Degree Of Intrauterine Growth Retardation Research Articles

Assessment of the arginine and glutamic acid content in the blood serum of full-term newborns with intrauterine growth retardation

The problem of intrauterine growth retardation is currently relevant, as it is one of the causes of neonatal morbidity and mortality. Purpose. To study the course of the neonatal period and evaluate the content of arginine and glutamic acid in full-term newborns depending on the severity of intrauterine growth retardation.Material and methods. 78 full-term newborns with intrauterine growth retardation according to hypotrophic type were examined. The content of glutamic acid and arginine in blood serum was determined in the early neonatal period by capillary electrophoresis using an unmodified quartz capillary (Kapel-105, Lumeks, St. Petersburg, Russia).Results. Markers of the formation of a severe degree of intrauterine growth retardation were identified: increased levels of glutamic acid and arginine, taking into account impaired cerebral blood flow in the early neonatal period. A model is proposed for predicting the persistence of a severe degree of intrauterine growth retardation in newborns by the end of the neonatal period.Conclusion. The proposed diagnostic criteria make it possible to start specific therapy in a timely manner in order to prevent the formation of a severe degree of intrauterine growth retardation.

Genetic selection against intrauterine growth retardation in piglets: a problem at the piglet level with a solution at the sow level

BackgroundIn polytocous livestock species, litter size and offspring weight act antagonistically; in modern pig breeds, selection for increased litter size has resulted in lower mean birth weights, an increased number of small piglets and an increased number of those affected by varying degrees of intrauterine growth retardation (IUGR). IUGR poses life-long challenges, both mental, with morphological brain changes and altered cognition, and physical, such as immaturity of organs, reduced colostrum intake and weight gain. In pigs, head morphology of newborn piglets is a good phenotypic marker for identifying such compromised piglets. Growth retardation could be considered as a property of the dam, in part due to either uterine capacity or insufficiency. A novel approach to this issue is to consider the proportion of IUGR-affected piglets in a litter as an indirect measure of uterine capacity. However, uterine capacity or sufficiency cannot be equated solely to litter size and thus is a trait difficult to measure on farm.ResultsA total of 21,159 Landrace × Large White or Landrace × White Duroc piglets (born over 52 weeks) with recorded head morphology and birth weights were followed from birth until death or weaning. At the piglet level, the estimated heritability for IUGR (as defined by head morphology) was low at 0.01 ± 0.01. Piglet direct genetic effects of birth weight (h2 = 0.07 ± 0.02) were strongly negatively correlated with head morphology (− 0.93), in that IUGR-affected piglets tended to have lower birth weights. At the sow level, analysis of the proportion of IUGR-affected piglets in a litter gave a heritability of 0.20 ± 0.06, with high and negative genetic correlations of the proportion of IUGR-affected piglets with average offspring birth weight (− 0.90) and with the proportion of piglets surviving until 24 h (− 0.80).ConclusionsThis suggests that the proportion of IUGR-affected piglets in a litter is a suitable indirect measure of uterine capacity for inclusion in breeding programmes that aim at reducing IUGR in piglets and improving piglet survival.

Discordance des poids de naissance des jumeaux bichoriaux : diagnostic, pronostic obstétrical et néonatal

ObjectiveTo describe neonatal and obstetrical prognosis in dichorionic (DC) twins with a birth weight discordance under 20% and evaluate the influence of intrauterine growth restriction on the management. Patients and methodsWe studied retrospectively 67 DC twins birth between July 2002 and July 2012 at our university labour ward. Birth weight discordance was considered slight between 20–25%, moderate between 25–30%, and severe over 30%. ResultsPrevalence of birth weight discordance in DC twins is estimated at 11.4% in our study. Eighty percent of severe discordance was diagnosed before delivery, 41% for moderate discordance and 20% for slight discordance. We note 30% of pre eclampsia in our population with 44% in the severe discordance group. Mean gestational age was 35.1 weeks for slight and moderate discordances, and 33 weeks for severe discordance. Caesarean section rate was 48% for severe discordance and only 36% for slight discordance. Vaginal delivery rate is 56.7%. More than half of patient with a severe discordance gave birth vaginally. Intrauterine growth restriction rate under the 10th percentile was 18.7%. Prevalence of IUGR was 24% in sever discordance group, 23.5% in the moderate discordance group and 10% in the slight group. Neonatal morbidity rate was 20.8% mainly in children with IUGR. Discussion and conclusionNeonatal mortality and morbidity rate are mainly increased in severe discordant twins. These pregnancies are at high risk of maternal morbidity. Vaginal delivery must be preferred for slight and moderate discordances. In case of severe discordance, vaginal delivery should be considered depending on the degree of intrauterine growth retardation.

