Term Small For Gestational Age Research Articles

IGF-II expression and methylation in small for gestational age infants.

Low birth weight is associated with an increased risk of adverse outcomes in many diseases in adult life. We investigated the expression of IGF-II and the status of differentially methylated regions (DMR) in small for gestational age (SGA) infants after birth. Plasma IGF-II, IGF-II receptor (IGF2R), IGF-I, and IGF-binding protein 3 (IGFBP3) levels were measured after birth in 150 newborn infants. These included 30 term appropriate for gestational age (AGA), 30 term SGA, 30 term large for gestational age (LGA), 30 preterm AGA, and 30 preterm SGA infants. H19 and IGF2 mRNA levels were quantified by fluorescence quantitative polymerase chain reaction (PCR). The methylation status of H19 DMR and IGF2 DMR2 was assessed by methylation-specific PCR (MSP). Plasma IGF-II, IGF2R, IGF-I, and IGFBP3 levels were measured by enzyme-linked immunosorbent assay in AGA infants of different gestational ages and term AGA infants on different days. Plasma IGF-II levels after birth were lower in both term SGA (435.1±33.82 vs. 620.4±44.79, p=0.002) and LGA infants (483.7±33.8 vs. 620.42±44.79, p=0.018) than in term AGA infants. The expression of IGF2 mRNA was higher in the term SGA group than in the preterm SGA group (p=0.014) and the preterm SGA group displayed lower expression than the preterm AGA group (p=0.048). The H19 DMR methylation level was higher in both term SGA (p=0.044) and term LGA infants (p=0.027) compared to term AGA infants. IGF-II was associated with birth weight and expressed at high levels, which suggests that IGF-II may continue to play an important role after birth. H19 DMR methylation may be involved in controlling IGF-II expression.

The Optimal Postnatal Growth Trajectory for Term Small for Gestational Age Babies: A Prospective Cohort Study

To identify an optimal growth trajectory for term small for gestational age (SGA) babies from birth to 7-years-old. Data were from the Collaborative Perinatal Project, a US multicenter prospective cohort study from 1959-1976. Five weight growth trajectories of the 1957 term SGA babies were grouped by a latent class model. We selected the optimal growth pattern based on the lowest overall risks of childhood diseases. Compared with appropriate for gestational age children, SGA babies with no catch-up growth (439, 22.4%) had higher risks of infection in infancy (aOR 1.2, 95% CI 1.0-1.6), growth restriction (11.2, 8.6-14.6), and low IQ (2.1, 1.7-2.8) at age 7 years. Those with excessive catch-up growth (176, 8.9%) had higher risks of overweight/obesity (7.5, 5.4-10.5) and elevated blood pressure (1.7, 1.1-2.4) at age 7 years. Babies with slow catch-up growth (328, 16.8%) or regression after 4 months (285, 14.6%) were associated with higher risks of low IQ (1.6, 1.2-2.1) and growth restriction (2.2, 1.5-3.2), respectively. Only babies with appropriate catch-up growth (729, 37.3%) did not have increased risk of adverse outcomes. Further, we also tested linear growth trajectories with similar findings. The optimal growth trajectory for term SGA infants may be fast catch-up growth to about the 30th percentile in the first several months, with modest catch-up growth thereafter, to be around the 50th percentile by 7-years-old.

Comparison of Wright's Formula and the Dunn Method for Measuring the Umbilical Arterial Catheter Insertion Length

