Intrauterine Growth Retardation Infants Research Articles

Neonatal resveratrol administration promotes skeletal muscle growth and insulin sensitivity in intrauterine growth-retarded suckling piglets associated with activation of FGF21-AMPKα pathway.

Skeletal muscle is a major insulin-sensitive tissue with a pivotal role in modulating glucose homeostasis. This study aimed to investigate the effect of resveratrol (RES) intervention during the suckling period on skeletal muscle growth and insulin sensitivity of neonates with intrauterine growth retardation (IUGR) in a pig model. Twelve pairs of normal birth weight (NBW) and IUGR neonatal male piglets were selected. The NBW and IUGR piglets were fed basal formula milk diet or identical diet supplemented with 0.1% RES from 7 to 21 days of age. Myofiber growth and differentiation, inflammation and insulin sensitivity in skeletal muscle were assessed. Early RES intervention promoted myofiber growth and maturity in IUGR piglets by ameliorating the myogenesis process and increasing thyroid hormone level. Administering RES also reduced triglyceride concentration in skeletal muscle of IUGR piglets, along with decreased inflammatory response, increased plasma fibroblast growth factor 21 (FGF21) concentration and improved insulin signaling. Meanwhile, the improvement of insulin sensitivity by RES may be partly regulated by activation of the FGF21/AMP-activated protein kinase α/sirtuin 1/peroxisome proliferator activated receptor-γ coactivator-1α pathway. Our results suggest that RES has beneficial effects in promoting myofiber growth and maturity and increasing skeletal muscle insulin sensitivity in IUGR piglets, which open a novel field of application of RES in IUGR infants for improving postnatal metabolic adaptation. © 2023 Society of Chemical Industry.

A Study of the Literature on Intrauterine Treatment Options for Chronic Placental Insufficiency with Intrauterine Growth Restriction Using Intrauterine Intravascular Amino Acid Supplementation.

Intrauterine growth retardation (IUGR) is a very serious prenatal condition with 3-5% incidence of all pregnancies. It results from numerous factors, including chronic placental insufficiency. IUGR is associated with an increased risk of mortality and morbidity and is considered a major cause of fetal mortality. Currently, treatment options are significantly limited and often result in preterm delivery. Postpartum, IUGR infants also have higher risks of disease and neurological abnormalities. The PubMed database was searched using the keywords "IUGR", "fetal growth restriction", "treatment", "management" and "placental insufficiency" for the period between 1975 and 2023. These terms were also combined together. There were 4160 papers, reviews and articles dealing with the topic of IUGR. In total, only 15 papers directly dealt with a prepartum therapy of IUGR; 10 of these were based on an animal model. Overall, the main focus was on maternal intravenous therapy with amino acids or intraamniotic infusion. Treatment methods have been tested since the 1970s to supplement the fetuses with nutrients lacking due to chronic placental insufficiency in various ways. In some studies, pregnant women were implanted with a subcutaneous intravascular perinatal port system, thus infusing the fetuses with a continuous amino acid solution. Prolongation of pregnancy was achieved, as well as improvement in fetal growth. However, insufficient benefit was observed in infusion with commercial amino acid solution in fetuses below 28 weeks' gestation. The authors attribute this primarily to the enormous variation in amino acid concentrations of the commercially available solutions compared with those observed in the plasma of preterm infants. These different concentrations are particularly important because differences in the fetal brain caused by metabolic changes have been demonstrated in the rabbit model. Several brain metabolites and amino acids were significantly decreased in IUGR brain tissue samples, resulting in abnormal neurodevelopment with decreased brain volume. There are currently only a few studies and case reports with correspondingly low case numbers. Most of the studies refer to prenatal treatment by supplementation of amino acids and nutrients to prolong pregnancy and support fetal growth. However, there is no infusion solution that matches the amino acid concentrations found in fetal plasma. The commercially available solutions have mismatched amino acid concentrations and have not shown sufficient benefit in fetuses below 28 weeks' gestation. More treatment avenues need to be explored and existing ones improved to better treat multifactorial IUGR fetuses.

