Intrauterine Growth Restriction Babies Research Articles

Study on clinical profile, risk factors, morbidity and mortality patterns of intrauterine growth restricted babies admitted in neonatal intensive care unit of tertiary care hospital, Vijayapura

Background: Intrauterine growth restriction (IUGR) is an important clinical problem associated with increased perinatal mortality and morbidity. The neonate may be either constitutionally small or small due to pathophysiological changes with maternal, placental or foetal factors involved. A foetus with IUGR has not achieved its genetic growth potential. In addition, emerging evidence suggests that they are also more likely than normal weight babies to suffer from degenerative diseases like hypertension, diabetes and cardiovascular diseases in adulthood. Methods: This is a cross-sectional study carried out in the neonatal unit, tertiary care hospital, Vijayapura. This study was carried out between April 2022 to April 2024. 120 IUGR babies were included in this study. Results: Of the 120 babies 22 (18.3%) have died in the hospital. 19 (15.5%) have been discharged with abnormal neurological examination and 79 (66.3%) have been discharged with good condition at discharge condition. Morbidity pattern of IUGR shows that hypoglycaemia (63.3%) and perinatal asphyxia (45.0%) are the commonest complication. Other commoner are sepsis (33.3%), hypocalcaemia (30.0%), hypothermia (28.3%) and thrombocytopenia (25.0%). Conclusions: Perinatal asphyxia and meconium aspiration are significantly associated with abnormal neurological examination at discharge. Perinatal asphyxia, pulmonary haemorrhage and persistent PH are significantly associated with death during the hospital stay. 73 (77.5%) mothers had one or more risk factors. Malnutrition is the commonest (40.0%), other are anaemia (34.2%), pregnancy-induced hypertension (PIH) (18.3%), multiple gestations (8.3%) and lower age of the mother.

Immediate Outcome of Intrauterine Growth Restricted Infants

Background: Intrauterine growth restriction (IUGR) is one of the major public health issues in developing countries like Bangladesh. IUGR has got significant importance due to its approach towards post neonatal, infant and childhood mortality and morbidity. Objective: To identify immediate outcome of IUGR infants. Methods: This case control study was conducted in department of Neonatology at BSMMU, Dhaka from August 2015 to July 2016, where 98 newborns in the NICU during study period were the study population. All the IUGR babies were labeled as case (Group- A), n=49 and the babies of the same gestational age were labeled as control (Group-B), n=49. The outcome was observed by the caution and careful NICU follow up of the baby. After collection, data were entered into a personal computer and were edited, analyzed, plotted in graphs and tables. Data were analyzed by chi square test, Mann Whitney U tests, using the statistical package for social sciences (SPSS) version 20. P values less than 0.05 (95% CI) were considered statistically significant. Result: During the study in case group, hypoglycemia (p=0.007) & hyperbilirubinemia (P=<0.001) were statistically significant complication. Length of hospital stay was more (P=0.001) in IUGR group which was also significant. Death was more in IUGR than AGA group. Conclusion: From our result, we can conclud e that Hypoglycemia and hyperbilirubinemia were significant complication of IUGR babies. IUGR babies had longer hospital stay than AGA babies. Death were more in IUGR babies but was not statistically significant. Sir Salimullah Med Coll J 2023; 31: 9-12

Cerebroplacental ratio as a predictor of perinatal outcomes in intrauterine growth restriction