Umbilical artery catheterization is the standard procedure for arterial access in neonatal intensive care units. An umbilical arterial catheter (UAC) needs to be placed accurately during the initial insertion because malpositioning increases catheter-related complications and subsequent repositioning exposes newborns to unnecessary handling, further radiologic exposure, and an increased risk of infection. To measure the UAC insertion length in newborns, we compared the conventional practice (i.e., the Dunn method) with a new formula: Wright's formula. The study enrolled 119 newborns. A nomogram derived from Dunn was used during the first study period and the new formula devised by Wright (4×birth weight+7cm) was used during the second study period. The catheter tip position on the initial radiograph was evaluated as correct (i.e., T6-T10), overinsertion (i.e., <T6), or underinsertion (i.e.,>T10). The demographic profiles were not different between the two groups, which included sex; birth weight; and the number of preterm births, low-birth-weight (LBW) newborns,and very-low-birth-weight (VLBW) newborns. When using Wright's formula and the Dunn method, 83% of newborns and 61% of newborns, respectively, received a correct insertion (p<0.05). The success rate for positioning the UAC tip between T7 and T8 was approximately two-fold higher when using Wright's formula than when using the Dunn method. In particular, the rateof correct insertion was significantly higher with Wright's formula in term newborns, LBW newborns, VLBW newborns, and small for gestational age (SGA) newborns (p<0.05); however,the rate of overinsertion with the Dunn method was much higher in term newborns, LBW newborns, VLBW newborns, and SGA newborns (p<0.05). The use of Wright's formula overall results in superior correct placement of the UAC tip. It may be a more accurate and practical method than the conventional practice for measuring the UAC insertion length in newborns.

The late preterm IUGR and/or SGA

It is well known that in late preterm infants the mortality and the morbidity are higher than in term neonates. The rate of complications decreases with the progression of gestational age through the late preterm period [1]. Intrauterine growth restriction (IUGR) is one of the cause for late preterm delivery and it occurs more often in late preterm infants than terms ones. Itself constitutes a risk factor for morbidity and mortality [2,3]. IUGR, as well as associated peri-natal morbidities, contributes to increase the risk, in these infants, of postnatal growth impairment, metabolic diseases and poor neuro-developmental outcome [1,4]. Late preterm small for gestational age (SGA) infants were 44 times more likely to die in the first month and 22 times more likely to die in their first year than term adequate for gestational age (AGA) newborns. This increased risk cannot be fully explained by an increasing prevalence of lethal congenital conditions among SGA late preterm newborns [5]. The ability to recognize abnormal growth at birth and or a intrauterine malnutrition is of great importance for the care and the prognosis of these neonates. Neonatal anthropometric charts are commonly used for the diagnosis at birth of SGA newborns [6]. The terms SGA and IUGR are often used as synonyms, however they reflect two different concepts. SGA refers to a statistical definition, based on an auxological cross-sectional evaluation (prenatal or neonatal), and denotes a fetus or a neonate whose anthropometric variables (usually weight) are lower than a given threshold value computed on a set of infants having the same gestational age. IUGR instead refers to a clinical and functional condition and denotes fetuses unable to achieve their own growth potential. Such a condition can be assessed by ultrasonography during pregnancy by a longitudinal evaluation of fetal growth rate. The current gold standard in neonatal auxological evaluation is based on informations obtained from both neonatal anthropometric charts and intrauterine growth charts [7]. At present specific growth charts to monitor postnatal growth of late preterm infants are not available. In the next future the late preterm postnatal longitudinal growth standards will be available as a result of “Intergrowth21st Project”.

Ghrelin and obestatin plasma levels and ghrelin/obestatin prepropeptide gene polymorphisms in small for gestational age infants

To investigate plasma ghrelin and obestatin levels, and ghrelin/obestatin prepropeptide gene polymorphisms, in sequentially enrolled small for gestational age (SGA) infants. Neonates were sequentially enrolled into this study and were then subdivided into different groups, according to different study aims and availability of study materials. Consequently, plasma ghrelin and obestatin levels were measured in term SGA, term appropriate for gestational age (AGA), term large for gestational age (LGA), preterm SGA and preterm AGA neonates. Levels of both peptides were also measured in AGA infants of different gestational ages, and in term AGA neonates at different days following birth. Three ghrelin/obestatin prepropeptide gene single nucleotide polymorphisms (SNPs), Arg51Gln, Leu72Met, and Gln90Leu, were measured in neonates. The study involved a total cohort of 581 neonates. Out of 150 neonates (30 term AGA, 30 term SGA, 30 term LGA, 30 preterm AGA, and 30 preterm SGA), plasma obestatin levels were significantly higher in term SGA versus term LGA neonates (0.21 ± 0.02 ng/ml versus 0.17 ± 0.01 ng/ml, respectively). Out of a wider cohort, there were no significant differences in genotypes and allele frequencies of Arg51Gln, Leu72Met, and Gln90Leu SNPs between term SGA and AGA neonates, or between preterm SGA and AGA neonates. Ghrelin/obestatin prepropeptide polymorphisms were not found to be associated with SGA status in neonates; however, ghrelin and obestatin levels may be involved in growth and development. Further studies are required to understand the relationship between ghrelin, obestatin and prenatal development.