Early-Life Nutrition, Growth Trajectories, and Long-Term Outcome.

It is well established that nutrition during the first 1,000 days of life can have a long-term effect on growth, metabolic outcome, and long-term health. We review the long-term anthropometric follow-ups of children with risk of later morbidity: (a) very-low-birth-weight (VLBW) infants who have birth weights <10th percentile of weight and receive fortified breast milk, (b) infants from developing countries who are breastfed according to the present recommendations but have low birth weight and length, and (c) children from developed countries who were enrolled in randomized controlled trials (RCTs) to test if breastfeeding and low-protein formulas can prevent from rapid weight gain and childhood obesity. VLBW infants can be appropriate, small for gestational age (SGA), or intrauterine growth retarded (IUGR). SGA and IUGR (due to placenta insufficiency) infants are born with birth weights <10th percentile of weight for gestational age (GA). We provided fortified breast milk until 52 weeks of GA to 31 SGA and 127 IUGR infants and followed up growth until 24 months. IUGR infants showed lower weight gain between birth and 3 months and had lower weight between 3 and 24 months (p < 0.05; ANCOVA). No significant BMI differences between SGA and IUGR infants were observed. It seems that IUGR infants receiving fortified breast milk need special attention, because without further improvement in breast milk fortification weight gain after discharge from hospital might be too slow. In developing countries, length and weight of breastfed infants during the first 2 years are strongly influenced by the respective anthropometric parameters at birth. Studies in the Gambia and Zimbabwe indicate that only breastfed infants with birth length and weight above the respective WHO 0 z-scores continue with adequate growth and have length and weight above the WHO 0 z-scores at 18 and 24 months. Prevalence of stunting and wasting in the overall Gambia breastfed infant population rapidly increases during the first year, peaks at around 3 years, but decreases thereafter. Long-term growth trajectories indicate later start of puberty and slow pubertal growth, but adult weight and height are not reached before 20-24 years. In adulthood, prevalence of stunting and wasting is much lower than during any period of childhood. Maternal risk factors, such as childhood marriage and poor nutrition before and during pregnancy, need to come into focus to improve birth length and weight and lower high stunting rates. Term breastfed infants from overweight/obese mothers and breastfed infants with rapid weight gain during infancy have increased risk of childhood obesity. Infants who are exclusively breastfed 4-6 months or receive low protein follow-up formulas (high-quality protein) grow slower during the first 2-3 years than infants fed high-protein formulas. During follow-up examinations at 5-6 years, they have lower BMI and obesity prevalence. Body composition measurements (DEXA) at 5-8 years in children who were breastfed and received low- or high-protein formula during infancy indicate that breastfeeding and feeding low-protein formulas are associated with lower gain of fat mass. Longitudinal cohort studies show that high-protein intake during the first 2 years results in higher BMI at 9 years and during adulthood. The studies presented indicate that breastfeeding but also other pre- and postnatal nutritional, epigenetic, and environmental factors influence growth trajectories and long-term health.

Altered tissue mineralization, increased hepatic lipid and inhibited autophagy in intrauterine growth retardation piglets

Mineral homeostasis is often disrupted in intrauterine growth retardation (IUGR) infants. Most studies focus on calcium or phosphorus metabolism of IUGR infants via determining serum mineral concentrations instead of tissues. This study was conducted to investigate the effects of IUGR on the mineralization and physiological functions of tissue in a piglet model. Six normal birth weight (NBW) and six IUGR neonatal piglets were slaughtered at 35 days. Mineral concentrations in blood and selected tissues (liver, kidney, lungs, heart, and longissimus dorsi muscle (LDM)), hepatic lipid, mRNA expressions of magnesium (Mg) metabolism, and autophagy were analysed. Results showed that IUGR pigs showed significantly lower phosphorus (P) in LDM, and lower Mg in the liver and LDM, and higher Mg in lungs than NBW pigs. There were no significant differences in concentrations of selenium (Se), calcium (Ca), copper (Cu), aluminium (Al), and lithium (Li) in selected tissues. IUGR pigs had similar mRNA expression of TRPM7 and MagT1 to NBW pigs, but significantly lower expressions of HNF1B and Mrs2 in the liver than NBW pigs. Hepatic triglyceride was significantly increased, and MAP1LC3B expression was significantly decreased in IUGR pigs compared with those of NBW pigs. These result suggested that IUGR pigs had tissue mineralization disturbance, especially for Mg, and liver dysfunction (increased hepatic lipid and inhibited autophagy). Hepatic Mg deficiency might result from increased Mg efflux via reducing HNF1B expression.Keywords: Hepatic triglyceride, magnesium metabolism, mineral homeostasis, physiological function