Intrauterine growth restriction (IUGR) complicates 7-15% of pregnancies and is associated with adverse perinatal outcomes. The primary goal of antenatal care is the early detection of such conditions. Doppler studies in fetus are used to predict the morbidity in IUGR. Studies show that cerebroplacental ratio is a better predictor of IUGR babies and adverse perinatal outcome. In this study we compare perinatal outcomes of IUGR babies with a normal CPR and an abnormal CPR. This prospective cohort study was carried out in the Department of Obstetrics and Gynaecology, Amala Institute of Medical Sciences, Thrissur, from January 2018 to June 2019. The study included 170 antenatal mothers diagnosed IUGR sonologically or are at risk of IUGR. CPR was calculated from Doppler parameters as ratio of MCA PI and Umbilical artery PI. CPR more than 1.08 was considered normal. Perinatal outcomes were compared between normal and abnormal CPR group. The incidence of abnormal CPR was found to be 39.4%. An abnormal CPR was associated with an increase in rate of emergency ceaserean rate for fetal distress (76.12%) and 64.18% had an APGAR of <7 at 5 mts of life. 97.02% babies with an abnormal CPR were admitted to NICU for several reasons. Frequency of adverse perinatal outcomes was increased in abnormal CPR group. These differences were statistically highly significant. In patients with IUGR, cerebroplacental ratio is a useful marker in prediction of adverse perinatal outcome. Integrating CPR into routine Doppler studies in clinical practice will help better identify fetuses at risk.

Association between Prenatal Maternal Tobacco Use and Intrauterine Growth Restriction: A Case-Control Study

Introduction: Intrauterine growth restriction (IUGR) refers to the poor growth of a baby while in the mother’s womb during pregnancy. More than 9% of women smoke tobacco and one-third of women consume smokeless tobacco in developing countries. The intent of the study was to examine the effect on fetal intrauterine growth retardation using maternal tobacco. Methods: This convenient case-control study was conducted with 75 cases and 150 suitably matched controls enrolled in the Department of Pediatrics at Sylhet MAG Osmani Medical College Hospital for about 12 months. Ethical considerations were undertaken before the enrollment of patients. Data were analyzed using SPSS software. Result: ST user mothers of IUGR infants used jarda or gul as smokeless tobacco about 5 times a day and smoker mothers smoked about 5 sticks a day. Maternal tobacco use had a higher (6.9 times) risk of having IUGR babies compared to the non-tobacco user. Conclusion: This study observed that maternal total tobacco use showed a risk of having IUGR infants more than 6.9 times in contrast to non-tobacco user.

Association of Parental Factors and Insulin-like Growth Factor 2 Polymorphism with Intrauterine Growth Restriction.

Polymorphism of insulin-like growth factor 2 (IGF2) is known to play a role in cell development. Only the paternal IGF2 copy is active, while the copy inherited from the mother is inactive. This study aimed to explore whether maternal and paternal factors influence IGF2 polymorphism in newborns with intrauterine growth restriction (IUGR) compared to appropriate for gestational age (AGA). A cross-sectional exploratory study was conducted from June 2014 to November 2015 at the Neonatology, Gynecology 1 Clinic, Cluj-Napoca, Romania. The ApaI IGF2 genotypes and allele frequencies were similar in the IUGR and AGA groups (p-value > 0.10). The IUGR babies with a protective IGF2 genetic profile had significantly younger parents (a difference in the median age of 8 years for mothers and 9 years for fathers; p-value < 0.009). The IUGR babies had parents with lower birth weights than AGA babies (mothers’ medians: 2800 g vs. 3100 g; fathers’ medians: 3000 g vs. 3400 g; p-value < 0.02). In univariable regression analysis, the mother’s and father’s birth weight proved to be associated with IUGR. The father’s birth weight proved to be the only factor significantly associated with IUGR, independent of the mother’s birth weight or the presence of a protective IGF2 genetic profile (odd ratio = 0.998 [0.996 to 1.000], p-value = 0.032).