OP25.05: Corpus callosum differences assessed by MRI in term small for gestational age fetuses and its association with neurobehaviour

To evaluate corpus callosum (CC) morphometry by MRI in term small for gestational age (SGA) fetuses compared to controls and its association with neurobehavioral outcome. 117 SGA and 73 control fetuses with normal umbilical Doppler were imaged using a 3T MRI scanner at 37 weeks of gestation, obtaining T2 HASTE anatomical acquisition in the three orthogonal planes. CC length, thickness, total area and the areas after a subdivision in 7 portions were blindly assessed by semi-automatic delineation. All measurements were corrected by the cephalic index. Neonatal neurobehaviour was evaluated with the Neonatal Behavioral Assessment Scale (NBAS) at 42 ± 1 week. Statistical analyses were performed by multivariate analysis of covariance adjusting for gender, smoking and body mass index. The association between CC measurements and NBAS scores in SGA was assessed by ordinal regression taking into account the same covariates plus age at NBAS test, considering the dependent variable the amount of NBAS test's clusters under the 5th centile. SGA fetuses showed significantly smaller total CC area (SGA: 1.3996 ± 0.26 vs. control: 1.664 ± 0.31; p < 0.01) and smaller genu, rostral body, anterior midbody, posterior midbody, isthmus and splenium areas. Overall, we found a significant association between smaller CC measures and worse neurobehavioral outcome in SGA newborns, particularly a smaller total area (p = 0.03), rostrum (p = 0.02), genu (p = 0.03), rostral body (p = 0.02), anterior midbody (p = 0.03) and splenium (p = 0.03) had a significant negative effect on the number of abnormal NBAS clusters. CC development was significantly altered in term SGA fetuses and correlated with worse neurobehavioral performance. CC could be further explored as a potential imaging biomarker to predict abnormal neurodevelopment in pregnancies at risk.

OP08.07: Cerebroaortic ratio: a new index for the prediction of adverse perinatal outcome in term small‐for‐gestational age fetuses with normal umbilical artery Doppler

To evaluate the clinical value of cerebroaortic ratio in predicting the risk of Caesarean section (CS) non-reassuring fetal status (NRFS) in term small-for-gestational-age (SGA) fetuses with normal umbilical artery Doppler. Combination of middle cerebral artery (MCA) and Aortic Isthmus (AoI) pulsatility indices (PI) in the cerebroaortic ratio (CAR = MCA/AoI) was evaluated within 1 week before labour induction in a cohort of 106 singleton consecutive SGA fetuses with normal umbilical artery PI (<95th centile) delivered above 37 weeks. The contribution of CAR to predict CS for NRFS alone or in combination with MCA PI, cerebroplacental ratio (CPR), AoI PI and uterine artery Doppler was assessed by logistic regression and decision tree analysis. Individual Doppler abnormalities were significantly associated with the risk of CS for NRFS, with an odds ratio (OR) of 4.9 (95% confidence intervals (CI) 4.9-11.9, p < 0.001) for abnormal CAR (<0.48), OR of 4.2 (95% CI 1.6-10.7, p = 0.003) for abnormal MCA (<5th centile), OR of 3.9 (95% CI 1.6-9.8, p = 0.003) for abnormal CPR (<5th centile) and OR of 2.8 (95% CI 1.1-7.3, p = 0.03) for abnormal uterine artery Doppler (mean PI >95th centile). Decision tree analysis combining abnormalities in CAR, MCA, CPR, and uterine artery Doppler identified the CAR as the best individual predictor discriminating two groups with high (51.0%) and low risk (17.5%). Combination of brain Doppler and Aortic Isthmus in the cerebroaortic ratio better discriminates term SGA fetuses at risk of adverse perinatal outcome.

Risk factors and adverse perinatal outcomes among term and preterm infants born small-for-gestational-age: secondary analyses of the WHO Multi-Country Survey on Maternal and Newborn Health.

