The Small for Gestational Age Infant: Accelerated or Delayed Pulmonary Maturation? Increased or Decreased Survival?

PEDIATRICS ◽  
1995 ◽  
Vol 95 (4) ◽  
pp. 534-538 ◽  
Author(s):  
Jon E. Tyson ◽  
Kathleen Kennedy ◽  
Sue Broyles ◽  
Charles R. Rosenfeld
Keyword(s):  
Respiratory Failure ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Lung Maturation ◽  
Intrauterine Growth ◽  
Increased Risk ◽  
Appropriate For Gestational Age ◽  
Almost All ◽  
Indigent Population ◽  
Better Than

Objective. Small for gestational age (SGA) neonates have been considered to have accelerated pulmonary maturation and thus a lower risk for respiratory distress syndrome (RDS) than appropriate for gestational age (AGA) neonates. This, however, has not been thoroughly examined. Therefore, we compared SGA infants with AGA infants of the same gestational age (GA) with respect to risk of RDS, respiratory failure, or death. Population. An indigent population born in a large county hospital. Methods. Multivariate analyses were performed controlling for GA alone or for GA, race, sex, and congenital anomalies. Because the proper method to identify SGA infants is unclear, we performed separate analyses using different GA estimates (obstetric or pediatric) and intrauterine growth grids (hospital-specific grids or grids for a healthy, geographically-defined population). Results. SGA infants did not fare better than AGA infants in any analysis. SGA infants had significantly increased risk in some analyses of RDS and in almost all analyses of respiratory failure or death. The risk associated with being SGA was generally comparable to that associated with male sex or White race. Conclusion. The concept that intrauterine growth retardation accelerates lung maturation and improves outcome is not supported in comparisons of SGA and AGA infants of the same GA, sex, and race. This widely accepted concept deserves critical re-evaluation.

Comparison of Phototherapy Results in Small-for-Gestational-Age and Appropriate-for-Gestational-Age Infants Weighing Less Than 2,000 Grams

PEDIATRICS ◽  
1985 ◽  
Vol 75 (2) ◽  
pp. 413-441
Author(s):  
Joan E. Hodgman ◽  
Paul Y. K. Wu ◽  
Nathaniel B. White ◽  
Dolores A. Bryla
Keyword(s):  
Birth Weight ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Congenital Defects ◽  
Intrauterine Growth ◽  
Appropriate For Gestational Age ◽  
Study Population ◽  
Similar Weight ◽  
Gestational Age At Birth ◽  
Evaluation Techniques

The infant who is small for gestational age (SGA) is more mature at birth than similar weight infants who are appropriate for gestational age (AGA). Whether the SGA infant behaves as does the larger gestationally equivalent infant, or whether there are specific changes related to intrauterine growth retardation is a matter of some interest in the understanding of the special needs of these infants. The National Institute of Child Health and Human Development (NICHD) phototherapy study provided a large newborn population for whom birth weight, gestational age at birth, and, thereby, intrauterine growth were carefully assessed. Infants who weighed 2,000 g or more at birth were included in the study only when they became jaundiced, whereas infants who weighed less than 2,000 g at birth were routinely entered into the study. Consequently, this report will be limited to the lowbirth-weight population selected by birth weight. Too few SGA babies were present in the groups with greater birth weight to allow meaningful comparisons. PATIENT SELECTIQN All infants whose birth weight was less than 2,000 g were entered into the study at 24 ± 12 hours. Those excluded from the study were: (1) infants who died before 24 hours, (2) infants with serious congenital defects, and (3) infants whose mothers refused consent for study. The study population consisted of 922 infants surviving at 24 hours. Gestational age was calculated from the first day of the last menstrual period obtained from maternal history and also by the evaluation techniques of Dubowitz.25 Intrauterine growth was determined by plotting birth weight and gestational age on the Denver Intrauterine Growth Curves8; infants below the 10th percentile were considered SGA.

scholarly journals Comparison of neonatal outcomes of small for gestational age and appropriate for gestational age preterm infants born at 28–36 weeks of gestation: a multicentre study in Ethiopia