Intrauterine Growth Retardation (IUGR) as a Novel Condition of Insulin-Like Growth Factor-1 (IGF-1) Deficiency.

Insulin-like growth factor 1 (IGF-1) is an anabolic hormone with several biological activities, such as proliferation, mitochondrial protection, cell survival, tissue growth and development, anti-inflammatory, antioxidant, antifibrogenic and antiaging. This hormone plays an important role in embryological and postnatal states, being essential for normal foetal and placental growth and differentiation. During gestation, the placenta is one of the major sources of IGF-1, among other hormones. This intrauterine organ expresses IGF-1 receptors and IGF-1 binding proteins (IGFBPs), which control IGF-1 activities. Intrauterine growth restriction (IUGR) is the second most frequent cause of perinatal morbidity and mortality, defined as the inability to achieve the expected weight for gestational age. Different studies have revealed that IUGR infants have placental dysfunction and low circulating levels of insulin, IGF-1, IGF-2 and IGFBPs. Such data suggest that IGF-1 deficiency in gestational state may be one of the major causes of foetal growth retardation. The aim of this review is to study the epidemiology, physiopathology and possible causes of IUGR. Also, it intends to study the possible role of the placenta as an IGF-1 target organ. The purpose is to establish if IUGR could be considered as a novel condition of IGF-1 deficiency and if its treatment with low doses of IGF-1 could be a suitable therapeutic strategy.

TYT Curve: Pilot Study on Alternatives Standards of Reference to Determine Intrauterine Growth in Low Resource Setting in Indonesia

Objective: To develop a new intrauterine growth curve based on local population for accurate intrauterine growth retardation (IUGR) infant identification. Methods: An observational analytic method was applied to develop Tina-Yessika-Tetty (TYT) curve derived from 13,405 neonatal anthropometric measurements taken from the medical record database of Dr. Hasan Sadikin General Hospital, Bandung, Indonesia. The infants included in this study were born during the period of January 1st, 2005 to December 31st, 2009. The new curve was then compared to the Lubchenco and Alisjahbana curves. Only 6,814 data met the inclusion and exclusion criteria. Results: The mean birth weight in this study was lower compared to that of the Lubchenco and Alisjahbana studies. Comparison of the three curves showed that there was a significant difference among the three curves (R=0.998, R2=0.996, p&lt;0.001), which indicates a probability for a newborn classification. Conclusions: TYT curve may be used as an alternative to identify IUGR immediately after birth, especially when detection during pregnancy is not available in low resource setting. A prospective study with a larger population is needed; However, this study has provided an evidence to support the need for timely evaluation for such growth chart as they change over time. Keywords: Alisjahbana curve, intrauterine growth, Lubchenco curve, TYT curve DOI : 10.15850/ijihs.v2n1.271

P.5.f.001 Correlations between pain intensity and cognitive dysfunction in surgery