BackgroundSmall for gestational age (SGA) is not only a major indicator of perinatal mortality and morbidity, but also the morbidity risks in later in life. We aim to estimate the association between the birth of SGA infants and the risk factors and adverse perinatal outcomes among twenty-nine countries in Africa, Latin America, the Middle East and Asia in 359 health facilities in 2010–11.MethodsWe analysed facility-based, cross-sectional data from the WHO Multi-country Survey on Maternal and Newborn Health. We constructed multilevel logistic regression models with random effects for facilities and countries to estimate the risk factors for SGA infants using country-specific birthweight reference standards in preterm and term delivery, and SGA’s association with adverse perinatal outcomes. We compared the risks and adverse perinatal outcomes with appropriate for gestational age (AGA) infants categorized by preterm and term delivery.ResultsA total of 295,829 singleton infants delivered were analysed. The overall prevalence of SGA was highest in Cambodia (18.8%), Nepal (17.9%), the Occupied Palestinian Territory (16.1%), and Japan (16.0%), while the lowest was observed in Afghanistan (4.8%), Uganda (6.6%) and Thailand (9.7%). The risk of preterm SGA infants was significantly higher among nulliparous mothers and mothers with chronic hypertension and preeclampsia/eclampsia (aOR: 2.89; 95% CI: 2.55–3.28) compared with AGA infants. Higher risks of term SGA were observed among sociodemographic factors and women with preeclampsia/eclampsia, anaemia and other medical conditions. Multiparity (> = 3) (AOR: 0.88; 95% CI: 0.83–0.92) was a protective factor for term SGA. The risk of perinatal mortality was significantly higher in preterm SGA deliveries in low to high HDI countries.ConclusionPreterm SGA is associated with medical conditions related to preeclampsia, but not with sociodemographic status. Term SGA is associated with sociodemographic status and various medical conditions.

CYP17A1 gene polymorphisms and environmental exposure to organochlorine pesticides contribute to the risk of small for gestational age

ObjectivesThe cytochrome P-450c17α enzyme encoded by the cytochrome P-450c17α (CYP17A1) gene plays a role in oestrogen synthesis. Genetic variation in the maternal CYP17A1 gene leads to differences in oestrogen level that affect fetal growth and cause small for gestational age (SGA). Organochlorine pesticides (OCPs) are endocrine disruptors that alter the normal oestrogen–progesterone balance, and are associated with adverse reproductive outcomes. This study was designed to investigate the effect of the gene–environment interaction between maternal CYP17A1 gene polymorphisms and maternal and cord OCP levels on the risk of SGA. Study designMaternal and cord blood samples of 50 term SGA cases (birth weight <10th percentile for gestational age as per Lubchenco's growth chart) and 50 normal pregnancies (controls) were collected. Women with occupational exposure to OCPs, anaemia, hypertension, antiphospholipid antibody syndrome, medical disease, parity of more than four, or a history of smoking, alcohol consumption or chronic drug intake were excluded from both groups. Maternal and cord blood samples were collected at the time of delivery or after delivery, respectively. The OCP levels of the samples were analyzed using a gas chromatography system equipped with an electron capture detector, and polymerase chain reaction–restriction fragment length polymorphism was used for polymorphic analysis of the CYP17A1 gene. ResultsSignificantly (p<0.05) higher levels of α-hexachlorocyclohexane (HCH), β-HCH and γ-HCH were found in maternal and cord blood samples of the SGA cases compared with the controls. The frequency of the A1A2/A2A2 genotype was significantly lower [p=0.041, odds ratio (OR) 0.421, 95% confidence interval (CI) 0.184–0.966] in the SGA cases compared with the controls. When gene–environment interactions between CYP17A1 gene polymorphisms and OCP levels were considered, a significant (p=0.004) association was found between a high level of endosulfan in cord blood and the A1A1 (wild-type) genotype of CYP17A1, leading to an estimated reduction in birth weight of 315g. ConclusionsHigher OCP levels and the A1A1 genotype of CYP17A1 in pregnant women may be considered as important aetiological factors in idiopathic SGA. This study provides evidence that genetic variation and its interaction with environmental exposure may increase the risk of SGA. Further studies are needed with a larger sample size, incorporating other gene polymorphisms and environmental exposures, to strengthen these observations.