Vroeggeboorte, intra-uteriene groeiachterstand en lichamelijke ziekten op de volwassen leeftijd; resultaten van 19 jaar pops-follow-up

Infants born very prematurely are at greater risk of neurosensory handicaps and developmental problems than are term born children. Premature birth, intrauterine growth retardation, and the combination of both, may also be risk factors for physical disease in adulthood. As this aspect has been little studied so far, we looked into its first signs in the pops-cohort (Project On Preterm and Small for gestational age infants). Prematurity seems to be a risk factor for the development of insulin resistance. The risk is extra high for individuals showing disposition to obesity at later age. Having experienced intrauterine growth retardation even increases the risk. Former premature infants on average show higher mean systolic blood pressure, yet unrelated to degree of intrauterine growth retardation. Renal function (clearance and protein excretion) in young adulthood is less favorable for prematurely born individuals who also experienced intrauterine growth retardation. Prematurely born children show more airway symptoms and poorer lung function in young adulthood. We conclude that neonatal follow up is not only indicated for very premature infants but also for children who experienced severe intrauterine or neonatal growth retardation. Pediatricians ought to inform parents and children as well as the family doctor that prematurity or intrauterine growth retardation may be risk factors for chronic disease at adult age. Active prevention of obesity from an early age onwards is indicated for prematurely born children who experienced intrauterine growth retardation. Family doctors should be extra alert to the development of particularly hypertension and microalbuminuria when these children reach young adult age; a regular check-up for example every two years is recommended. Awareness of their medical history may stimulate the children themselves to prevent obesity, take up sports, and never start smoking.

A Variable Degree of Intrauterine and Postnatal Growth Retardation in a Family with a Missense Mutation in the Insulin-Like Growth Factor I Receptor

The type 1 IGF-I receptor (IGF1R) mediates the biological functions of IGF-I. Binding of IGF-I to the IGF1R results in autophosphorylation of the intracellular beta-subunit and activation of intracellular signaling. The objective of this study was to evaluate the functional characteristics of a novel IGF1R mutation and describe the phenotypic features of two patients with this mutation. The study was performed in a university hospital. We describe a 35-yr-old female with mild intrauterine growth failure, progressive postnatal growth retardation, severe failure to thrive, and microcephaly. Her daughter was born with severe intrauterine growth retardation and also showed postnatal failure to thrive and microcephaly. We found a heterozygous G3148-->A nucleotide substitution in the IGF1R gene, changing a negatively charged glutamic acid at position 1050 into a positively charged lysine residue (E1050K). E1050 is a conserved residue in the intracellular kinase domain. Dermal fibroblasts of the mother showed normal binding of iodinated IGF-I, but autophosphorylation and activation of downstream signaling cascades upon challenging with IGF-I was markedly reduced. Consequently, the maximal [(3)H]thymidine incorporation upon challenge with a dose range of IGF-I was reduced compared with a panel of control cells (3.65 +/- 1.79-fold vs. 6.75 +/- 4.7-fold stimulation; P < 0.01). These data suggest that the mutation results in the inactivation of one copy of the IGF1R gene. These two patients support the key role for IGF-I in intrauterine and postnatal growth. The different phenotypes of these and earlier described patients may be associated with variability in IGF-I signaling. The degree of intrauterine growth retardation may be partially determined by the presence or absence of maternal IGF-I resistance.