Intrauterine growth retardation (IUGR) infants have impaired gastrointestinal function with resultant feeding difficulties and predisposition to necrotizing enterocolitis. Supplemented amniotic fluid swallowed by the developing fetus is a potential prenatal treatment for IUGR. Rabbits have naturally occurring IUGR fetuses based on uterine position. To determine intestinal response to epidermal growth factor (EGF) infusion, this rabbit model of IUGR was studied.Eight pregnant rabbits underwent placement of intraamniotic catheters into 2 normal and 2 IUGR fetuses per mother on gestational day 24 of a 31-day gestation. Miniosmotic pumps infused either EGF (about 300 μg/kg/d) or control solution forming 4 study groups (EGF-Favored [Fav] v. Cont-Fav; EGF-IUGR v. Cont-IUGR). On gestational day 31, the fetal gastrointestinal tracts were harvested for analysis. Intestinal epithelial cell proliferation was studied by 5-bromo-2-deoxyuridine (BrdU) incorporation, villus heights were measured, and EGF mRNA was measured by reverse transcriptase polymerase chain reaction (RT-PCR). Statistical analysis was performed using Students’ t test.Fetal survival rate was 87%. EGF-IUGR fetal weights were increased compared with Cont-IUGR fetuses. EGF infusion significantly increased IUGR fetal small intestinal villus height and BrdU-positive small intestinal (SI) crypt cells, all approaching Cont-Fav levels. EGF mRNA was expressed throughout the gastrointestinal tract.Supplemental amniotic EGF normalizes fetal weight and intestinal proliferation in the IUGR fetal rabbit. The inclusion of EGF in supplemental amniotic feeding solutions is supported.

AUDITORY FUNCTION IN PRETERM INFANTS AT THE AGE OF 3 MONTHS WITH INTRAUTERINE GROWTH RETARDATION AND BORN AT THE GESTATION PERIOD LESS THAN 32 WEEKS

The results of auditory function assessment in children with intrauterine growth retardation are analyzed in this study. The audiologic examination with distortion product evoked otoacoustic emission and auditory steady state evoked potentials methods was performed in 49 preterm infants, born at the gestation period less than 32 weeks from the monofetal pregnancy, at the age of 3 months. The observed patients were divided into 2 groups: preterm infants with intrauterine growth retardation (n=25) and preterm infants with body birth-weight appropriate for the gestation period (normotrophic) (n=24). In the group of children with intrauterine growth retardation the amount of patients who did not pass the distortion product evoked otoacoustic emission test was higher than in the group of normotrophic preterm children. The analysis of the results of the auditory steady state evoked potentials in preterm children suggest that there is no reliable hearing impairment in preterm infants with intrauterine growth retardation in comparison with normotrophic age-matched infants . For the objective description of the auditory function in preterm infants with intrauterine growth retardation and normotrophic children born at the gestation period less than 32 weeks at the age of 3 months both afore-mentioned methods should be used.

Amount of Stimulation Received at Home and Growth During Infancy Have Positive Association With Psychomotor Development of Poor Urban Bangladeshi Infants

Biological and psychosocial factors along with cumulative environmental factor have effect on the later childhood development. The detrimental effect of these factors on development varies from studies to studies in different geographical regions with variation in the causality. LBW (Low birth weight) children (birth weight&lt;2500 g) generally have poorer levels of development compared to NBW (Normal birth weight) infants. The development of term-LBW/SGA (Small for gestanational age) or IUGR (Intrauterine growth retardation) infant is more complex and controversial. To assess the factors influencing cognitive development of Bangladeshi infants from poor socio-economic background. This study was conducted using pooled data derived from a previously done randomized control trial on 400 pregnant women. To find the biological and socio-environmental factors that associated with development, we broke down the randomization. A house-to-house survey was carried out in a defined poor urban area and all women who were 5 to 6 months pregnant were enrolled and the gestational period was ascertained by the report of LMP (Last menstrual period) given by the mothers. Data of 249 mother-infant dyads who completed the study and had all the measurements up to 10 months were used for this analysis. The detailed information regarding enrolment and findings from the main study has been published elsewhere. Distribution of each variable was checked for normality and where necessary appropriate transformations were made. Bivariate correlations between the developmental variables and socioeconomic measures were assessed. To examine the effect of biological and psychosocial factors on development of infants, series of multiple linear regression analyses were performed where each of the developmental variables was treated as a dependent variable. Family wealth and play material available for the child at home have a strong positive influence on both mental and psychomotor development whereas overcrowding exerts a negative impact on development. Similarly younger infants, being female, having larger head at birth and greater increase in head size over 10 month were found to have better mental developmental index, while taller children at birth had better psychomotor development at 10 month. Birth length and head-circumference and growth in head-circumference in the early months affect child development even after controlling for social background.&#x0D; JCMCTA 2012; 23(1): 11-16

Heat Shock Protein 70 Expression is Increased in the Liver of Neonatal Intrauterine Growth Retardation Piglets.

