Severe intra-uterine growth retardation: obstetrical management and follow up studies in children born between 1970 and 1985

Abstract

Peri- and postnatal data of 263 children with severe intra-uterine growth retardation (IUGR) born between 1970–75 (n = 145) and between 1976–85 (n = 118) are presented. The incidence of premature delivery in IUGR patients rose from 15% (1970–75) to 34% (1976–85). The rate of perinatal asphyxia in premature children with IUGR decreased from 64% during 1970–75 to 45% during 1976–85. Perinatal mortality in preterm SFD babies was higher in 1976–85 (20%) than in 1970–75 (14%), due to an 8-fold higher incidence of very low birth weight (≦ 1000 g) SFD babies. Without this high-risk group perinatal mortality ranged between 2 and 3% in both groups. The incidence of deliveries by Cesarean section increased from 19 to 45% while vaginal deliveries decreased from 73 to 52% during 1976–85 compared with the 1970–75 age group. Follow up studies were carried out in 63 patients (1970–75) and in 41 patients (1976–85). Deficits of body height and weight persisted in one third of the patients, being severe in 10–20%. Infantile developmental milestones were retarded in 22–32%. Neurologic sequelae mostly of a mild degree were seen in 29% (1970–75) and 37% (1976–85). Psychologic testing showed abnormalities in 38% of the older age group, using the Göttinger Formreproduktionstest and in 21% of the younger age group, where the Denver Developmental Screening Test was performed. EEG investigations demonstrated unspecific abnormalities of a mild to moderate degree in one third of the patients. There were no differences between follow-up results of full-term and premature children with IUGR. Early diagnosis of IUGR and preterm delivery of severely growth-retarded children seems to have successfully reduced the rate of fetal deaths. However, up to 1982 long-term morbidity of children with IUGR has remained unchanged. Due to advances in neonatal intensive care treatment of very low birth weight babies during the last 5 years, the benefits of this new obstetrical management may be more clearly demonstrated in further follow-up studies of this still very young population of children with IUGR.