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SGA/IUGR. Sue Ann Smith, MD Neonatologist Doernbecher Neonatal Care Center. Intrauterine Growth Restriction (IUGR). No universal definition Any baby who does not achieve intrauterine growth potential Usually defined as < 2 SD below the mean for weight. Small for Gestational Age (SGA).

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sga iugr

SGA/IUGR

Sue Ann Smith, MD

Neonatologist

Doernbecher Neonatal Care Center

intrauterine growth restriction iugr
Intrauterine Growth Restriction (IUGR)
  • No universal definition
  • Any baby who does not achieve intrauterine growth potential
  • Usually defined as < 2 SD below the mean for weight.
small for gestational age sga
Small for Gestational Age (SGA)
  • Usually defined as <2SD or <10th % for growth parameters
  • Babies <3% are at greatest risk of morbidity and mortality.
  • Babies who are constitutionally small are at less risk of complications than those who are SGA from pathologic process.
etiology of sga
Etiology of SGA
  • Maternal Factors
  • Placental Factors
  • Fetal Factors
maternal factors
Maternal Factors
  • Genetic size
  • Demographics
    • Age (extremes of reproductive age)
    • Race
    • Socioeconomic status
  • Underweight before pregnancy or malnutrition
  • Chronic disease
  • Exposure to teratogens (EtOH, drugs, radiation, etc.)
maternal factors cont
Heart disease

Renal disease

Hypertension

Pulmonary disease

Hemoglobinopathies

Collagen-vascular disease

Diabetes

Postmaturity

Multiple gestation

Uterine anomalies

Thrombotic disease

High altitude environment

Smoking

Cocaine

Maternal Factors (cont.)

Factors that interfere with placental flow and function

placental factors
Malformations – vascular

Chorioangioma

Infarction

Abruption

Previa

Abnormal trophoblast invasion

Placental Factors
fetal factors
Fetal Factors
  • Constitutional – genetically small, but genetically normal
  • Chromosomal abnormality – only about 5% of SGA babies
  • Malformations – CNS, skeletal, gastroschisis
  • Congenital infections – CMV, rubella
characteristics of iugr

Characteristics of IUGR

Symmetric

Early onset

Constitutional or “normal” small

Decreased growth potential

Normal ponderal index

Lower risk for transitional problems

Brain symmetrical to body

Examples

Genetic causes, chromosomal

TORCH infections

Anomalad Syndromes

characteristics of iugr10
Characteristics of IUGR
  • Asymmetric
  • Late onset
  • Environmental
  • Growth arrest
  • Higher risk for transitional problems
  • Brain sparing

Examples

  • Chronic hypoxia
  • Preeclampsia (PIH, PET)
  • Chronic hypertension
  • Malnutrition
neonatal complications of iugr
Neonatal Complications of IUGR
  • Mortality rate 5-20x that of AGA
  • Perinatal asphyxia
  • Abnormal temperature regulation
  • Hypoglycemia
  • Hyperviscosity-polycythemia syndrome
  • Altered immunity
  • Thrombocytopenia
neonatal complications of iugr cont
Neonatal Complications of IUGR(cont)
  • Pulmonary hemorrhage
  • PPHN
  • Hypocalcemia
evaluation of sga newborn

Evaluation of SGA Newborn

Careful physical examination

Measure & plot head circumference & length

CBC with differential and platelet count

Monitor glucose carefully

Further evaluation?

Urine for CMV

TORCH titers

Liver function tests

Head Ultrasound

long term morbidity of iugr

“Long term” Morbidity of IUGR

Factors associated with abnormal outcome ?

Microcephaly

Hypoxic ischemic encephalopathy

Symptomatic hypoglycemia

Symptomatic hyperviscosity

slide15

50

50

40

40

30

30

20

20

10

10

<10

10-50

50-90

>90

<10

10-50

50-90

>90

Term AGA

Term SGA

Preterm SGA

Growth Consequences of IUGR

Height at 4 years

Weight at 4 years

Percent

Percent

Percent

Percent

slide16

50

40

30

20

10

<10

10-50

50-90

>90

Term AGA

Term SGA

Preterm SGA

Growth Consequences of IUGR

Head Circumference at 4 years

Percent

fetal origins of adult diseases
Fetal Origins of Adult Diseases ?
  • Coronary artery disease correlates inversely with birth weight
  • Rate of non-insulin dependent diabetes mellitus is highest in the “thinnest” babies at birth (low ponderal index)
  • High serum cholesterol are linked to disproportionate size at birth (body smaller than head)
  • Increased rate of hypertension in infants who were thin, short, &/or proportionately small at birth
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