Intrauterine growth retardation (IUGR) leads to the dysfunction in digestive system, as well as the alteration in the expression of some functional proteins. Heat shock protein 70 (Hsp70) could be induced by various stress factors, but whether Hsp70 expression is changed in neonatal IUGR infants has not been demonstrated. This study was conducted to explore the expression of Hsp70 in the liver by using the IUGR piglet model. Liver and plasma samples were obtained from IUGR and normal birth weight (NBW) piglets at birth. The neonatal IUGR piglets had significantly lower liver weight than their counterparts. The activities of aspartate aminotransferase and alanine aminotransferase in serum were enhanced significantly in IUGR indicating liver dysfunction. The activities of superoxide dismutase (p<0.01), glutathione peroxidase (p<0.01) and catalase (p>0.05) were lower and the level of malondialdehybe was higher (p<0.05) in IUGR liver compared with in NBW. According to the results of histological tests, fatty hepatic infiltrates and cytoplasmic vacuolization were present in the liver of IUGR piglets, but not in NBW liver. The expression of Hsp70 protein was significantly higher (p<0.05) in IUGR piglet liver than in NBW. Similar to where the hepatic injuries were observed, location of Hsp70 was mostly in the midzonal hepatic lobule indicating that oxidative stress might be responsible for the increased expression of Hsp70.

Subclinical hypoxia of infants with intrauterine growth retardation determined by increased serum S100B protein levels

To test the hypothesis that serum S100B levels could be useful in detecting neurological damage in infants with intrauterine growth retardation (IUGR). Materials and methods: The study group consisted of infants with IUGR and the control group consisted of age-matched healthy infants. S100B protein levels were measured after birth and compared between groups. Results: For this study, 43 infants with IUGR and 25 infants as a control group were recruited. Gender, gestational age, type of delivery, and maternal age of the groups were statistically insignificant, with the exception of the mean birth weights (2120 ± 450 g in the IUGR group and 3096 ± 570 g in the control group (P < 0.001), respectively). S100B protein levels of the IUGR infants (1.13 ± 0.54) were significantly higher than those of the control group (0.45 ± 0.13) (P < 0.001). IUGR infants treated with antenatal steroids showed lower S100B levels than IUGR infants that did not receive antenatal steroid treatments (P < 0.05). The study group infants were divided into 2 groups, for growth retardation (GR) that was asymmetric (n = 15) and symmetric (n = 28). The asymmetric and symmetric GR infants’ S100B levels were 1.14 ± 0.47 pg/mL and 1.21 ± 0.34 pg/mL, respectively, and no significant differences were found between the 2 groups in terms of S100B levels (P = 0.32). Conclusion: The results of this study favor the opinion that there is an existing intrauterine hypoxia causing hypoxic brain tissue damage in IUGR infants, even when followed up with modern obstetrical screening protocols. Measurements of S100B may be useful in the prediction of outcome in these infants.

Racial residential segregation impacts on low birth weight using improved neighborhood boundary definitions

