IUGR
Dana Rivera, M.D.
October, 2010
SGA vs IUGR
SGA: IUGR:
BW less than population BW < expected
norms inhibition of normal
< 10th %-tile OR growth potential
< 2 standard deviations
below the mean (~3rd implies pathology
%-tile)
pathologic or non-
pathologic causes
True or False?
Produced by fetus
placental insufficiency
post dates
anatomic
abnormal insertion
hemangiomas
infarcts
abruption
Case # 1
A baby is delivered at
36 WGA via repeat C-
section
BW- 2 kg
HC- < 10th %tile
Lt- < 10th %tile
CMV
Case #1- What if?
Toxoplasmosis
Rubella
TORCH Stigmata
hepatoslpenomegaly
petechiae/ ecchymoses
blueberry muffin rash
vesicles/ mucocutaneous lesions
chorioretinitis/ cataracts/ salt-pepper retinopathy
PPS/PDA
microcephaly/ hydrocephaly
Intracranial calcifications
Diagnosis Algorithm
IUGR
yes
TORCH stigmata work-up?
no
Case # 2
A baby is delivered
via NSVD, no
prenatal care, EGA 35
weeks
BW- 1500 gm
HC- < 10th
Lt- <10th
Trisomy 13
Case #2- What if?
IUGR
yes
TORCH stigmata work-up?
no
yes
Dysmorphic features work-up?
no
Case # 3
Infant is delivered at
38 weeks to mom
who presents with
headaches and
epigastric pain
BW: 2.1 kg
HC: 50th%tile
Lt: 30th%tile
Pre-eclampsia/ HELLP
Case # 3- What if?
Mom with no prenatal
care delivers
undiagnosed twins at
EGA 34 weeks
Discordant twins
Case # 3- What if?
An infant is delivered
at 42 weeks via c-
section due to NRHTs
after induction
IUGR
yes
TORCH stigmata work-up?
no
yes
Dysmorphic features work-up?
no
yes
Maternal/placental explanation work-up?
no
Case # 3- What if?
Infant delivered at
EGA 34 weeks to
mom with no prenatal
care and positive tox
screen
Diagnosis Algorithm
IUGR
yes
TORCH stigmata work-up?
no
yes
Dysmorphic features work-up?
no
yes
Maternal/placental explanation work-up?
no
yes
Maternal drug use tox screen
no
Unknown cause
True or False
IUGR infants are Why or why not?
prone to asphyxia Perinatal hypoxia
Chronic and acute
Increased C/S rate,
True decreased Apgar,
increased resuscitation
need
An IUGR infant is at risk for
Hypothermia? decreased subcutaneous fat,
increased surface- volume
ratio, decreased heat
production
Physical exam
Labs
- blood sugar - urine shell vial (CMV)
- calcium - viral cultures (HSV)
- CBC diff/plt - syphilis w/u
- bilirubin - tox screen
- head ultrasound - chromosomes
- total IgM vs specific
Quick algorithm
Evaluation and Management
Monitor postnatal weight ? Safety of aggressive
gain/ head growth feeding
rapid weight gain may
needs may exceed predispose to childhood
100-120 cal/kg/d obesity highest risk for
developing type 2 DM
catch- up by 6-12
months
Hypersomatotropism-
accelerated growth
velocity
IUGR- Outcome
Neurodevelopment
etiology and adverse event dependent
lower intelligence, learning/ behavioral
disorders, neurologic handicaps
symmetric, chromosomal disorders, congenital
infections--- poorer outcome
school performance influenced by social class
Worlds smallest..