4CPS-176 Electrolyte disturbances in premature infants with intrauterine growth restriction receiving parenteral nutrition

Abstract 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.

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Relationship Between Intracranial Abnormalities In Premature Infants With Intrauterine Growth Restriction And Fetal Doppler Parameters

10.1542/peds.147.3_meetingabstract.726 ◽

2021 ◽

Author(s):

Faith Kim ◽

Jean-Ju Sheen ◽

Donna Garey

Keyword(s):

Premature Infants ◽

Intrauterine Growth Restriction ◽

Growth Restriction ◽

Intrauterine Growth ◽

Fetal Doppler

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Intrauterine Growth Restriction Impacts Tolerance to Total Parenteral Nutrition in Extremely Low Birth Weight Infants

Journal of Perinatology ◽

10.1038/sj.jp.7211137 ◽

2004 ◽

Vol 24 (8) ◽

pp. 476-481 ◽

Cited By ~ 30

Author(s):

Mariana C Baserga ◽

Augusto Sola

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Parenteral Nutrition ◽

Total Parenteral Nutrition ◽

Intrauterine Growth Restriction ◽

Growth Restriction ◽

Extremely Low Birth Weight ◽

Low Birth Weight Infants ◽

Intrauterine Growth

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OP14.08: Neurodevelopmental outcome in premature infants affected with intrauterine growth restriction

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.4551 ◽

2007 ◽

Vol 30 (4) ◽

pp. 503-503

Author(s):

E. Gratacos ◽

N. F. Padilla ◽

J. Maia ◽

A. Martinez ◽

A. Arranz ◽

...

Keyword(s):

Premature Infants ◽

Intrauterine Growth Restriction ◽

Neurodevelopmental Outcome ◽

Growth Restriction ◽

Intrauterine Growth

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Total Parenteral Nutrition Treatment in a Diabetic Pregnant Woman Complicated with Hyperemesis Gravidarum, Malnutrition, and Intrauterine Growth Restriction

Taiwanese Journal of Obstetrics and Gynecology ◽

10.1016/s1028-4559(09)60054-1 ◽

2004 ◽

Vol 43 (1) ◽

pp. 42-45

Author(s):

Chih-Wei Chen ◽

Te-Yao Hsu ◽

Shiuh-Young Chang ◽

Men-Yin Tsai

Keyword(s):

Pregnant Woman ◽

Parenteral Nutrition ◽

Total Parenteral Nutrition ◽

Intrauterine Growth Restriction ◽

Hyperemesis Gravidarum ◽

Growth Restriction ◽

Intrauterine Growth

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Placental factors of intrauterine growth restriction in premature infants

Voprosy praktičeskoj pediatrii ◽

10.20953/1817-7646-2018-3-7-12 ◽

2018 ◽

Vol 13 (3) ◽

pp. 7-12 ◽

Cited By ~ 1

Author(s):

T.V. Kovalenko ◽

◽

I.N. Petrova ◽

А.D. Yuditskiy ◽

I.V. Fedorova ◽

...

Keyword(s):

Premature Infants ◽

Intrauterine Growth Restriction ◽

Growth Restriction ◽

Intrauterine Growth

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Prevalence of neonatal ultrasound brain lesions in premature infants with and without intrauterine growth restriction

Acta Paediatrica ◽

10.1111/j.1651-2227.2007.00496.x ◽

2007 ◽

Vol 96 (11) ◽

pp. 1582-1587 ◽

Cited By ~ 30

Author(s):

Nelly F Padilla-Gomes ◽

Goya Enríquez ◽

Ruthy Acosta-Rojas ◽

Josep Perapoch ◽

Edgar Hernandez-Andrade ◽

...

Keyword(s):

Premature Infants ◽

Intrauterine Growth Restriction ◽

Brain Lesions ◽

Growth Restriction ◽

Intrauterine Growth

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Nutritional and Hormonal Status of Premature Infants Born with Intrauterine Growth Restriction at the Term Corrected Age

Annals of the Russian academy of medical sciences ◽

10.15690/vramn730 ◽

2016 ◽

Vol 71 (6) ◽

Cited By ~ 1

Author(s):

I. A. Belyaeva ◽

L. S. Namazova-Baranova ◽

E. P. Bombardirova ◽

M. V. Okuneva

Keyword(s):

Body Composition ◽

Premature Infants ◽

Fat Mass ◽

Intrauterine Growth Restriction ◽

Growth Restriction ◽

Hormonal Status ◽

High Concentration ◽

Anthropometric Measures ◽

C Peptide ◽

Intrauterine Growth

Background: Inadequate nutrition supply during the period of intrauterine growth and the first year of life leads to persistent metabolic changes and provokes development of various diseases. Aims: Тo compare physical development, body composition, and hormonal status (insulin, insulin-like growth factor-1 (IGF-1), somatotropic hormone (STH), C-Peptide, cortisol) indices in premature infants born with intrauterine growth restriction (IUGR) at the term corrected age with the same indices in mature infants with IUGR and premature infants with weight appropriate for their gestational age (GA). Materials and methods: А crossover study of anthropometric measures, body composition and growth hormones changes assessment was carried out. It included 140 premature infants with weight appropriate for their GA, 58 premature infants with IUGR and 64 mature infants with IUGR. Anthropometric measures were assessed with Fenton and Anthro growth charts (WHO, 2009); body composition was studied with the air plethysmography method (РЕA POD, LMi, USA). Level of hormones in blood serum was assessed with biochemical methods. Results: It is found that anthropometric measures in premature infants with weight appropriate for their GA and premature infants with IUGR at the term corrected age did not have any significant differences while premature infants with IUGR tended to have lower weight. Studying body composition we found that both groups of premature infants had slightly higher level of fat mass in comparison with mature infants. High concentration of insulin, cortisol, IGF-1, and C-peptide was found in premature and mature infants with IUGR. Instead, lower levels of STH was found in infants with IUGR. Formula fed premature infants (comparing to breastfed ones) had higher levels of fat mass, insulin, IGF-1, and C-peptide. Mature infants with IUGR did not tend to have the correlation between levels of fat mass, insulin, IGF-1, C-peptide, and type of feeding. Conclusions: Not only insufficient intrauterine growth but also nutrition pattern plays important role in development of body composition disbalance and hormonal shifts in premature infants.

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