Research on local racial residential segregation and health generally utilize census tract boundaries as a proxy from within which to estimate individual exposures. Census tracts however, may not accurately reflect the neighborhood environments in which people live and interact. Census tract geography may also capture non-exchangeable populations in socially stratified cities, impacting statistical assumptions of independence. To address these concerns, this study assessed the impact of racial residential segregation (i.e., racial isolation and racial clusters) on low birth weight (i.e., intrauterine growth retardation (IUGR) and preterm birth) in the Detroit Metropolitan Area using optimized neighborhood boundary definitions. Automated zone-matching (AZM) methodology was applied to redefine neighborhood (zones). Maternal and infant health information was obtained from Michigan’s vital statistics birth registry (n=137,965) for the years 2004–2006. Multilevel models were estimated to assess the effect of high racial isolation and high racial clusters on IUGR and preterm birth, controlling for maternal race, single marital status, smoking and area-level poverty. The results from this study showed that high racial isolation had a significant effect on IUGR, while the odds of preterm birth were higher in racially clustered zones. African American mothers were at increased odds of having IUGR or preterm infants than other mothers; however, these disparities reduced in highly segregated zones. The predicted incidence of IUGR across racially isolated zones and census tracts differed indicating a modifiable area unit problem (MAUP). MAUP effects were not observed in models predicting preterm incidence in high racial clusters or IUGR or preterm incidence in high poverty areas, demonstrating the stability-reliability of these estimates. Future research should continue to optimize neighborhood boundary definitions, while assessing the sensitivity of segregation measures to changes in scale, to improve our understanding of segregation impacts on racial disparities in low birth weight.

Upper limb movements and outcome in intrauterine-growth-retarded infants at 2 years

This study aims to examine the usefulness of spontaneous upper limb movements (ULM) as an early marker for predicting neurodevelopmental outcome in infants with intrauterine-growth retardation (IUGR). The assessment of general movements (GMs) during the first 20 weeks is an accepted method for early detection of brain dysfunction. During this period, spontaneous upper limb movements were examined in 32 infants with IUGR and 32 appropriate-for-gestational-age-matched controls. ULM (arms, forearms and hands) were scored as optimal or suboptimal by sequential videotape recordings in the writhing (term-2 weeks: score 0–5); early fidgety (9–11 weeks: score 0–6); and late fidgety (14–16 weeks: score 0–6) periods, and correlated with neurodevelopmental score at 2 years of age. The mean ULM score was lower in the IUGR infants than the controls ( p < 0.05) and in the IUGR group was lower in the infants with abnormal outcome ( p < 0.05). Significant correlations were found between ULM and 2-year neurodevelopmental scores in the IUGR group. The ULM during late-fidgety period was most predictive for 2-year neurodevelopmental score. No difference was found in the mean ULM score between the pre-term and term IUGR infants. We conclude that ULM score can serve as an early predictor for neurodevelopmental outcome at 2 years of age in infants with IUGR.

Growth hormone in Intra-uterine growth retarded newborns

To study growth hormone levels in IUGR and healthy controls and its association with birth weight and ponderal index. We studied 50 Intra uterine growth retarded (IUGR) and 50 healthy newborns born at term by vaginal delivery in JIPMER, Pondicherry, India. Cord blood was collected at the time of delivery for measurement of growth hormone. When compared with healthy newborns, IUGR newborns had higher growth hormone levels (mean +/- SD, 23.5 +/- 15.6 vs 16.2 +/- 7.61 ngm/ml, P = 0.019). A negative correlation was identified between growth hormone levels and birth weight (r2 = - 0.22, P = 0.03) and ponderal index (r2 = - 0.36, P = 0.008). Correlation of growth hormone levels was much more confident with ponderal index than with birth weight. At birth IUGR infants display increased growth hormone levels which correlate with ponderal index much more confidently than with birth weight.

Urinary S100B Protein Concentrations Are Increased in Intrauterine Growth-Retarded Newborns