2020 ◽  
Vol 4 (1) ◽  
pp. e000740
Author(s):  
Netsanet Workneh Gidi ◽  
Robert L Goldenberg ◽  
Assaye K Nigussie ◽  
Elizabeth McClure ◽  
Amha Mekasha ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Late Onset ◽  
Early Recognition ◽  
Neonatal Outcomes ◽  
P Value ◽  
Prolonged Hospitalisation ◽  
Increased Risk ◽  
Appropriate For Gestational Age

PurposeThe aim of this study was to assess morbidity and mortality pattern of small for gestational age (SGA) preterm infants in comparison to appropriate for gestational age (AGA) preterm infants of similar gestational age.MethodWe compared neonatal outcomes of 1336, 1:1 matched, singleton SGA and AGA preterm infants based on their gestational age using data from the study ‘Causes of Illness and Death of Preterm Infants in Ethiopia (SIP)’. Data were analysed using SPSS V.23. ORs and 95% CIs and χ2 tests were done, p value of <0.05 was considered statistically significant.ResultThe majority of the infants (1194, 89%) were moderate to late preterm (32–36 weeks of gestation), 763 (57%) were females. Male preterm infants had higher risk of being SGA than female infants (p<0.001). SGA infants had increased risk of hypoglycaemic (OR and 95% CI 1.6 (1.2 to 2.0), necrotising enterocolitis (NEC) 2.3 (1.2 to 4.1), polycythaemia 3.0 (1.6 to 5.4), late-onset neonatal sepsis (LOS) 3.6 (1.1 to 10.9)) and prolonged hospitalisation 2.9 (2.0 to 4.2). The rates of respiratory distress syndrome (RDS), apnoea and mortality were similar in the SGA and AGA groups.ConclusionNeonatal complications such as hypoglycaemic, NEC, LOS, polycythaemia and prolonged hospitalisation are more common in SGA infants, while rates of RDS and mortality are similar in SGA and AGA groups. Early recognition of SGA status, high index of suspicion and screening for complications associated and timely intervention to prevent complications need due consideration.

Maternal zinc and intrauterine growth retardation

1985 ◽  
Vol 68 (4) ◽  
pp. 395-399 ◽  
Author(s):  
Karen Simmer ◽  
R. P. H. Thompson
Keyword(s):  
Racial Differences ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Intrauterine Growth Retardation ◽  
Maternal Plasma ◽  
Intrauterine Growth ◽  
Group I ◽  
Appropriate For Gestational Age ◽  
Group Ii ◽  
Zinc Levels

1. The levels of zinc in plasma, erythrocytes, polymorphonuclear (PMN) and mononuclear (MN) white cells were measured after delivery in women giving birth to appropriate-for-gestational-age (AGA) babies (group I mothers), or small-for-gestational-age (SGA) babies (group II mothers) and in non-pregnant controls. 2. Mean maternal plasma zinc and albumin levels 24-48 h after delivery were lower than in controls, but PMN and MN zinc levels were unchanged. PMN zinc levels were lower than those of MN cells. 3. PMN and MN zinc levels were significantly lower in group II mothers than in group I, irrespective of smoking habits. There were no racial differences in peripheral white cell zinc levels. 4. PMN, and to a lesser degree MN, zinc levels were lower in smoking than in non-smoking mothers. 5. Erythrocyte zinc did not correlate with other zinc measurements nor with the size of the babies. Fetal erythrocyte zinc levels were one-third of maternal levels. 6. A combination of smoking and/or low PMN zinc levels selects 85% of mothers having small-for-gestational-age babies.

Babies Who Are Small for Gestational Age

1995 ◽  
Vol 16 (9) ◽  
pp. 354-354
Author(s):  
Barbara K. Russell
Keyword(s):  
Gestational Age ◽  
Small For Gestational Age ◽  
Intrauterine Growth Retardation ◽  
Growth Parameters ◽  
Mortality Rates ◽  
Heterogeneous Population ◽  
Growth Chart ◽  
Intrauterine Growth ◽  
Increased Risk ◽  
Definition Of

Small for gestational age (SGA) is a term applied to a heterogeneous population of babies who do not meet the expected growth parameters for their gestational age. The definition of SGA is variable, but the clinical definition used most often is any baby who weighs less than 2500 g and falls below the 10th percentile on the growth chart for its gestational age. These infants are at increased risk for hypoglycemia, polycythemia, and temperature instability and suffer higher neonatal mortality rates. Although they often are used interchangeably, the terms SGA and intrauterine growth retardation (IUGR) are not always synonymous. Approximately 60% of infants classified as SGA are constitutionally small babies who are small for gestational age but not growth retarded.