PFM.65 Impact of cerebral redistribution on neurological outcomes in small for gestational age babies: a systematic review

BackgroundCerebral redistribution (CR) in fetuses with growth restriction has been thought to be a protective, compensatory mechanism.Aimto systematically review the evidence on whether CR, as assessed by MCA Doppler, in...

Breast Milk versus Formula Milk and Neuropsychological Development and Sleep

A cohort study including 14000 newborns, about half of them were exclusively breast fed for the first four months of their lives, this percentage dropped down to about 4% by the end of the fourth month of age. One third of these babies were not breast fed at all; 9% of them were identified with a degree of gross motor delay, 6% with fine motor delay by the age of 9 months. The proportion of infants who acquired their milestones overtime increased with exclusivity of breastfeeding. Infants who had never been breastfed were 40-50% more prone to have some sort of motor delay than breast fed infants (10.7% vs 7.3%). These findings did not decrease with adjustment of other confounders, e.g. biological, socioeconomic or psychosocial factors [1]. Neuro-physiological outcomes in breast fed infants was evaluated through flash Visual Evoked Potential (VEP), Brainstem Auditory Evoked Potential (BAEP) and Somato-Sensory Evoked Potential (SSEP) and showed significant prolongation of P-100 wave latencies in formula fed infants, in addition to that, prolongation of absolute waves I, III, V wave latencies of BAEP was also seen in formula fed infants in comparison with breast fed infants. SSEP showed similar findings to VEP and BAEP. This concludes that maturation and brain myelination patterns in breast fed infants is more mature than formula fed infants [2]. Small for Gestational Age (SGA) born babies are at high risk for neuro-developmental delay. Studies have shown that enriched formula fed to term SGA infants improve their growth and their neuro-developmental outcome. A multicenter randomized controlled study in United Kingdom showed that there was no significant intergroup difference in Bayley Mental Development Index (MDI) or Psychomotor Development Index (PDI) scores at 18 months. Though, breast fed infants have significantly higher MDI and PDI scores than formula fed infants. Confounding factors accounted for one third of the resulted association with MDI score and none of the association with PDI score. It is previously reported that enriched formula do have significant effect on enhancing linear growth, though this was not correlated with neurodevelopmental benefit [3]. Breast feeding should be encouraged for best neurodevelopmental outcome in infants born SGA. Behavioral assessment of neonates was done for 83 neonates at their ninth day of life, though special assessment scale “Brazelton Neonatal Behavioral Assessment Scale”. 42 neonates were exclusively breast fed and 42 were formula fed, the study showed that breast fed infants exhibited fewer abnormal reflexes, signs of depression, and withdrawal. This proves that breast feeding

Angiogenic factors at diagnosis of late-onset small-for-gestational age and histological placental underperfusion

ObjectiveThis study was designed to explore the association between angiogenic factors levels at diagnosis of small-for-gestational age (SGA) and placental underperfusion (PUP). MethodsIn a cohort of SGA singleton pregnancies, each delivered at >34 weeks, uterine (UtA), umbilical (UA), and middle cerebral (MCA) arteries were evaluated by Doppler upon diagnosis of SGA status. In addition, maternal circulating concentrations of placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) were assayed by ELISA, and each placenta was evaluated for histologic signs of PUP using a hierarchical and standardized classification system. Logistic regression was applied to analyze independent relationships (at diagnosis) between angiogenic factors and Doppler parameters. ResultsA total of 122 suspected SGA pregnancies were studied, 70 (57.4%) of which ultimately met PUP criteria. In this group, 85 placental findings qualified as PUP. Both mean UtA pulsatility index z-values (1.26 vs. 0.84; p = 0.038) and PlGF multiples of normal median (0.21 vs. 0.55; p = 0.002) differed significantly in pregnancies with and without PUP, respectively. By logistic regression, PlGF alone was independently predictive of PUP (OR = 0.11 [95% CI 0.025–0.57]; p = 0.008). DiscussionHistologic placental abnormalities in term SGA neonates reflect latent insufficiency in uteroplacental blood supply. The heightened risk of adverse perinatal outcomes in this context underscores a need for new Doppler or biochemical prenatal markers of placental disease. Angiogenic factors may be pivotal identifying SGA neonates. ConclusionsDiminished circulating levels of placental growth factor, determined upon discovery of SGA status, are associated with histologic evidence of PUP.