Nephron Number, Hypertension, Renal Disease, and Renal Failure

Essential hypertension is one of the most common diseases in the Western world, affecting about 26.4% of the adult population, and it is increasing (1). Its causes are heterogeneous and include genetic and environmental factors (2), but several observations point to an important role of the kidney in its genesis (3). In addition to variations in tubular transport mechanisms that could, for example, affect salt handling, structural characteristics of the kidney might also contribute to hypertension. The burden of chronic kidney disease is also increasing worldwide, due to population growth, increasing longevity, and changing risk factors. Although single-cause models of disease are still widely promoted, multideterminant or multihit models that can accommodate multiple risk factors in an individual or in a population are probably more applicable (4,5). In such a framework, nephron endowment is one potential determinant of disease susceptibility. Some time ago, Brenner and colleagues (6,7) proposed that lower nephron numbers predispose both to essential hypertension and to renal disease. They also proposed that hypertension and progressive renal insufficiency might be initiated and accelerated by glomerular hypertrophy and intraglomerular hypertension that develops as nephron number is reduced (8). In this review, we summarize data from recent studies that shed more light on these hypotheses. The data supply a new twist to possible mechanisms of the Barker hypothesis, which proposes that intrauterine growth retardation predisposes to chronic disease in later life (9). The review describes how nephron number is estimated and its range and some determinants and morphologic correlates. It then considers possible causes of low nephron numbers. Finally, associations of hypertension and renal disease with reduced nephron numbers are considered, and some potential clinical implications are discussed.

Biological vulnerability in infants with failure to thrive: the association with birthweight.

The development of failure to thrive (FTT) is hypothesized to be caused by the interaction between biological and environmental factors. Birthweight is one biological variable thought to play a role in the infant's growth failure. In studies that enrolled infants with FTT who were full-term at birth, the reported birthweights of these infants were significantly less than healthy control infants (M = 2959 g vs. M = 3364 g), t(14) = -4.597, P < 0.000. There is growing evidence that there is a subgroup of full-term newborn infants who actually may have experienced some degree of intrauterine growth retardation but their birthweights remain above the traditional cut-off of 2500 g so that they go unrecognized. The question to consider is whether these infants are as behaviourally vulnerable as full-term infants with classic intrauterine growth retardation. It may be that this unrecognized group is at a higher risk of developing FTT. The purpose of this manuscript is to discuss birthweight as a possible precursor to the development of FTT.

Postnatal Development of Urea Synthesis Capacity in Preterm Infants with Intrauterine Growth Retardation

The postnatal development of the urea-synthesizing capacity was studied in 21 preterm infants with intrauterine growth retardation (IUGR) and compared with results found in 12 infants without IUGR as controls. The urea-synthesizing capacity was estimated by the ratio Q of ¹⁵N abundance of ammonia and urea in 6-hour urine samples collected after enteral administration of 3 mg [¹⁵N]H₄Cl/kg body weight. The measurements were performed on the first day when a protein intake of 3.0–3.5 g/kg/day and an energy intake of 120 kcal/kg/day were tolerated (study day 1: postnatal 14–21 days) and on the day of discharge from the hospital (study day 2: postnatal age 39–56 days). The group of infants with IUGR was subdivided in one group of infants who developed catch-up growth (n = 12) and one group who did not demonstrate catch-up growth (n = 9). On study day 1, the Q values of the IUGR infants without catch-up growth were significantly higher than those of the IUGR infants with catch-up growth (13.4 ± 2.3 vs. 9.2 ± 2.2) or of the control infants without IUGR. During the time period from study day 1 to study day 2 the Q values of the IUGR infants with catch-up growth decreased significantly (9.2 ± 2.2 vs. 4.8 ± 2.0; p < 0.001) and were in the range of the control infants without IUGR. In contrast, the Q values of the IUGR infants without catch-up growth did not significantly change during the study period (13.4 ± 2.3 vs. 11.3 ± 2.8; p = 0.097). On both study days there was a significant correlation between the Q values and the degree of IUGR (study day 1: r = 0.652, p < 0.01; study day 2: r = 0.842, p < 0.001). The data indicate that the urea-synthesizing capacity of preterm infants increases during early postnatal life and that severe IUGR may impair this development. Metabolic investigations using urea as marker for evaluation of optimal quantity or quality of dietary proteins should carefully be interpreted when infants with severe IUGR are studied.

