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 <10
th
% 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.)
Heart disease
Renal disease
Hypertension
Pulmonary disease
Hemoglobinopathies
Collagen-vascular
disease
Diabetes

Postmaturity
Multiple gestation
Uterine anomalies
Thrombotic disease
High altitude
environment
Smoking
Cocaine

Factors that interfere with placental flow and function
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 of 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 Complications of 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 of SGA 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 term Morbidity of IUGR
Factors associated with abnormal outcome
?
Microcephaly
Hypoxic ischemic encephalopathy
Symptomatic hypoglycemia
Symptomatic hyperviscosity
Growth Consequences of IUGR
50
40
20
30
10
>90 50-90 10-50 <10
Height at 4 years
50
40
20
30
10
>90 50-90 10-50 <10
Weight at 4 years
Percent
Percent
P
e
r
c
e
n
t

P
e
r
c
e
n
t

Term AGA Term SGA Preterm SGA
Growth Consequences of IUGR
50
40
20
30
10
>90 50-90 10-50 <10
Head Circumference at 4 years
Percent
Term AGA Term SGA Preterm SGA
Fetal Origins of Adult 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