Intrauterine growth retardation is one of the major causes of perinatal mortality and morbidity. To date, there are no reliable methods to detect brain damage in these patients. We conducted a case-control study in tertiary NICUs from December 2001 to December 2003 with 42 intrauterine growth retardation infants and 84 controls. Routine laboratory variables, neurologic outcome at 7-day follow-up, ultrasound imaging, and urine concentrations of S100B protein were determined at 5 time points. Urine S100B levels were measured by an immunoluminometric assay at first urination, 24, 48, and 72 hours, and 7 days after birth. Routine laboratory parameters and neurologic patterns were assessed at the same time as urine sampling. S100B protein was significantly higher at all of the monitoring time points in urine taken from intrauterine growth retardation newborns than in control infants. When intrauterine growth retardation infants were corrected for the presence of abnormal (group A) or normal (group B) neurologic examination 7 days after birth, S100B was significantly higher at all of the predetermined monitoring time points in group A infants than in group B or controls. At a cutoff of 7.37 multiples of median at first urination, S100B achieved a sensitivity of 95% and a specificity of 99.1% as a single marker for predicting an adverse neurologic outcome. Twenty of 126 patients had neurologic abnormalities, making an overall prevalence of the disease in our population of 15.9% (pretest probability). With respect to the performance of S100B in predicting brain damage, its positive and negative predictive values were 91.0% and 99.0%, respectively. Increased urine S100B protein levels in intrauterine growth retardation newborns in the first week after birth suggest the presence of brain damage reasonably because of intrauterine hypoxia. Longitudinal S100B protein measurements soon after birth are a useful tool to identify which intrauterine growth retardation infants are at risk of possible neurologic sequelae.

Surfactant era (1990–2002) 2-year outcomes of infants less than 1500 g from a Community Level 3 Neonatal Intensive Care Unit

To report Bayley scores of 572 twenty-four-month corrected age infants whose birth weights (BWs) were less than 1500 g cared for in a Community Level 3 Neonatal Intensive Care Unit (NICU) between 1990 and 2002 when surfactant was routinely used. Survival, "normal" defined as both Mental Developmental Index (MDI) and Psychomotor Developmental Index (PDI)>84, MDI>69 and MDI>84 were analyzed by gestational age (GA) and BW. Comparisons were made between infants born pre- and post-1996 when high-frequency oscillatory ventilation came into frequent use, Medicaid and non-Medicaid infants, multiples and singletons, outborn and inborn infants, boys and girls and infants with intrauterine growth retardation (IUGR) and those appropriate for gestational age (AGA). There was a correlation between GA and BW and improving outcomes. Scores do not approach those of normal standardization sample populations (60% for "normal", 68% for MDI>84 and 95% for MDI>69) until 1400 g and 30 weeks. Medicaid, outborn and IUGR infants, and boys did worse in some aspects. There was a correlation between both GA and BW and improving outcomes. Availability of these developmental data on a laminated pocket card can facilitate presentation of outcome experience to families by pediatric and obstetric caregivers.

Increased insulin sensitivity in intrauterine growth retarded newborns – Do thyroid hormones play a role?

BackgroundThyroid hormones are necessary for normal brain development. We studied thyroid hormone profile and insulin sensitivity in intrauterine growth retarded (IUGR) newborns to find correlation between insulin sensitivity and thyroid status in IUGR newborns. MethodsFifty IUGR and fifty healthy control infants were studied at birth. Cord blood was collected for determination of T3, T4, TSH, glucose and insulin levels. ResultsIUGR newborns had significantly lower insulin, mean±S.D., 5.25±2.81 vs. 11.02±1.85μU/ml, but significantly higher insulin sensitivity measured as glucose to insulin ratio (G/I), 9.80±2.91 vs. 6.93±1.08 compared to healthy newborns. TSH was also significantly higher 6.0±2.70 vs. 2.99±1.05μU/ml with significantly lower T4, 8.65±1.95 vs. 9.77±2.18μg/dl, but similar T3 levels, 100.8±24.36 vs. 101.45±23.45ng/dl. On stepwise linear regression analysis in IUGR infants, insulin sensitivity was found to have a significant negative association with T4 and significant positive association with TSH. ConclusionThyroid hormones may play a role in increased insulin sensitivity at birth in IUGR.