Decrease in Severity of Intrauterine Growth Retardation in Subsequent Pregnancies

Kuno, N.; Itakura, A.; Kurauchi, O.; Mizutani, S.; Kazeto, S.; Tomoda, Y. Author Information

Decrease in severity of intrauterine growth retardation in subsequent pregnancies

Objective: Intrauterine growth retardation (IUGR) is likely to recur ina subsequent pregnancy. We investigated the obstetric features of recurrent cases and the severity of IUGR by comparing initial and subsequent deliveries. Methods: From a total of 12 567 deliveries, 95 women who were delivered of small-for-gestational-age (SGA) infants and who became pregnant again within 5 years, were enrolled. A retrospective, comparative study of recurrent and non-recurrent groups was performed. Results: Twenty-two of ninety-five women gave birth to SGA infants again, and a relatively high risk of recurrence was confirmed, but no single recurrence-associated features were revealed. Within the recurrent group, the degree of IUGR was more severe in only five cases in the subsequent pregnancy. Conclusions: IUGR tends to recur, but does not increase in severity in most cases. We conclude that there is no need for excessive concern about the recurrence of IUGR.

Decrease in severity of intrauterine growth retardation in subsequent pregnancies

Objective: Intrauterine growth retardation (IUGR) is likely to recur ina subsequent pregnancy. We investigated the obstetric features of recurrent cases and the severity of IUGR by comparing initial and subsequent deliveries. Methods: From a total of 12 567 deliveries, 95 women who were delivered of small-for-gestational-age (SGA) infants and who became pregnant again within 5 years, were enrolled. A retrospective, comparative study of recurrent and non-recurrent groups was performed. Results: Twenty-two of ninety-five women gave birth to SGA infants again, and a relatively high risk of recurrence was confirmed, but no single recurrence-associated features were revealed. Within the recurrent group, the degree of IUGR was more severe in only five cases in the subsequent pregnancy. Conclusions: IUGR tends to recur, but does not increase in severity in most cases. We conclude that there is no need for excessive concern about the recurrence of IUGR.

Low neonatal cerebral oxygen delivery is associated with brain injury in preterm infants

Neonatal cerebral oxygen delivery was estimated in 93 preterm infants (gestational age < 34 weeks) who survived the neonatal period. Of these, 26 had developed neurological handicap at follow-up 1.7-4.6 years later. Neonatal cerebral oxygen delivery was dependent on gestational age, and was also related to the degree of intra-uterine growth retardation, carbon dioxide tension, and blood glucose concentration. Lower oxygen delivery was observed in infants who developed germinal layer haemorrhage or periventricular leucomalacia compared with infants with normal brains. However, as no information on cerebral metabolic demand or oxygen extraction is available, it is unclear whether decreased oxygen delivery is a contributing factor to brain damage or whether it is a marker of existing injury.

Activities of Lipase and Trypsin in Duodenal Juice of Infants Small for Gestational Age

In 18 low birth weight infants, small for gestational age, with different degrees of intrauterine growth retardation the activities of pancreatic lipase and trypsin and the concentrations of bile acids were measured in preprandially aspirated duodenal juice. The results were compared to those of 24 low birth weight infants, appropriate for gestational age, with comparable birth weights and postnatal ages. The activities of both measured pancreatic enzymes were negatively correlated with the degree of intrauterine growth retardation, expressed as the difference between the individual birth weight and the weight of the 10th percentile of the intrauterine growth curve (lipase: r = -0.697, p less than 0.001; trypsin: r = -0.739, p less than 0.001). The activity of trypsin in the small for gestational age infants was within the range of that found in the infants appropriate for gestational age. However, the lipase activity was decreased in infants who presented with growth retardation of greater than 400 g/kg birthweight. The concentrations of bile acids were similar in both groups (4.60 +/- 2.51 and 4.55 +/- 2.26 mmol/L, respectively) and sufficient for activating the bile salt stimulated lipase in human milk. The data suggest that in intrauterine growth retarded infants the lipase activity in the duodenal juice can be a limiting factor for optimal fat digestion. This should be considered in the nutritional management of such infants.

Activities of Lipase and Trypsin in Duodenal Juice of Infants Small for Gestational Age

SummaryIn 18 low birth weight infants, small for gestational age, with different degrees of intrauterine growth retardation the activities of pancreatic lipase and trypsin and the concentrations of bile acids were measured in preprandially aspirated duodenal juice. The results were compared to those of 24 low birth weight infants, appropriate for gestational age, with comparable birth weights and postnatal ages. The activities of both measured pancreatic enzymes were negatively correlated with the degree of intrauterine growth retardation, expressed as the difference between the individual birth weight and the weight of the 10th percentile of the intrauterine growth curve (lipase: r = −0.697, p &lt; 0.001; trypsin: r = −0.739, p &lt; 0.001). The activity of trypsin in the small for gestational age infants was within the range of that found in the infants appropriate for gestational age. However, the lipase activity was decreased in infants who presented with growth retardation of &gt;400 g/kg birth‐weight. The concentrations of bile acids were similar in both groups (4.60 ± 2.51 and 4.55 ± 2.26 mmol/L, respectively) and sufficient for activating the bile salt stimulated lipase in human milk. The data suggest that in intrauterine growth retarded infants the lipase activity in the duodenal juice can be a limiting factor for optimal fat digestion. This should be considered in the nutritional management of such infants.