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

2015 ◽  
Vol 28 (5-6) ◽  
Author(s):  
Shulian Zhang ◽  
Guanpeng Zhai ◽  
Jin Wang ◽  
Wenjing Shi ◽  
Rong Zhang ◽  
...  
Keyword(s):  
Birth Weight ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Newborn Infants ◽  
Adult Life ◽  
Adverse Outcomes ◽  
Large For Gestational Age ◽  
Increased Risk ◽  
The Status ◽  
Appropriate For Gestational Age

AbstractLow 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.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 ofIGF-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.

scholarly journals The importance of small for gestational age in the risk assessment of infants with critical congenital heart disease

2013 ◽  
Vol 23 (6) ◽  
pp. 896-904 ◽  
Author(s):  
Anthony A. Sochet ◽  
Mark Ayers ◽  
Emilio Quezada ◽  
Katherine Braley ◽  
Jennifer Leshko ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Congenital Heart ◽  
Surgical Intervention ◽  
Critical Congenital Heart Disease ◽  
Foetal Growth Restriction ◽  
Increased Risk ◽  
Appropriate For Gestational Age

AbstractBackgroundInfants with critical congenital heart disease who require cardiothoracic surgical intervention may have significant post-operative mortality and morbidity. Infants who are small for gestational age <10th percentile with foetal growth restriction may have end-organ dysfunction that may predispose them to increased morbidity or mortality.MethodsA single-institution retrospective review was performed in 230 infants with congenital heart disease who had cardiothoracic surgical intervention <60 days of age. Pre-, peri-, and post-operative morbidity and mortality markers were collected along with demographics and anthropometric measurements.ResultsThere were 230 infants, 57 (23.3%) small for gestational age and 173 (70.6%) appropriate for gestational age. No significant difference was noted in pre-operative markers – gestational age, age at surgery, corrected gestational age, Society for Thoracic Surgeons and European Association for Cardiothoracic Surgery mortality score; or post-operative factors – length of stay, ventilation days, arrhythmias, need for extracorporeal membrane oxygenation, vocal cord dysfunction, hearing loss; or end-organ dysfunction – gastro-intestinal, renal, central nervous system, or genetic. Small for gestational age infants were more likely to have failed vision tests (p = 0.006). Small for gestational age infants were more likely to have increased 30-day (p = 0.005) and discharge mortality (p = 0.035). Small for gestational age infants with normal birth weight (>2500 g) were also at increased risk of 30-day mortality compared with appropriate for gestational age infants (p = 0.045).ConclusionsSmall for gestational age infants with congenital heart disease who undergo cardiothoracic surgery <60 days of age have increased risk of mortality and failed vision screening. Assessment of foetal growth restriction as part of routine pre-operative screening may be beneficial.

Myocardial performance index in term appropriate and small for gestational age neonates - a cross sectional study

2021 ◽  
pp. 1-7
Author(s):  
K. Vats ◽  
S.K. Choudhary ◽  
D. Kumar ◽  
A. Maria ◽  
T. Bandopadhyay
Keyword(s):  
Gestational Age ◽  
Small For Gestational Age ◽  
Performance Index ◽  
Neonatal Period ◽  
Left Ventricular ◽  
Myocardial Performance Index ◽  
Doppler Imaging ◽  
Myocardial Performance ◽  
Increased Risk ◽  
Appropriate For Gestational Age