Insulin sensitivity and insulin secretion at birth in intrauterine growth retarded infants

To study insulin sensitivity, secretion and relation of insulin levels with birth weight and ponderal index in intrauterine growth retarded (IUGR) infants at birth. We studied 30 IUGR and 30 healthy newborns born at term by vaginal delivery in Jipmer, Pondicherry, India. Cord blood was collected at the time of delivery for measurement of plasma glucose and insulin. When compared with healthy newborns, IUGR newborns had lower plasma glucose levels (mean 2.3+/-0.98 versus 4.1+/-0.51 mmol/L, p<0.001); lower plasma insulin levels (mean 4.5+/-2.64 versus 11.03+/-1.68 microU/L, p<0.001); higher insulin sensitivity calculated using G/I ratio (mean 11.6+/-5.1 versus 6.7+/-0.31, p<0.001), HOMA IS (mean 5.5+/-6.0 versus 0.53+/-0.15, p<0.001), and QUICKI (mean 0.47+/-0.12 versus 0.34+/-0.02, p<0.001); and decreased pancreatic beta-cell function test measured as I/G (mean 0.10+/-0.037 versus 0.15+/-0.006, p<0.001). A positive correlation was identified between insulin levels and birth weight in both the healthy control group (r2 = 0.17, p = 0.024) and IUGR group (r2 = 0.13, p = 0.048). However correlation of insulin levels with ponderal index was much more confident in both healthy control (r2 = 0.90, p<0.001) and IUGR groups (r2 = 0.28, p = 0.003). Insulin status correlated both with birth weight and ponderal index more confidently in control group than in IUGR group. At birth, IUGR infants are hypoglycaemic, hypoinsulinaemic and display increased insulin sensitivity and decreased pancreatic beta-cell function. Insulin levels correlate with ponderal index much more confidently than with birth weight.

Perinatal Outcome and Later Implications of Intrauterine Growth Restriction

This chapter reviews outcomes for children who have intrauterine growth retardation (IUGR) or small-for-gestation-age (SGA) status at birth. Such infants are at risk for increased perinatal mortality, birth adaptation complications, including perinatal acidosis, hypoglycemia, hypothermia, coagulation abnormalities, and selected immunologic deficiencies. IUGR infants also appear to be at great risk for complications of prematurity, including chronic lung disease and necrotizing enterocolitis. Childhood implications for IUGR include an increased risk for short stature, cognitive delays with decreased academic achievement, and a small but significant increased risk of neurologic disorders, including cerebral palsy. Low socioeconomic status is correlated with the occurrence of IUGR and is significantly related to long-term disabilities. Morbidities associated with preterm delivery appear to be additive to those associated with fetal growth restriction so IUGR, preterm infants may be at great risk for poor neurodevelopmental outcome.

Cytokines in the Placenta of Pakistani Newborns With and Without Intrauterine Growth Retardation

Although intrauterine growth retardation (IUGR) is a major risk factor for increased neonatal mortality and morbidity, the mechanisms behind it are not clear. We analyzed cytokine gene expression and gene polymorphisms in infants with and without IUGR in Pakistan, where IUGR is very common. 45 IUGR and 55 control mother/infant pairs were studied. mRNA for IL-10, IL-8, TNF-alpha, TGF-beta, IL-6, IL-4, IL-1beta, IL-12, IFN-gamma and GAPDH was quantified with RT-PCR from placenta. Cytokine and cytokine receptor gene polymorphisms for -1087IL10, -308TNFA, -174IL6, +915TGFB1, intron 2 IL1RN, +36TNFR1, 150V IL4RA and -159CD14 were determined from genomic DNA. The serum levels of IL-1beta, IL-6, IL-8, IL-10, IL-12, TNF-alpha and TGF-beta were measured. There was a significant decrease of IL-10 and IL-12, but increase of TGF-beta in the decidua and similarly decrease of IL-10, but increase of TGF-beta in the trophoblasts of the IUGR placentas compared with the non-IUGR placentas. We found significantly lower levels of IL-1beta in serum from the mothers of the IUGR infants and of TGF-beta in serum of the infants with IUGR compared with the non-IUGR infants. We note that the IL-10 mRNA expression in the decidua was down-regulated, but the TGF-beta mRNA up-regulated in IUGR placentas of mothers from a population with multiple risk factors for IUGR. We propose that the low IL-10 in the placenta may be involved in the pathogenesis of IUGR and might possibly be treatable.