Intracranial Hemorrhage in Small-for-gestational-age Neonates: Comparison With Weight-matched Appropriate-for-gestational-age Infants

Abstract

In a comparative study of 93 small-for-gestational-age (SGA) infants against 93 weight-matched, appropriate-for-gestational-age (AGA) neonates, the SGA group exhibited a significantly lower incidence of periventricular-intraventricular type intracranial hemorrhage (ICH) at the first ultrasound scan than did the AGA neonates (9/93 vs 21/93; p less than 0.02). This apparent advantage was no longer maintained in later scans of the first week (16/93 vs 27/93; NS), despite the fact that the SGA group were 4 weeks advanced in gestational age and had fewer respiratory problems than the AGA controls. It is prudent, therefore, to follow SGA infants closely for ICH by repeat ultrasound examinations even if the first scan is negative. Evaluation of the subgroup of SGA infants with ICH against the total SGA population revealed lower admission body temperature and Apgar scores, and higher incidence of asphyxia, resuscitation, and mortality. The above observations in SGA infants with ICH and the lack of a similar trend between the AGA infants with ICH and the total AGA population suggest that SGA status, hypothermia, and ICH are interrelated. Hypothermia, therefore, can be used as a convenient marker for the possibility of ICH in low birth weight SGA infants. The authors' data is consistent with the view that hypothermia and ICH are both the consequences of perinatal asphyxia in SGA infants and probably reflect the magnitude of stormy perinatal events.

Increased Morbidity in Severe Early Intrauterine Growth Restriction

“…Several studies have found a decrease in the morbidity associated with prematurity when the infants are also poorly grown, suggesting an advantage to the stress of poor growth. [1][2][3] Others 4 found increased respiratory morbidity. A number of studies have confirmed that mortality in preterm growth-restricted infants is higher when compared to normally grown infants of the same gestational age.…”

Complete blood count parameters for healthy, small-for-gestational-age, full-term newborns

“…Small‐for‐gestational‐age (SGA) neonates have clinical problems linked to intrauterine hypoxia and decreased subcutaneous fat tissue. Some of the common issues in these newborns include hypoxic‐ischemic encephalopathy; intraventricular hemorrhage; periventricular leukomalacia (Dincsoy et al. , 1988; Doctor et al.…”

“…Small-for-gestational-age (SGA) neonates have clinical problems linked to intrauterine hypoxia and decreased subcutaneous fat tissue. Some of the common issues in these newborns include hypoxic-ischemic encephalopathy; intraventricular hemorrhage; periventricular leukomalacia (Dincsoy et al, 1988;Doctor et al, 2001;Taeusch, Ballard & Gleason, 2005); respiratory distress syndrome; pulmonary hypertension; hemorrhagic pulmonary edema; meconium aspiration syndrome (Taeusch et al, 2005); metabolic disorders such as hypoglycemia, hyperglycemia, and hypocalcemia Bhat et al, 2000); mesenteric ischemia; necrotizing enterocolitis (Hakanson & Oh, 1977), and thermoregulatory disorders (Taeusch et al, 2005).…”

Does Admission Hypothermia Predispose to Intraventricular Hemorrhage in Very-Low-Birth-Weight Infants?

“…Three previous studies found no association between AHT and IVH [7,13,25] , while other studies showed borderline-significant association [12,26] and three studies showed some significant association [5,6,16,24] . The above-mentioned studies vary considerably in the methodology, study populations, definitions, variables assessed, etc.…”

“…In preterm infants ! 26 weeks' gestation, AHT occurs more after cesarean delivery (48%) than after vaginal delivery (33%) [11] and more in SGA than in appropriate-for-gestational-age preterm infants [12] . Recent guidelines for resuscitation of premature infants in the delivery room, published by the American Heart Association and American Academy of Pediatrics in 2006 and by other investigators [10,[13][14][15] , have suggested the use of polyethylene wraps or chemical warming mattresses in order to prevent heat loss in verypreterm infants immediately after birth.…”