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)
 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
 Maternal Factors
 Placental Factors
 Fetal 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.)
Factors that interfere with placental flow and function
 Heart disease  Postmaturity

 Renal disease  Multiple gestation

 Hypertension  Uterine anomalies

 Pulmonary disease  Thrombotic disease

 Hemoglobinopathies  High altitude

 Collagen-vascular environment
disease  Smoking

 Diabetes  Cocaine
 Placental Factors

 Malformations – vascular
 Chorioangioma
 Infarction
 Abruption
 Previa
 Abnormal trophoblast invasion
 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
Characteristics of
of IUGR
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 IUGR
Asymmetric
 Late onset
 Environmental
 Growth arrest
 Higher risk for transitional problems
 Brain sparing
Examples
 Chronic hypoxia
 Preeclampsia (PIH, PET)
 Chronic hypertension
 Malnutrition
Neonatal
Neonatal Complications
Complications of
of
IUGR
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)
 Pulmonary hemorrhage
 PPHN
 Hypocalcemia
 Evaluation
Evaluation of
of SGA
SGA Newborn
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
Long term”
term” Morbidity
Morbidity of
of
IUGR
IUGR
Factors associated with abnormal outcome ?
 Microcephaly
 Hypoxic ischemic encephalopathy
 Symptomatic hypoglycemia
 Symptomatic hyperviscosity
 Growth
Growth Consequences
Consequences of
of IUGR
IUGR

Height at 4 years Weight at 4 years

50 50
40 40
Percent

Percent
30 30

20 20
10 10

<10 10-50 50-90 >90 <10 10-50 50-90 >90

Percent Percent
Term AGA Term SGA Preterm SGA
Growth
Growth Consequences
Consequences of
of IUGR
IUGR
Head Circumference at 4 years

50
40
30

20
10

<10 10-50 50-90 >90

Percent
Term AGA Term SGA Preterm SGA
 Fetal
Fetal Origins
Origins of of Adult
Adult
Diseases
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