Role of Ultrasonography in Screening High Risk Mothers for Detection of IUGR

Introduction: The 10th percentile of expected foetal weight for gestational age is classified as intrauterine growth restriction (IUGR) or foetal growth restriction. IUGR occurs for a variety of reasons. Any issue with the placenta is a major contributor. Aims and objectives: 1) To determine the role of ultrasonography in screening high risk mothers for detection of IUGR. 2) To find out the impact of fetal parameters on the extent of IUGR.3) For correlation between sonographic pattern of IUGR and the birth weight. 4) For correlation between doppler parameters and perinatal outcome. Materials and methods: This is a prospective study done over a period of 2 years in Mamata General Hospital (MGH) from Oct 2017 to Oct 2019. Study included 50 pregnant women with high risk factors and clinically suspected IUGR attending for ultrasound examination were subjected to Uterine, Umbilical and Middle cerebral artery Doppler along with morphology and biometry scan after fulfilling the inclusion and exclusion criteria. Results: Reverse, absence or slow end diastolic flow was considered abnormal which was seen in 33 patients. Nine patients had Absent /Reversed end diastolic flow of which, 3 patients had IUD, 4 had Still births, 2 were admitted in NICU with apgar at 1min &lt;7. Middle cerebral artery was abnormal in 10 patients, of which 8 patients had IUGR babies with adverse perinatal outcome. MCA/UA S.D ratio, which was abnormal in 19 patients of which 16 patients had adverse perinatal outcome. Conclusion: Doppler has proven to be more sensitive than other methods of foetal monitoring in recognising fetal compromises early and assisting in the proper time of delivery. Keywords: Ultrasonography, doppler, IUGR.

A Case Series of Four Preterm Intrauterine Growth Restricted Babies With Transient Hyper-Insulinemic Hypoglycemia and Cholestasis

Background: Premature infants with intrauterine growth restriction (IUGR) are predisposed to stress related hyper Insulinemic hypoglycemia (HIH). These babies are at risk for other prematurity related complications including direct hyperbilirubinemia. However, association of HIH with this has not been described, and transient cholestasis in HIH infants has not been reported. We present 4 such infants with perinatal stress related HIH who had cholestasis that resolved with time. Case series: In our retrospective review of these preemies with IUGR who had developed HIH, we found that 4 infants developed direct hyperbilirubinemia. Their gestational ages at birth ranged between 26 to 27 weeks, with birth weights between 527 to 642 grams. These infants had received total parenteral nutrition (TPN) for durations ranging between 12 to 19 days of life (DOL). HIH was established in them at variable ages between 55 to 75 DOL, based on an exaggerated glycemic response to glucagon. Of these, 1 baby was not started on Diazoxide due to underlying fluid overload. His HIH resolved by DOL 182. Two babies responded to therapy and while one remained on this till its resolution at 9 months age, another had the Diazoxide discontinued due to acute respiratory worsening leading to readmission. HIH in the latter resolved by 109 DOL. Fasting The last baby developed fluid overload early in therapy leading to its discontinuation without establishing response. Hypoglycemia in these infants resolved by ages between 4 to 9 months of life. Interestingly direct hyperbilirubinemia was noted by age 16 to 59 DOL. In all infants, the diagnosis of HIH was established after the onset of cholestasis. Extensive work up for hyperbilirubinemia ruled out any organic pathology. This transient cholestasis was noted to have resolved by ages 80 to 115 DOL. Conclusion: It appears from our experience in these premature infants, cholestasis may be associated with HIH. Its diagnosis preceded the establishment of HIH. We noted that HIH diagnosis was delayed by around 30 days after the onset of intermittent hypoglycemia. Both the cholestasis and HIH were transient. Whether the cholestasis may prognosticate the development of HIH or is indicative of transient HIH needs to be investigated. Any association between the two needs to be studied to address a common causality. IUGR babies with conjugated hyperbilirubinemia develop a mild and transient HI state which is self-resolving. Due to transient nature of this HIH in these IUGR babies with cholestasis, a genetic work up for HIH may be deferred.

Global DNA Methylation in Cord Blood and Neurodevelopmental Outcome at 18 Months of Age among Intrauterine Growth Restricted and Appropriate for Gestational Age Infants.