Polymorphisms in inflammatory genes are associated with term small for gestational age and preeclampsia.

Inflammatory biomarkers are associated with preeclampsia (PE) and poor fetal growth; however, genetic epidemiologic studies have been limited by reduced gene coverage and the exclusion of African American mothers. Cases and controls (N=1646) from a pregnancy cohort were genotyped for 503 tagSNPs in 40 genes related to inflammation. Gene-set analyses were stratified by race and were followed by a single SNP analysis within significant gene sets. Gene-level associations were found for IL6 and KLRD1 for term small for gestational age (SGA) among African Americans. LTA/TNF and TBX21 were associated with PE among European Americans. The strongest association was for PE among European Americans for an upstream regulator of TNF with RR=1.8 (95% CI 1.1-2.7). Although previous studies have suggested null associations, increased tagging and stratification by genetic ancestry suggests important associations between IL6 and term SGA for African Americans, and a TNF regulator and PE among European Americans (N=149).

Induction of Labor for Term Small-for-Gestational-Age Fetuses

Induction of labor (IOL) when the fetus appears small for gestational age (SGA) toward term may improve perinatal outcomes and prevent fetal death. If these fetuses are small as a variant of the normal spectrum, early induction may not improve outcomes and may cause obstetric complications. This study was undertaken to determine the impact of early IOL on neonatal outcomes and rates of maternal obstetric interventions in SGA term infants. The cohort included all term singleton deliveries and their neonatal outcomes occurring in 2004 to 2008. Maternal and neonatal outcomes of term (37–42 weeks) growth-restricted singleton deliveries were analyzed. Small for gestational age was defined as birth weight lower than the 10th percentile adjusted for gestational age and sex. The exposed group, termed early-induction SGA group, included women giving birth after IOL for suspected intrauterine growth restriction (IUGR) of a singleton SGA neonate at 37 to 39 weeks. The unexposed group, or no-early-induction SGA group, included women giving birth at 40 weeks of gestation or later and those who gave birth spontaneously to term SGA neonates at 37 to 39 weeks. Maternal characteristics, pregnancy and neonatal complications, and obstetric interventions were compared to evaluate benefits/drawbacks of early term IOL for IUGR. Of 37,342 women who had a singleton neonate at 37 weeks of gestation or later, 2378 (6.36%) neonates were born SGA. The early-induction and no-early-induction SGA groups included 445 and 1933 neonates, respectively. Most obstetric complications were similar in the 2 groups. Women in the early-induction group had significantly more hypertensive complications and a higher rate of cesarean deliveries compared with the unexposed group, and only 65.5% reached noninstrumental vaginal delivery (P < 0.0001). Neonatal Apgar scores at 1 and 5 minutes and sex were similar between the 2 groups. Compared with the unexposed group, the early-induction group had higher rates of hyperbilirubinemia necessitating phototherapy (odds ratio [OR], 1.75; 95% confidence interval [CI], 1.21–2.53) and hypoglycemia (OR, 2.38; 95% CI, 1.56–3.62). Two neonates in the early-induction group had respiratory complications. Necrotizing enterocolitis, sepsis, adverse neurologic outcomes, and need for resuscitation were rare and similar in both groups. No neonates died. The risk for any adverse neonatal outcome was ~2 times higher for the early-induction compared with the unexposed group (OR, 1.95; 95% CI, 1.46–2.61; P < 0.0001). The most significant danger in abstaining from IOL for IUGR at term is intrauterine fetal death. Of 37,342 singleton deliveries, 33 fetal deaths occurred at 37 to 42 weeks, 0.88 cases per 1000 live births at term; only 1 was an SGA fetus at 37 weeks. The risk for intrauterine fetal demise at term for non–early-induction SGA was 0.52 cases per 1000 live births, similar to that of the general term population (OR, 0.57; 95% CI, 0.08–3.85; P = 0.99). For suspected IUGR at term, awaiting spontaneous labor risks fetal decompensation, yet active IOL might increase rates of obstetric interventions and neonatal complications of early term delivery. This study found no apparent neonatal benefit for early term IOL for SGA neonates.

