IUGR patterns and problems in preterm and growth-restricted babies
THE CONTEXT
Intrauterine growth retardation (IUGR)* occurs when adverse factors prevent a fetus from achieving its normal growth potential. Preterm and IUGR neonates have different problems but share management principles.
Patterns of IUGR
•
Symmetric IUGR follows an early gestational insult, with proportionate reductions in head size, body weight, and length. Causes include genetic disorders, chromosomal disorders, and intrauterine TORCH infections.
•
Asymmetric IUGR follows a late gestational insult that spares brain growth. Head size is relatively preserved compared with length and weight.
•
Causes of asymmetric IUGR include placental insufficiency, pregnancy-induced hypertension, and maternal medical diseases.
Small for gestational age
•
Small for gestational age (SGA) denotes infant weight below the population norm by more than two standard deviations or below the tenth percentile on an intrauterine growth chart.
•
For practical purposes, the source treats SGA and IUGR as synonymous.
Major problems in preterm babies
•
Problems include hypothermia, perinatal asphyxia, bacterial sepsis, and apnea of prematurity.
•
Respiratory problems include hyaline membrane disease, pulmonary hemorrhage, pneumothorax, bronchopulmonary dysplasia, and pneumonia.
•
Metabolic problems include hypoglycemia and hypocalcemia; hematologic problems include anemia and hyperbilirubinemia.
•
Feeding problems and poor weight gain also occur.
Major problems in babies with IUGR
•
Listed problems include perinatal asphyxia, meconium aspiration, hypothermia, hypoglycemia, feed intolerance, polycythemia, and poor weight gain.