Über den Einfluß der intrauterinen Mangelentwicklung und der Gestationsdauer auf den Status praesens des Neugeborenen

We investigated on the basis of 14,498 singleton births between the completed 24th and 42nd week of pregnancy, the dependence of the Apgar index after one minute and of the actual pH in the umbilical artery on two clinical variables 1. the duration of gestation and 2. the degree of intrauterine growth retardation. To determine the latter, each of the 14498 infant weights was transformed arithmetically to a percentile, i.e. a figure between 0 and 100. It was shown that the duration of pregnancy has a significant effect on increasing foetal acidity, which is greater (nonlinear correlation), the more immature the baby is. The influence of intrauterine growth retardation is slight but demonstrable in mature neonates and with adequate clinical management. In premature infants, especially in very small premature babies, intrauterine growth retardation becomes a major risk factor: increasing hypotrophy leads to a probably exponential rise of the acidity figures as well as to an increase in the percentage of low and very low Apgar scores. Hypertrophic premature babies and hypertrophic mature neonates are also subject to an increased risk. The effects mentioned above, of clinical maturity and intrauterine nutrient and oxygen supply on the unborn baby, result in a numerical continuity in the behaviour of the parameters: there are no abrupt alterations. This suggests, that the conventional definitions of hypotrophy or hypertrophy should be reconsidered. Furthermore, the data allow the conclusion, that prematurity and dysmaturity are two important variables thus suggesting an individual (i.e. non-schematic) obstetric procedure in premature deliveries.

Long-term growth in small-for-date children.

The growth patterns of 158 infants with significant intrauterine growth retardation (IUGR) were studied for the first 2 years of life. Eighty-four infants were born after 36 completed weeks. All these full-term infants survived; complete follow-up data were obtained for 78. Acceleration of growth in weight began soon after birth and continued for an average of 6 months. Acceleration of linear growth began somewhat later, but was limited to the first 9 months. Twenty-three infants (29%) were still below the 5th centile for both weight and height by 2 years of age. There was a negative correlation between the neonatal ponderal index and length at 18 months for females only. Seventy-four infants were born prematurely, before 37 weeks' gestation. Mortality in this group was 18% and complete follow-up data were obtained for 49 of the 61 survivors. Birth weight was regained on average at 11 days; accelerated weight velocity began 4-6 weeks before the expected date of delivery (term date). The potential for catch-up growth lasted up to 9 months after the term date. By 18 months, however, 44% of these pre-term infants were still below the 5th centile for weight. Size at 18 months post-term was correlated with weight at the term date and length at 3 months post-term, but not with the degree of IUGR or with the ponderal index.

Umbilical artery blood velocimetry: a prospective longitudinal study in search of the intrauterine growth-retarded fetus

In a longitudinal prospective study involving 125 patients, blood velocity waveforms in the umbilical artery were recorded and analyzed from the 15th week of gestation until term to evaluate the predictive value of blood velocity parameters with regard to fetal growth retardation. Measurements were performed with a combined real-time linear array and 2-MHz pulsed Doppler technique. The mean values ( ± 2 S.D.) of the A/B ratio, resistance index (RI) and pulsatility index (PI) were calculated from the 15th to the 40th week of gestation. The degree of intrauterine growth retardation was related to postnatal catch-up growth. Three groups of patients were compared with regard to blood velocity waveform indices. Group NLI/II: waveform indices (WI) within 2 S.D. of the population mean. Group EL-I: at least a single WI above 2 S.D. of the population mean. Group EL-II: consistently WIs above 2 S.D. of the population mean. Significant differences with regard to neonatal growth variables were found between these groups. In spite of the fact that these differences in growth variables were statistically significant, no clear relationship was found between the velocity waveform indices and true intrauterine growth retardation, defined by a non-birthweight criterion. It seems that umbilical artery velocimetry cannot predict true intrauterine growth retardation.