Neonatal screening for congenital cytomegalovirus infection in preterm and small for gestational age infants

Congenital cytomegalovirus (CMV) infection affects many organs: reticuloendothelial and central nervous system are particularly involved. Congenital CMV infection is the leading cause of non-genetic sensorineural hearing loss. Hearing impairment can be present at birth or it can occur months or even years after birth. It is as well an important risk factor for antenatal stillbirth, preterm birth and small for gestational age (SGA) condition. For these reasons we should early identify congenital CMV infection investigating at least at risk newborns such as preterm or SGA babies given that a simple and standardized method for a large scale screening program is lacking. In our study, we found an association between congenital CMV infection and preterm births (3.03%) and with SGA condition (3.7%). Consequently, routine CMV urine detection should be performed at least in all babies born before 37 weeks of gestational age and in term SGA newborns.

Cardiac function and arterial indices in infants born small for gestational age: analysis by speckle tracking

To compare strain indices between small for gestational age (SGA) infants and asymptomatic appropriate for gestational age (AGA) infants and to ascertain correlations with arterial biophysical properties. In this prospective observational echocardiographic study, 20 inborn term SGA infants weighing <3rd centile for gestational age were compared with 20 AGA infants. Demographic and echocardiographic data were analysed regarding cardiac strain and strain rate and arterial indices (stiffness, impedance and strain elastic modulus). Correlations between variables were assessed using Pearson's coefficient of correlation. Ponderal index was significantly lower in SGA infants (24.6 ± 2.9 vs. 29.5 ± 2.5). Left ventricular global longitudinal strain (GLS) was noted to be significantly impaired in the SGA infants (-15.9% ± 2.1 vs. -21.3% ± 2.8, p < 0.001). A basal to apical gradient was noted in segmental strain. Arterial biophysical measurements were significantly altered in the SGA infants. Significant correlations were noted between GLS and arterial stiffness (r = -0.4, p = 0.03), weight-indexed stiffness (r = -0.45, p = 0.02) and pressure-strain elastic modulus (r = -0.49, p = 0.01). Impairment in myocardial deformation was noted in the presence of altered arterial biophysical properties in the SGA infants.

Brainstem and cerebellar differences and their association with neurobehavior in term small-for-gestational-age fetuses assessed by fetal MRI

We tested the hypothesis whether small-for-gestational-age (SGA) fetuses have different brain stem and cerebellar morphometry when compared with appropriate-for-gestational-age (AGA) fetuses and whether the differences in these structures were associated with their neonatal neurobehavior. Magnetic resonance imaging was performed on 51 SGA fetuses and 47 AGA fetuses at 37 weeks' gestation. Pontine width, medullar width, vermian width and height, cerebellar primary fissure's depth, and cerebellar volume were measured and corrected by biparietal diameter and cerebellar volume by total intracranial volume. Ratios were compared between cases and control subjects. The association between morphometric differences and neurobehavioral outcome in SGAs was tested. Brainstem and cerebellar ratios were significantly larger in SGA fetuses: pontine width, SGA 0.143 ± 0.01 vs AGA 0.135 ± 0.01 (P < .01); medullar width, SGA 0.088 ± 0.01 vs AGA 0.083 ± 0.01 (P = .03); vermian width, SGA 0.181 ± 0.03 vs AGA 0.162 ± 0.02 (P < .01); vermian height, SGA 0.235 ± 0.03 vs AGA 0.222 ± 0.01 (P < .01); cerebellar volume, SGA 0.042 ± 0.01 vs AGA 0.038 ± 0.00 (P = .04); with deeper cerebellar primary fissure in SGAs, SGA 0.041 ± 0.01 vs AGA 0.035 ± 0.01 (P = .01). Medullar, cerebellar biometries, and volumetry were significantly associated with different Neonatal Behavioral Assessment Scale cluster scores in SGA infants. Brain stem and cerebellar morphometric measurements are significantly different in term SGA fetuses, which are associated significantly with their neurobehavioral outcome. This finding supports the existence of brain microstructural changes in SGA fetuses and lays the basis for potential image biomarkers to detect fetuses who are at risk.

