A Critical Birth Weight and Other Determinants of Survival for Infants with Severe Intrauterine Growth Restriction

Abstract

Our objective was to assess the perinatal management and neonatal outcomes of premature, severely intrauterine growth-restricted (IUGR) neonates. A cohort of neonates <1000 grams, < or = first percentile for weight, and <37 weeks' gestation was identified and matched 2:1 to two control sets of premature, appropriate-for-gestational age (AGA) infants-one with similar gestational age (AGA-GA group) and the other with similar birth weight (AGA-BW group) to determine the effect of IUGR on the outcome of the premature infant. The IUGR group was then examined in detail for descriptive statistics. Data were analyzed by t-tests and Chi-square analyses where appropriate. The IUGR infants had worse outcomes than AGA-GA controls but had somewhat better results than the AGA-BW controls. In the IUGR group, a birth weight less than 550 grams was significantly associated with neonatal death (p < 0.001). However, increasing gestational age was not associated with neonatal survival (p = 0.661) if birthweight remained below 550 grams. Classical cesarean delivery was associated with neonatal death (p = 0.003). Neonatal variables associated with poor outcome included patent ductus arteriosus (p = 0.034), feeding intolerance (p = 0.046), and failure to thrive (p = 0.05). Overall, neonatal survival was 73%. Of the surviving neonates, 69% had evidence of neurodevelopmental delay when tested at 6 and 12 months. Premature, growth-restricted neonates with birth weights of <550 grams versus those of >550 grams have dismal outcomes despite a gestational age that is compatible with survival.

Prenatal diagnosis and management of intrauterine growth restriction: A long‐term prospective study on outcome and maternal stress

“…It may be particularly an issue among parents if fetuses are diagnosed with IUGR. The parents are confronted during pregnancy with distressing information about their offspring's abnormal size and growth rate (Doubilet & Benson, 1995;Hay, Thureen, & Anderson, 2001;Lee, Conner, Charafeddine, Woods, & Priore, 2001;Waugh & Kilby, 2001). Inevitably, their parental representations of themselves and their child are affected by diagnosis of IUGR.…”

Differential expression of imprinted genes in normal and IUGR human placentas

“…8 Intrauterine growth restriction (IUGR), which accounts for almost 10% of all pregnancies in the US, is associated with major perinatal morbidity and mortality in comparison to their normal size, appropriate for gestational age neonates. 11,12 Although IUGR has multifactorial etiologies, one major cause of IUGR is that of uteroplacental insufficiency; i.e., an imbalance between fetal nutritional or respiratory demands and uteroplacental reserve. 13 The pathophysiology behind uteroplacental insufficiency is believed to have its roots in early pregnancy due to abnormal implantation of the embryo with subsequent shallow placental invasion and a relatively hypoxic intrauterine environment.…”

Arginine and Mixed Amino Acids Increase Protein Accretion in the Growth-Restricted and Normal Ovine Fetus by Different Mechanisms

“…Intrauterine growth restriction (IUGR) is a major cause of perinatal mortality and morbidity (1,2). Although there are many possible causes, the key feature of IUGR is impaired fetal growth and, hence, by inference, impaired protein accretion.…”