Intrauterine growth restriction (IUGR) is associated with faltered growth and development later in life. Alteration in DNA methylation may occur among IUGR babies and it can have bearing on the outcome. To compare the DNA methylation in the cord blood among IUGR and appropriate for gestational age (AGA) babies and find it is association with their neurodevelopmental outcome at 18 months of age. Genomic DNA methylation among 40 IUGR and equal number of AGA neonates was estimated by using 5-mC ELISA kit in the cord blood. Infants were assessed at birth and their anthropometric measurements were taken. They were regularly followed up and assessed for neurodevelopment outcome till 18 months of age using DASII (Developmental Assessment Scale for Indian Infants). DNA methylation was correlated with neurodevelopmental outcome. Numbers and percentages were used for categorical data. Mean and SD were used for continuous variables. The significant mean difference between IUGR and AGA was determined by independent Student t-test. To study the association between the DNA methylation and outcome, Spearman correlation was used. A p < 0.05 was considered as statistically significant. Significant difference in DNA methylation was observed between IUGR and AGA infants (IUGR: 3.12 ± 1.24; AGA: 4.40 ± 2.03; p < 0.001). Anthropometry (weight, length and head circumference) at birth was significantly decreased among IUGR infants. Hospital stay was significantly longer for IUGR infants. Motor (IUGR: 89.98 ± 18.77; AGA: 101.75 ± 9.62; p < 0.001), and mental (IUGR: 90.81 ± 11.13; AGA: 105.71 ± 7.20; p < 0.001) scores were significantly decreased among IUGR compared with AGA neonates at 18 months of follow-up. Global DNA methylation had a significant positive correlation with mental score but not with motor developmental score. IUGR babies had lower motor and mental score compared with AGA babies. Cord blood global DNA methylation significantly correlated with mental development score but not with motor development at 18 months of age.

Identification of differentially methylated candidate genes and their biological significance in IUGR neonates by methylation EPIC array

Background Intrauterine growth restriction (IUGR) is a pregnancy-associated disease manifested by decreased growth rate of fetus than the normal genetic growth potential. It is associated with increased susceptibility to metabolic diseases later in life. Although the mechanisms underlying the origin of metabolic diseases are poorly understood, DNA methylation is a crucial investigation for the identification of epigenetic changes. Objectives To assess the degree of change of DNA methylation in IUGR neonates and compare with that of appropriate for gestational age (AGA) neonates and to explore the differentially methylated candidate genes and their biological significance. Methods This cohort study was conducted in the Neonatology Department of JIPMER during the period of November 2017 to December 2018. Forty each of IUGR and gestation matched AGA neonates were recruited. Umbilical cord blood samples were collected at birth. DNA was separated from the blood samples; and, using 5-mC DNA ELISA method, the percentage of genomic DNA methylated in these neonates was established. Data were expressed as mean ± standard deviation. Methylation EPIC array was performed to identify the differentially methylated candidate genes. David analysis was used to find out the functional annotation chart by KEGG pathway. Results Genomic DNA methylation varied significantly between IUGR and AGA neonates (IUGR: 3.12 ± 1.24; AGA: 4.40 ± 2.03; p value: <.01). A global shift toward hypomethylation was seen in IUGR compared with AGA, targeted to regulatory regions of the genome, and specifically promoters. Pathway analysis identified deregulation of pathways involved in metabolic diseases. Altered methylation of PTPRN2 & HLADQB1 genes leads to dysregulation of T-cells and reactive oxygen species (ROS). These changes may lead to complications later among these neonates subjected to IUGR. Conclusion Our findings show significant changes in the methylation pattern of genes among IUGR and AGA babies. Steps for correcting the changes may help in reducing later complications among IUGR babies.

