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• Premature


  Neonates born before 37 weeks' gestational age (GA)
• IUGR


  Failure of the normal fetal growth secondary to multiple adverse effects
• Causes of Prematurity


  • Fetal distress
  • Multiple gestation
  • Erythroblastosis
  • Nonimmune hydrops
  • Placental dysfunction
  • Placenta previa
  • Abruptio placentae
  • Bicornuate uterus
  • Incompetent cervix
  • Preeclampsia
  • Chronic medical illness
  • Infection
  • Drug abuse
  • Premature rupture of membranes
  • Polyhydramnios
  • Iatrogenic
  • Trauma
• Factors Often Associated with Intrauterine Growth Restriction

  • Chromosomal disorders (autosomal trisomies)
  • Chronic fetal infections
  • Congenital anomalies
  • Irradiation
  • Multiple gestation
  • Pancreatic hypoplasia
  • Insulin deficiency
  • Insulin-like growth factor type I deficiency
  • Decreased placental weight or cellularity, or both
  • Decrease in surface area
  • Villous placentitis (bacterial, viral, parasitic)
  • Infarction
  • Tumor (chorioangioma, hydatidiform mole)
  • Placental separation
  • Twin transfusion syndrome
  • Toxemia
  • Hypertension or renal disease, or both
  • Hypoxemia (high altitude, cyanotic cardiac or pulmonary disease)
  • Malnutrition (micro- or macronutrient deficiencies)
  • Chronic illness
  • Sickle cell anemia
  • Drugs (narcotics, alcohol, cigarettes, cocaine, antimetabolites)
• IUGR


  May be a normal fetal response to nutritional or oxygen deprivation<|>Can be symmetric or asymmetric
• Problems of IUGR (SGA) Infants

  • Intrauterine fetal demise
  • Perinatal asphyxia
  • Meconium aspiration syndrome
  • Hypoglycemia
  • Reduced oxygen consumption/hypothermia
  • Dysmorphology
• Pathogenesis of Intrauterine fetal demise

  Hypoxia, acidosis, infection, lethal anomaly
• Pathogenesis of Perinatal asphyxia


  Decreased uteroplacental perfusion during labor ± chronic fetal hypoxia-acidosis
• Pathogenesis of Hypoglycemia


  Decreased tissue glycogen stores, decreased gluconeogenesis, hyperinsulinism, increased glucose needs of hypoxia, hypothermia, large brain
• Pathogenesis of Reduced oxygen consumption/hypothermia


  Fetal hypoxia with increased erythropoietin production
• Pathogenesis of Dysmorphology


  Syndrome anomalads, chromosomal-genetic disorders, oligohydramnios-induced deformation, TORCH infection
• Assessment of Gestational Age at Birth

  • Reduced birthweight with larger head
  • Lack subcutaneous fat in both groups
  • Neurologic maturity correlates with gestational age despite reduced fetal weight
  • Gestational age at birth: the Ballard scoring system
• Ballard scoring system


  Used to assess gestational age at birth
• An infant should be presumed to be at high risk for mortality or morbidity if a discrepancy exists between the estimation of gestational age by physical examination, the mother's estimated date of her last menstrual period, and fetal ultrasonic evaluation
• Diseases common in preterm and IUGR infants

  • Respiratory
  • Cardiovascular
  • Hematologic
  • Gastrointestinal
  • Metabolic-Endocrine
  • Central Nervous System
  • Renal
  • Infections
• Nursery Care


  • Thermal Control
  • Oxygen
  • Fluid Requirements
  • Trophic feeding
  • Prevention of Infection
  • Immaturity of drug metabolism
  • Discharge from the hospital
• Reference: Nelson Textbook of Pediatrics, 18th ed., Chapter 97.2 Prematurity and Intrauterine Growth Retardation
• Reduced Oxygen Consumption/Hypothermia


  Newborns with IUGR (SGA) may have reduced oxygen consumption (due to underdeveloped lungs or heart) and hypothermia (unable to regulate body temperature)
• Insulin


  Hormone that regulates blood sugar levels; NOT related to hypoglycemia in IUGR (SGA) infants (caused by immature liver function or inadequate maternal glucose transfer)
• Oxygen


  Reduced oxygen consumption, making IUGR (SGA) infants more susceptible to hypoxia