Respiratory distress syndrome in infants with impaired intrauterine growth

Abstract

The recently introduced intrauterine growth curve, based on ultrasonically estimated foetal weights, was retrospectively applied to an inborn population of 883 infants born before 33 gestational weeks at the University Hospital of Lund, during 1985-94. The estimation of birthweight deviation resulted in 630 (71.3%) infants with a birthweight appropriate for gestational age (AGA), 244 (27.6%) infants with a birthweight small for gestational age (SGA) and 9 (1.1%) infants with a birthweight large for gestational age. Birthweight deviation was associated with an increased mortality [odds ratio (OR) adjusted for gestational age 1.29 per SD (12%) change in birthweight for gestational age, 95% CI: 1.10-1.50; p = 0.002]. At gestational age 25-28 weeks, SGA-infants had an increased incidence of respiratory distress syndrome (RDS) as compared to AGA-infants (OR adjusted for gestational age: 1.98, 95% CI: 1.12-3.52; p = 0.019). At gestational age 29-32 weeks, SGA-infants had a lower incidence of RDS as compared to AGA-infants (OR adjusted for gestational age: OR 0.52, 95% CI: 0.34-0.80; p = 0.003). After adjustment for confounding variables, infants born at gestational age 25-28 weeks from mothers with pre-eclampsia, appeared to be a high-risk group for RDS, whereas at the age of 29-32 gestational weeks, negative birthweight deviation had a protective effect against RDS. Antenatal corticosteroid administration appeared to have a less beneficial effect on mortality, RDS and cerebral haemorrhage in infants born SGA vs in those born AGA.

Hypoxic fetoplacental vasoconstriction in humans is mediated by potassium channel inhibition

“…In fact, despite the limited published information on HFPV to date, it is often cited as a principal factor in the pathogenesis of intrauterine growth retardation (IUGR) (23,32), a major cause of neonatal mortality and morbidity affecting 3% of newborns (17,20,34). Newborns with IUGR, especially when combined with prematurity, are at increased risk for extreme respiratory distress syndrome (20), severe bronchopulmonary dysplasia (17), and adverse neurodevelopmental outcome (34). Because of that risk, management of premature newborns with IUGR remains one of the main challenges in neonatology.…”

Pulmonary Vascular Endothelial Growth Factor Expression and Disaturated Phospholipid Content in a Chicken Model of Hypoxia-Induced Fetal Growth Restriction

“…Accordingly, investigators have found decreased rates of RDS in infants with intrauterine growth retardation [6] . However, others have found no difference [7,8] or even increased rates of RDS [9][10][11] in infants with intrauterine growth retardation.…”

Assessment of gestational age and neuromaturation

“…Studies of smaller and more immature IUGR infants (most with GAs less than 30 weeks) demonstrate a mortality rate and incidence of RDS that is similar to or even higher than preterm AGA infants [Pena et al, 1988;Tyson et al, 1995;Ley et al, 1997;Bernstein et al, 2000;Allen and Donohue, 2002;Allen and Donohue, 2005;]. Similarly, there are some data to suggest that very immature multiples have mortality rates and incidence of RDS that are similar to or even higher than preterm singletons [Gardner et al, 1995;Luke 1996;Allen and Donohue, 2002;Allen and Donohue, 2005].…”

“…Similarly, there are some data to suggest that very immature multiples have mortality rates and incidence of RDS that are similar to or even higher than preterm singletons [Gardner et al, 1995;Luke 1996;Allen and Donohue, 2002;Allen and Donohue, 2005]. A study of 883 infants born before 33 weeks' gestation suggests that protective responses begin no sooner than 29 weeks' gestation; at least for the lungs: infants born SGA before 29 weeks' gestation had a higher incidence of RDS than AGA infants, whereas RDS was less frequent in SGA infants born after 29 weeks [Ley et al, 1997]. Thus, adverse intrauterine circumstances that occur too early do not trigger effective compensatory mechanisms.…”