Role of Maternal Serum Ferritin in the Prediction of Asymmetric Intrauterine Growth Restriction

Aim: Asymmetric intrauterine growth restriction (IUGR) carries increased intrauterine and neonatal risks. Since most cases are idiopathic, identifying a predictive test remains an ideal prevention management. Maternal serum ferritin level is a potential predictor of later developing asymmetric IUGR. Patients and Methods: Blood samples were drawn, at 30-32 gestational weeks, from 450 women who were then followed-up resulting in 32 term pregnancies with asymmetric IUGR. The control group included the first recruited 32 women delivering adequate for gestational age neonates at term. Serum ferritin was then measured in the stored serum samples. Ultrasound scanning was performed at 30-32 weeks then at 37 weeks. Umbilical and middle cerebral artery Doppler scans were added at 37 weeks. Results: Serum ferritin, at 30-32 weeks, was higher in women delivering IUGR babies (19.3±6.83 vs 14±5.18, p 18.2 ng/mL had a sensitivity of 59.4% and a specificity of 90.6%. The area under curve showed an accuracy of 76.8%. Women with ferritin >18.2 ng/ml were 10.23 times more likely to get asymmetrically growth restricted neonates (CI 2.89–36.17, p<0.001). Conclusion: This study presents further evidence that maternal serum ferritin may be a useful test in the prediction of asymmetric IUGR.

Role of Maternal Serum Ferritin in the Prediction of Asymmetric Intrauterine Growth Restriction. Short running title: Ferritin predicts asymmetric IUGR

Background and aim: Asymmetric intrauterine growth restriction (IUGR) carries increased intrauterine and neonatal risks. Since most cases are idiopathic, identifying a predictive test remains an ideal prevention management. Maternal serum ferritin level is a potential predictor of later developing asymmetric IUGR. Methods: Blood samples were drawn, at 30-32 gestational weeks, from 450 women who were then followed-up, resulting in 32 term pregnancies with asymmetric IUGR. The control group included the first recruited 32 women delivering adequate for gestational age ne- onates at term. Serum ferritin was then measured in the stored serum samples. Ultrasound scanning was performed at 30-32 weeks then at 37 weeks. Umbilical and middle cerebral artery Doppler scans were added at 37 weeks. Results: Serum ferritin, at 30-32 weeks, was higher in women de- livering IUGR babies (19.3±6.83 vs 14±5.18, p 18.2 ng/mL had a sensitivity of 59.4% and a specificity of 90.6%. The area under curve showed an accuracy of 76.8%. Women with ferri- tin >18.2 ng/ml, were 10.23 times more likely to get asymmetrically growth restricted neonates (CI 2.89–36.17, p<0.001). Conclusion: This study presents further evidence that maternal serum ferritin may be a useful test in the prediction of asymmetric IUGR.

Intrauterine Growth Restriction and Hyperoxia as a Cause of White Matter Injury

Intrauterine growth restriction (IUGR) is estimated to occur in 5% of pregnancies, with placental insufficiency being the most common cause in developed countries. While it is known that white matter injury occurs in premature infants, the extent of IUGR on white matter injury is less defined in term infants. We used a novel murine model that utilizes a thromboxane A₂ (TXA₂) analog (U46619), a potent vasoconstrictor, to induce maternal hypertension and mimic human placental insufficiency-induced IUGR to study the white matter. We also investigated the role of hyperoxia as an additional risk factor for white matter injury, as IUGR infants are at increased risk of respiratory comorbidities leading to increased oxygen exposure. We found that TXA₂ analog-induced IUGR results in white matter injury as demonstrated by altered myelin structure and changes in the oligodendroglial cell/oligodendrocyte population. In addition, our study demonstrates that hyperoxia exposure independently results in white matter perturbation. To our knowledge, this is the first study to report single and combined effects of IUGR with hyperoxia impacting the white matter and motor function. These results draw attention to the need for close monitoring of motor development in IUGR babies following hospital discharge as well as highlighting the importance of limiting, as clinically feasible, the degree of oxygen overexposure to potentially improve motor outcomes in this population of infants.

