Brain metabolite alterations in infants born preterm with intrauterine growth restriction: association with structural changes and neurodevelopmental outcome
Rui V. SimõesEmma Muñoz‐MorenoM. Cruz‐LeminiE. EixarchNúria BargallóMagdalena Sanz CortésE. Gratacós
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Intrauterine growth restriction
Association (psychology)
Growth restriction
Intrauterine growth restriction (IUGR) is a unique and important issue for obstetricians. The acute neonatal consequences of IUGR are perinatal asphyxia and neonatal adaptive problems. However, the long-term outcomes of such neonates are less discussed because obstetricians usually only care for pregnant woman until delivery. The aim of this article is to review the sequelae, especially the long-term effects including the neurological, cardiovascular, renal, and metabolic effects of the growth restriction in an obstetrician's view.
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Neonates show considerable variation in growth that can be recognized through serial measurements of basic variables such as weight, length, and head circumference. If possible, measurement of subcutaneous and total body fat mass can also be useful. These biometric measurements at birth may be influenced by demographics, maternal and paternal anthropometrics, maternal metabolism, preconceptional nutritional status, and placental health. Subsequent growth may depend on optimal feeding, total caloric intake, total metabolic activity, genetic makeup, postnatal morbidities, medications, and environmental conditions. For premature infants, these factors become even more important; poor in utero growth can be an important reason for spontaneous or induced preterm delivery. Later, many infants who have had intrauterine growth restriction (IUGR) and are born small for gestational age (SGA) continue to show suboptimal growth below the 10th percentile, a condition that has been defined as extrauterine growth restriction (EUGR) or postnatal growth restriction (PNGR). More importantly, a subset of these growth-restricted infants may also be at high risk of abnormal neurodevelopmental outcomes. There is a need for well-defined criteria to recognize EUGR/PNGR, so that correctional steps can be instituted in a timely fashion.
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Intrauterine growth restriction is a condition fetus does not reach its growth potential and associated with perinatal mobility and mortality. Intrauterine growth restriction is caused by placental insufficiency, which determines cardiovascular abnormalities in the fetus. This condition, moreover, should prompt intensive antenatal surveillance of the fetus as well as follow-up of infants that had intrauterine growth restriction as short and long-term sequele should be considered.
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The diagnosis of Silver–Russell syndrome is based on the characteristic growth restriction and the presence of typical dysmorphic features. We present the prenatal and postnatal findings of a case that was treated at our perinatal center. The suspected diagnosis Silver–Russell syndrome was confirmed after delivery by our medical genetic and neonatology services. The authors want to point out that SRS should be considered in the differential diagnosis of early asymmetric intrauterine growth restriction. Copyright © 2005 John Wiley & Sons, Ltd.
Neonatology
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Background Intrauterine growth restriction (IUGR) is associated with an increased morbidity rate, as well as extrauterine growth restriction (EUGR). EUGR remains a significant challenge in nutritional care and is associated with impaired neurodevelopment. The optimal feeding regimen, especially in growth-restricted infants, is unknown. The diagnosis of IUGR is based on fetal biometry and doppler ultrasound parameters, whereas small for gestational age (SGA) is defined as a birth weight < 10th percentile solely, regardless of the aetiology. The term SGA is often used as a proxy for IUGR, but the differentiation might be essential for the nutritional treatment concepts. However, body composition is a valuable tool to assess nutritional status and management. The aim of the study was to investigate body composition of infants with IUGR and SGA compared to infants appropriate for gestational age (AGA).
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Neonatology
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Intrauterine growth restriction
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Intrauterine growth restriction
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Intrauterine growth restriction
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Our objective was to determine if sonographic estimate of fetal weight (SEFW) can identify fetal growth restriction (FGR; birthweight < 10% for gestational age [GA]) among patients with preterm (28 to 32 weeks) severe preeclampsia (P SPE). At two centers, all singletons with reliable GA, P SPE, and SEFW within 3 weeks of birth were identified retrospectively. Intrauterine growth restriction was SEFW < or = 10% for GA. Likelihood ratio (LR) and guidelines by an Evidence-Based Medicine Working Group were used. At the two centers, IUGR was suspected in 20% (4 of 20) and 28% (5 of 18) of P SPE, and FGR was noted in 35% and 44%. At one center, suspected intrauterine growth restriction (IUGR) was associated with actual FGR in 50% of the cases and at center II, in 80%. The LR for IUGR to identify FGR was 3.0. We concluded that SEFW is not a useful diagnostic test in identifying FGR among patients with preterm SPE.
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