Male disadvantage for neonatal complications of term infants, especially in small-for-gestational age neonates

Objective: Sex differences in long and short-term outcomes for infants are observed. This has also been shown for several neonatal complications in preterm neonates. We aimed to evaluate whether sex impacts neonatal outcome among term neonates. Furthermore, we were interested in whether small-for-gestational age male and female neonates at term presented with different patterns of neonatal complications.Methods: Data on all term singleton deliveries and respective neonatal outcomes between 2004 and 2008 at a single tertiary medical center were utilized for this retrospective cohort study. Immediate neurological complications were defined as one or more of the following: intraventricular hemorrhage, convulsions, asphyxia and acidosis. Neonatal complications were compared between male and female term infants, as well as male and female term small-for-gestational age (SGA) neonates.Results: 37 342 singleton neonates were born ≥37 weeks’ gestation. 19 112 neonates were males. Birth weight, cesarean sections and operative deliveries were significantly higher for males. Neonatal hypoglycemia and immediate neurological complications were significantly more frequent in males. For term SGA’s, low 5-min apgar scores (<7) at 39–40 weeks were 2.65 times higher for males compared with females, as was hypoglycemia.Conclusions: Male infants at term, especially male SGA infants, are more likely to encounter complications during labor and require special neonatal care due to metabolic and/or neurological complications.

Placental findings in late-onset SGA births without Doppler signs of placental insufficiency

ObjectivesTo describe placental pathological findings in late-onset small-for-gestational age (SGA) births for which Doppler signs of placental insufficiency are lacking. MethodsA series of placentas were evaluated from singleton pregnancies of SGA births (birth weight below the 10th percentile) delivered after 34 weeks with normal umbilical artery Doppler (pulsatility index below the 95th percentile), that were matched by gestational age with adequate-for-gestational age (AGA) controls. Using a hierarchical and standardized system, placental lesions were classified histologically as consequence of maternal underperfusion, fetal underperfusion or inflammation. ResultsA total of 284 placentas were evaluated (142 SGA and 142 AGA). In the SGA group, 54.2% (77/142) of the placentas had weights below the 3rd percentile for GA while it was a 9.9% (14/142) in the AGA group (p < 0.001). Only 21.8% (31/142) of SGA placentas were free of histological abnormalities, while it was 74.6% (106/142) in the AGA group (p < 0.001). In the abnormal SGA placentas (111/142) there were a total of 161 lesions, attributable to MUP in 64% (103/161), FUP in 15.5% (25/161), and inflammation in 20.5% (33/161). DiscussionIn most placentas of term SGA neonates with normal UA Doppler histological abnormalities secondary to maternal underperfusion prevail, reflecting latent insufficiency in uteroplacental blood supply. This is consistent with the higher risk of adverse perinatal outcome reported in this population and underscores a need for new markers of placental disease. ConclusionsA significant proportion of late-onset SGA births with normal umbilical artery Doppler may still be explained by placental insufficiency.

Induction of labor for term small-for-gestational-age fetuses: what are the consequences?

ObjectiveTo evaluate whether early term labor induction for suspected intrauterine growth restriction (weeks 37–39) improves neonatal outcome for small-for-gestational-age (SGA) neonates. Study designDelivery room data for 2004–2008 from a single tertiary medical center were linked to neonatal discharge data from the same institution. Data were limited to all singleton, liveborn SGA neonates born at 37–42 weeks of gestation and their mothers. Births with known congenital anomalies were excluded. Women undergoing induction of labor for suspected growth restriction between 37 and 39 weeks’ gestation (early induction SGA) were compared with women who gave birth to term SGA neonates without early induction. SGA (<10th percentile for gestational age and gender) was used as a surrogate for intrauterine growth restriction. Associations between early term labor induction and neonatal morbidities were estimated using logistic regression. ResultsA total of 2378 SGA neonates meeting study criteria were identified. Of these, 445 underwent early term induction and 1933 were in the non-early induction SGA group. Intrauterine demise among term (37–42 weeks) SGAs occurred in one case at 37 weeks. Early term induction for SGA was associated with an increased risk of cesarean delivery. Several neonatal complications, including hyperbilirubinemia, hypoglycemia and respiratory complications were more prevalent in the early induction SGA group. The increased odds for neonatal complications persisted after controlling for possible confounders. ConclusionsEarly term induction for SGA fetuses results in an increased risk of cesarean deliveries as well as neonatal metabolic and respiratory complications, with no apparent neonatal benefit.