A comparative study of blood glucose and serum calcium levels in term IUGR neonates and normal neonates: a cross sectional study

Background: Hypoglycemia and hypocalcemia are common metabolic problems occurring in the newborn and have direct consequences in the early neonatal period, prompt identification and treatment prevents severe neurodevelopmental outcomes. The primary objective was to compare blood glucose and serum calcium levels in term Intrauterine growth restriction (IUGR) babies with term appropriate for age (AGA) babies and secondarily to compute number of term IUGR babies with hypoglycemia and hypocalcemia.Methods: Fifty term IUGR and 50 term AGA babies delivered at SDMCMSH, Dharwad during the study period of one year were included as cases and controls respectively after considering the inclusion and exclusion criteria. Two ml of peripheral venous blood was analyzed at 3 hours and 24 hours of life. Serum calcium was measured by calorimetric test method and blood glucose by auto analyzer. Statistical analysis was done using SPSS-17.Results: At 3 hours of birth, 24% of term IUGR and 4% of AGA neonates had hypoglycemia. The mean RBS of cases at 3rd hour was 61.36±23.56 mg/dl, significantly lower than control group (75.90±22.57mg/dl). The mean RBS among cases at 24 hours of life was 70.42±16.14 mg/dl compared to 78.84±15.90 mg/dl among controls. Both correlations were statistically significant. 8% cases had hypocalcemia at 3 hours and 6% had at 24 hours. The mean serum calcium level was lower in cases (8.50±1.40 mg/dl) than controls (8.63±1.14 mg/dl) at the 3rd hour of life and 24 hours of life [cases (8.42±1.07 mg/dl) versus controls (8.64±0.91 mg/dl)].Conclusions: Significantly lower blood glucose levels were identified in term IUGR neonates. This association was apparent at 3 hours of life. The measurement of serum calcium &amp; glucose in IUGR babies could predict a poorer outcome in these patients. Identifying and treating these biochemical abnormalities can avoid short term as well as long term sequelae.

Maternal Predictors of Intrauterine Growth Retardation.

To identify maternal factors associated with intrauterine growth restriction (IUGR). A case-control study. Neonatal Unit of The Aga Khan Hospital for Women (AKHW), Karimabad, from January 2014 to December 2015. Cases were IUGR live born babies (n=90), while control were appropriate-for-gestational age (AGA) babies (n=180). Information recorded in pre-designed proforma included gestational age and birth weight of baby, demographics of mothers, pregnancy related medical and obstetric complications. Data were analysed through SPSS-19. Multivariable logistic regression was used to determine the maternal factors associated with the intrauterine growth restriction. Maternal factors associated with IUGR after adjusting for confounders in the multivariable model included younger age (OR=0.9, CI=0.8-0.9), poor gestational weight gain (OR=3.0, CI=1.6-6.1) and history of previous abortion (OR=3.06, CI=1.1-8.0). Significant interaction was found between pregnancy-induced hypertension (PIH) and parity of mother, primary-para mother with PIH having an increased risk for IUGR babies (OR=10.1, CI=1.0-23.2). Young age, primigravida status, low gestational weight gain, previous history of abortion, PIH and GDM have strong association with IUGR; hence, special consideration is essential to overcome these issues in order to improve maternal and neonatal health.

Disparities of Clinical Features and Associated Maternal Factors among Symmetrical and a Symmetrical Intra-Uterine Growth Restriction (IUGR) in NICU at Al-Yarmouk Teaching Hospital in Baghdad, Iraq