A case control study of necrotizing enterocolitis occurring over 8 years in a neonatal intensive care unit.

The perinatal histories of 27 newborn infants with NEC were compared to those of 54 infants of equivalent birth weight who did not have NEC during an 8-year study period to see if possible predisposing factors were independent of the confounding effect of birth weight. No differences were observed in gestational age, degree of intrauterine growth retardation, premature rupture of membranes, perinatal asphyxia, skin temperature at admission, haematocrit, presence or absence of respiratory distress syndrome, umbilical catheter placement, start and type of feeding or presence of positive blood cultures. Prematurity is the greatest risk factor predisposing to the development of NEC and the perinatal problems which precede the onset of NEC are common among all premature infants.

Growth of 519 small for gestational age infants during the first two years of life.

The physical growth of 519 small for gestational age infants (SGA), with a birth weight below the 10th percentile on our own growth curve, born in the region of University Central Hospital of Turku during the period June 1, 1981-May 31, 1982, was studied. The study population consists of 4,517 term, appropriate for gestational age (AGA) infants, 488 term SGA infants, 320 preterm AGA infants and 31 preterm SGA infants. The degree of intrauterine growth retardation (IUGR) seemed to have an effect on physical growth in term SGA infants. Those term SGA infants with a low Ponderal Index (PI) (type II) were taller and had a larger head circumference at the age of 24 months than term SGA infants with adequate PI (type I). Among the preterm SGA infants the degree of IUGR seemed to have no effect on later growth. Smoking is still one of the main risk factors associated with poor intrauterine growth. In this study we also found that smoking has an effect on later growth; the children of smoking mothers were smaller than those of non-smoking mothers in the AGA group. Among the SGA infants the infants of non-smoking mothers were bigger than those of smoking mothers. This difference could be explained by other factors associated with SGA. We found that in spite of the catch-up growth during the first months, 26% of the severely SGA infants (birth weight below the 2.5th percentile) still had a weight below the 2.5th percentile at the age of 24 months.

Growth and Fatty Acid Metabolism in Experimental Intrauterine Growth Retardation: Effect of Postnatal Nutrition in Rat

Rats, 3½ to 4 d of age, were used to study weight gain and fatty acid (FA) metabolism as a function of degree of intrauterine growth retardation (IUGR) and of postnatal nutrition. The IUGR, quantified postnatally as mild and severe, was produced by uterine artery ligation on d 17 of gestation, and controls were sham-operated. Food intake was manipulated by varying the litter size; i.e., pup number per dam was 4 or 5 for overfeeding, 8–10 for normal feeding and 13–15 for underfeeding. Fatty acid synthesis rate (FASR) (determined by tritiated water incorporation in FA) and contents were determined in selected organs at 84 to 96 h of age. The initial weights (grams) at 2 to 12 h of age were: 5.88 ± 0.74 (mean ± SD) for controls, 5.18 ± 0.11 for mild IUGR and 4.18 ± 0.24 for severe IUGR. During the first 96 h of life, weight gain was less in underfed control pups while overfeeding resulted in the same weight gain as in normally fed pups. Pups with mild IUGR showed the same effect of under- or overfeeding as control pups. In the severe IUGR groups, weight gains were similar in all three feeding groups. In the carcass, the fatty acid content was reduced as a result of both prenatal and postnatal undernutrition. Although the underfed control group had a high FASR, underfeeding had no effect on the FASR of groups with IUGR. In the liver, the FA content was also lower in the underfed controls and in IUGR groups, without any difference in FASR. Feeding did not influence the FASR of liver. In the brain, the FA synthesis rate of normally fed IUGR pups was significantly greater and was almost twice as high in underfed IUGR pups as in normally fed IUGR pups. This was accompanied by significantly lower FA contents in both normally fed and underfed IUGR pups. It is concluded that in the rat, during the first few days of life, 1) a generous food supply does not augment weight gain, 2) a restricted food supply reduces weight gain in normal and mild IUGR but not in severe IUGR and 3) the reduction fatty acid content in prenatal and postnatal under-nutrition is consistent with the reduction in weight gain.