BACKGROUND: It is known that small for gestational age (SGA) babies may be at an increased risk of cardiovascular diseases during adulthood. There is paucity of literature regarding comparative cardiac functions of SGA and appropriate for gestational age (AGA) babies in neonatal period. The present study was conceived to compare the cardiac function of term small and appropriate for gestational age (AGA) babies through a relatively novel echocardiographic index in early neonatal period. OBJECTIVES: To compare values of myocardial performance index (MPI) index (MPI = IVCT + IVRT/ET) at 48–72 hours of age among AGA and SGA babies. METHODS: Morphological and anthropometric assessment of serially born term babies was done at time of birth to recruit hundred each of AGA and SGA babies. Tissue Doppler Imaging (TDI) was done between 48–72 hours for each enrolled baby to assess both right and left ventricle MPI in each group. RESULTS: Mean±SD values for right ventricular MPI in AGA and SGA groups were 0.268 + 0.007 and 0.30 + 0.026 respectively (p <  0.001). Mean±SD values for left ventricular MPI in AGA and SGA groups were 0.25 + 0.012 and 0.30 + 0.017 respectively (p <  0.001). There was significant negative correlation between MPI values for either ventricles and the birth weight (spearmen’s rho of –0.66) (p <  0.001). Mean±SD values for LVET in AGA and SGA group were 0.304 + 0.026 and 0.266 + 0.032 respectively (p <  0.001). CONCLUSION: MPI had a higher absolute value in the SGA babies as compared to AGA babies. These observations point towards suboptimal cardiac performance among SGA babies as compared to AGA babies on the basis of myocardial performance index.

Predicting infant temperament from neonatal reactivity for AGA/SGA twin pairs

Twin Research ◽  
1998 ◽  
Vol 1 (2) ◽  
pp. 65-70 ◽  
Author(s):  
Marilyn L Riese
Keyword(s):  
Gestational Age ◽  
Growth Retardation ◽  
Small For Gestational Age ◽  
Intrauterine Growth Retardation ◽  
Infant Temperament ◽  
Social Orientation ◽  
Group Differences ◽  
Intrauterine Growth ◽  
Appropriate For Gestational Age ◽  
Bull's Eye

AbstractThe predictive relation between neonatal reactivity and 12-, 18-, and 24-month temperament was assessed for 22 appropriate-for-gestational-age (AGA)/small-for-gestational-age (SGA) twin pairs. Neonatal reactivity included ratings of visual and auditory orienting responses to a bull's-eye, rattle, bell, voice, and face plus voice combined, as well as alertness. Infant temperament ratings were made of emotional tone, activity, attentiveness, and social orientation to staff during ageappropriate activities in the laboratory. There were no group differences in the neonatal or infant ratings. For AGA twins, a pattern of predictive correlations was obtained between neonatal reactivity and temperament at each age. A similar predictive pattern was not observed for the SGA twins. Group differences in rates of maturation related to stresses associated with intrauterine growth retardation influenced the significance of the neonatal variables for later temperament development.

ALTERATIONS IN HUMAN BRAIN BIOCHEMISTRY FOLLOWING INTRAUTERINE GROWTH RETARDATION

PEDIATRICS ◽  
1972 ◽  
Vol 50 (3) ◽  
pp. 403-411
Author(s):  
H. Peter Chase ◽  
N. Noreen Welch ◽  
Carol S. Dabiere ◽  
N. S. Vasan ◽  
L. Joseph Butterfield
Keyword(s):  
Human Brain ◽  
Gestational Age ◽  
Growth Retardation ◽  
Small For Gestational Age ◽  
Intrauterine Growth Retardation ◽  
Similar Reduction ◽  
Myelin Lipids ◽  
Intrauterine Growth ◽  
Appropriate For Gestational Age ◽  
The Brain

Analyses of brains from six infants whose birth weights were "small for gestational age" (SGA) and ten infants whose birth weights were ‘appropriate for gestational age" (AGA) show the cerebellum to be the area of the brain most greatly affected by intrauterine underdevelopment. The SGA cerebellar weight was reduced 37% and cellularity 35%, compared to reductions of only 21% and 19% for weight and cellularity in the remainder of the brain. The myelin lipids, cerebroside and sulfatide, were significantly reduced (p &lt; .01) in concentration or total quantity in the brains of SGA infants, in contrast to phospholipids, cholesterol, and gangliosides which did not show a similar reduction. Galactolipid sulfotransferase activity, important in sulfatide formation, was also significantly reduced (p &lt; .01) in the brains from SGA infants.

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