Background: Worldwide Intra-Uterine Growth Restriction carries out high rate of fetal and neonatal morbidity and mortality. Perinatal mortality rates are 4-8 times higher for growth-retarded infants. IUGR are subdivided into symmetrical and asymmetrical subtypes. Aim of Study: To focus on the actual incidence of each subtype of IUGR and disparities. Methods: Across-sectional descriptive study applied on 52 singleton newborns admitted to the NICU at Al-Yarmouk Teaching Hospital, Baghdad, Iraq, from January to December2015.We assessed them for some demographic characteristics, anthropometric measures, investigation and a thorough physical examination with an estimation of the Ponderal Index (PI) values; these data were analyzed using SPSS version 18.0 software.Results: We found equal gender distribution for each sex. The 63.46% of IUGR babies was of asymmetrical type while 36.53%wassymmetrical.Incidencerate was higher among multiparous mothers than primiparous as 51.9%. The asymmetrical subtype mostly delivered by NVD 63.6% while the symmetrical subtype mostly delivered by CS delivery 68.4 %. RDS was the commonest early complication, the higher percentage was among symmetrical than asymmetrical subtypes 57.9%, 27.3%, respectively. Among all deaths 33.35% had asymmetrical subtype. The mean birth weight for a symmetrical subtype was 1.41 kg, while for the symmetrical subtype it was 1.76 kg.Conclusion: The asymmetrical IUGR newborns were more than symmetrical type. More than two thirds of symmetrical IUGR were delivered with Cesarean section, while more than two thirds of asymmetrical IUGR were delivered normally and more than half of symmetrical IUGR were with RDS. Sex had no effect on IUGR distribution.

Accuracy of Transverse Cerebellar Diameter measurement by Ultrasonography in the evaluation of fetal age

Background: Perinatal mortality a concern in the developing countries and intrauterine growth restriction (IUGR) is an important cause. Therefore early diagnosis of IUGR babies is the key to prevent complications as well as mortality. Multiple biometric parameters including trans-cerebellar diameter can be used to predict the gestational age. Thus, the present study was designed to measure and compare the trans-cerebellar diameter and evaluates the usefulness of transverse cerebellar diameter as against the conventional parameters and to find out the usefulness of transverse cerebellar diameter in antenatal diagnosis of intrauterine growth retardation. Methods: A cross-sectional study was conducted on normal antenatal women of 15-40 weeks gestational age referred for antenatal ultrasonography between January to December 2015. Total 250 patients were examined. Data collected was compared with the conventional parameters. Results: Good correlation was found between transverse cerebellar diameter (TCD) and other parameters. Also TCD showed a linear relationship between the cerebellar growth and the gestational age. It was found to be better than BPD in circumstances like excessive molding and dolicocephaly. Also TCD measurement was not fraught with problems as encountered in FL measurement. The mean TCD/AC ratio was 13.866%. So it was found that TCD can be used as a reliable parameter for determination of gestational age in mass studies. Conclusion: There is good correlation between TCD and other parameters in normal pregnancies at 15 to 40 weeks of gestation. This implies that, TCD is a better parameter for gestational age assessment compared to BPD and FL.

Maternal determinist of term intrauterine growth restriction (IUGR) in the Kingdom of Saudi Arabia

ABSTRACTIntrauterine growth restriction was defined as occurring if birth weight of the newborn is below 10th percentile for gestational age. We investigated its maternal determinants in Riyadh, Saudi Arabia by comparing 76 cases to 76 controls to aid in early detection, diagnosis and proper prevention. A history of stillbirth, less than three years interpregnancy intervals, experiencing preeclampsia during pregnancy besides gaining less than nine kilograms during term pregnancy would signal a risk of having intrauterine growth restriction babies. Mothers living in rural areas as well as smokers along with those above 34 years old were associated with the same risk.

Effect of signal acquisition method on the fetal heart rate analysis with phase rectified signal averaging

