional. Terms of Use.

Causes and Symptoms

The two types of IUGR described previously contribute to IUGR according to the development
at that stage. Symmetrical IUGR may occur when the unborn baby experiences a problem during
early development. Asymmetrical IUGR may occur when the unborn baby experiences a
problem during later development. In general, most physicians believe that IUGR is the
consequence of a disease process within one or more of the three partitions that maintain and
regulate fetal growth, i.e., the maternal compartment, the placenta, or the fetus.
In consideration of risk factors uteroplacental insufficiency contributes to 80 percent of IUGR
due to the following maternal causes:
 • deficient supply of nutrients
• smoking
• malnutrition
• anemia
• drug abuse
• vascular diseases, i.e., high blood pressure
• chronic kidney disease
• severe diabetes
• multiple gestation
Intrauterine growth retardation (IUGR)
Conditions associated with IUGR
Maternal history Alcohol use
Cocaine use
Smoking
Malnutrition
Use of prescription drugs warfarin
(Coumadin, Panwarfarin) and phenytoin
(Dilantin)
Prior history of IUGR pregnancy
Residing at altitude over 5,000 ft (1,500 m)
Medical conditions (of mother) Chronic hypertension
Preeclampia early in gestation
Diabetes mellitus
Systemic lupus erythematosus
Chronic kidney disease
Inflammatory bowel disease
Severe lung disease
Infectious diseases Syphilis
Cytomegalovirus
Toxoplasmosis
Rubella
Hepatitis B
Herpes simplex virus 1 or 2
HIV-1
Congenital disorders (of fetus) Trisomy 21 (Down syndrome)
Trisomy 18 (Edwards syndrome)
Trisomy 13 (Patau syndrome)
Turner's syndrome
• antigen/antibody reactions, i.e., lupus, antiphospholipid antibody syndrome (APA)
• primary placental causes, i.e., extensive placental infarctions, chronic placental
separation, placenta previa
Primary fetal causes contribute to 20 percent of IUGR and include the following:
• exposure to an infection, i.e., rubella (German measles), cytomegalovirus, syphilis, or
toxoplasmosis
• birth defects, i.e., congenital heart disease, genitourinary anomalies, central nervous
system defects
• chromosomal abnormalities, i.e., trisomy 13, 18, or 21
• primary bone or cartilage disorder
• decreased intrinsic growth, symmetrical IUGR
While most fetuses with IUGR usually have no complications, there is an increased risk for
intrapartum asphyxia, neonatal hypoglycemia and hypocalcemia, meconium aspiration, and
neurodevelopmental delays. The following summarizes these complications:

Intrapartum Asphyxia
Because the fetus is compromised with IUGR, its ability to tolerate the stress of labor is
decreased. Therefore, when uterine contractions occur and the flow of blood to the fetus is
diminished with each contraction, the fetus with IUGR may not be able to adapt. This leads to an
imbalance between the ability of the placenta to supply the fetus with oxygen and nutrients and
the need for these substances. When an imbalance occurs, this may lead to an accumulation of
byproducts resulting in acidosis which can be harmful. If intrapartum asphyxia is allowed to
progress, irreversible brain damage can occur.
Medical Literature

Neonatal Hypoglycemia and Hypocalcemia

As the result of IUGR, a newborn may be deficient in glucose (sugar) and calcium. The lack of
these important substances can result in significant compromise to the newborn and result in
neurological damage.
Medical Literature
Medical Literature

Meconium Aspiration
This occurs when the fetus defecates in the uterus resulting in the appearance of a brown, murky
substance. Since the contents from the fetal bowel contains many substances that can be harmful
to the fetus if swallowed, meconium aspiration is of major concern. In severe forms, the newborn
may develop lung disease resulting in respiratory and cardiovascular complications that could
lead to neonatal death.
Medical Literature

Neurodevelopmental Delay
A number of studies have shown that fetuses with significant IUGR are at higher risk for
developmental delays, cardiovascular disease, and other problems later in life. For these reasons,
and those stated above, it is important to identify the fetus with IUGR and manage the pregnancy
accordingly
Medical Literature