Phase rectified signal averaging (PRSA) is increasingly used for fetal heart rate (FHR) monitoring, both with traces acquired with external Doppler cardiotocography (D-FHR), and with transabdominal fetal electrocardiography (ta-FHR). However, it is unclear to what extend the acquisition method influences the PRSA analysis, whether results from using one acquisition method are comparable to those based on FHR acquired by the other method, and if not, which should be the preferred method.To address these questions, we applied PRSA analysis to 28 antepartum synchronous recordings of the FHR using simultaneously D-FHR and ta-FHR. The data included late-onset intrauterine growth restricted (IUGR) fetuses (n = 20) and non-IUGR fetuses (n = 8), all of them at gestation ⩾34 weeks. PRSA analysis depends on two parameters intrinsic to the algorithm, T and S. We analyzed the data using parameters that included all values adopted by other researchers previously (derived from a literature search in PubMed and Google Scholar). T and S were adjusted for the difference in acquisition techniques. We found that the correlation between PRSA analysis based on D-FHR and ta-FHR decreased with decreasing values of the PRSA parameters T and S. Therefore, the acquisition technique affects PRSA values for high resolution PRSA (low values of T and S).In conclusion, for low resolution PRSA, the results from both acquisition methods are comparable. Because ta-FHR signals provide beat to beat data and thus capture more subtle differences in the heart rate variation than D-FHR signals (pre-processed by commercial monitors), we assumed that ta-FHR may provide potentially valuable extra information compared to D-FHR. However, no parameter settings or acquisition method seemed to have a diagnostic value for identifying the late-onset IUGR babies in our dataset.

Maternal pre-eclampsia as a risk factor for necrotizing enterocolitis

Objective: Similar pro-inflammatory responses are present in pre-eclampsia (PE) and necrotizing enterocolitis (NEC). We hypothesized that maternal PE is an independent risk factor for the development of NEC.Methods: A retrospective database of all live births (2008–2011) at a tertiary center was constructed. Infant and maternal characteristics were gathered. Babies born to mothers with or without PE were compared. Data were analyzed using Mann–Whitney U, Pearson's χ2, binary logistic regression and relative risks.Results: Incidence of NEC was 1.5% in non-PE and 4.6% in the PE group (p < 0.001), but once controlled for gestational age and birth weight, the difference lost statistical significance. PE babies were more frequently preterm (41.4% versus 14.5%, p < 0.001) and had intrauterine growth restriction (IUGR) (10.2% versus 6.3%, p < 0.001). Within preterm babies, 9.0% of non-PE and 10.8% of PE babies developed NEC (p = 0.25). Effect of PE was significant in sub-group of IUGR babies, with NEC in 1.5% of non-PE and 13.6% in PE babies (p < 0.001).Conclusions: Maternal PE is an independent risk factor for the development of NEC in some sub-groups of babies, most notably with IUGR. Fetal hypoxia caused by abnormal placentation in PE leads to restricted growth, and may be the underlying mechanism that predisposes the newborn to NEC.

Perinatal mortality and morbidity among low birth weight babies

Background: This study was conducted to assess the perinatal mortality and morbidity among Low Birth Babies (LBW) and to determine the associated maternal health and sociodemographic factors. Methods: This was a hospital based cross sectional observational study conducted over a period of three years. All the babies (1002) with birth weight ˂2500 gm but >1000 gm born during this period and their mothers were included in the study. Babies were followed up for one week after birth and perinatal mortality and morbidity were assessed. Results: The perinatal mortality rate among LBW babies was 124.7/1000 babies. Very low birth weight babies (˂1500 g) had 10 times mortality rates than babies with birth weight between 1.5-2.5 kg. Preterm and growth restricted babies had the worst perinatal outcomes. The most common perinatal complication was hyperbilirubinemia (16.77%) followed by hypoglycemia (14.99%) and Hyaline membrane disease (14.86%). Preterm babies had higher rates of birth asphyxia, hypoglcemia, hyperbilirubinemia and neonatal ICU admissions (P ˂0.001).Intrauterine growth restricted babies had better perinatal outcomes than preterm babies. Majority of the mothers (96.87%) belonged to low socio-economic status. The most common maternal complications associated with LBW were anemia (43.36%) and hypertensive disorders of pregnancy (17.6%). Conclusions: Low birth weight babies had higher perinatal mortality and morbidity rates. To decrease the incidence of low birth weight, measures to improve the general health and nutrition of mothers should be employed. Appropriate referral of high risk pregnancies and delivery in centres with good neonatal facilities should be engaged.