Body size and neonatal hypoglycemia in intrauterine growth retardation

doi:10.1016/0378-3782(77)90027-5

Early Human Development

Volume 1, Issue 1, October 1977, Pages 25-38

https://doi.org/10.1016/0378-3782(77)90027-5 Get rights and content

Abstract

The relationship between blood glucose and body physique of 233 (42 hypo and 191 normoglycemic) intrauterine growth-retarded neonates was analyzed using different body measurements and indices of body proportions. Classification by combination of weight and length deficit for fetal age revealed that the disproportionately retarded infants (deficit in weight for age >30%; deficit in length for age <15%) were particularly prone to hypoglycemia. The lowest incidence of hypoglycemia was observed in the group with severe proportionate retardation (weight deficit for age >30%; length deficit for age >15%). Among the indices of body proportions ponderal index (W/L³), and percentage deviation from the expected weight for length turned out to be a sensitive predictor of the risk of hypoglycemia. The majority of hypoglycemia neonates were underweight for length and a considerable number of normoglycemic infants were overweight for length. These findings point to the significance of soft tissue wasting rather than low birth weight for gestational age itself, in the development and diagnosis of neonatal hypoglycemia. The significance of anthropometry in the classification of different types of intrauterine growth impairment, as well as in predicting specific hazards after birth is discussed.

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The differential neonatal morbidity of the intrauterine growth retardation syndrome
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This is a prospective study of differential morbidity among subgroups of intrauterine growth retardation. Cases of intrauterine growth retardation (N = 3450) (≥37 weeks, <10th percentile birth weight for gestational age) were classified by their ponderal index (weight/length³) in four subgroups using the 10th, 25th, and 90th percentiles of the Lubchenco's ponderal index-gestational age distribution. There were 432 cases (12.5%) with low ponderal index or disproportionate intrauterine growth retardation, 936 (27.1%) with intermediate ponderal index, 2030 (58.8%) with adequate ponderal index or proportionate intrauterine growth retardation, and 52 (1.5%) with high ponderal index. The low ponderal index group or disproportionate intrauterine growth retardation group had a statistically significant higher risk (between 1.6 and 12.5 times) for low 1- and 5-minute Apgar scores, aspiration syndrome, hypoglycemia, and perinatal asphyxia than the adequate ponderal index group. The low ponderal index group also had an increased risk (relative risk = 2.0 [95% confidence interval, 1.0 to 3.8]) for hospital stay of more than 1 week. These differences persist after a stratified analysis by birth weight and in a multiple logistic regression analysis. Similarly, higher neonatal morbidity is observed among infants with normal birth weights but with low ponderal index. These data provide further evidence of the heterogeneity of the intrauterine growth retardation syndrome and of the independent effect of body disproportion on neonatal morbidity, even among infants with normal birth weights. Because there are significant clinical implications attributed to the low ponderal index group, this subgroup should be identified as early as possible.
Indices of fetal growth-retardation, perinatal hypoxia-related factors and childhood neurological morbidity
1989, Early Human Development
Data from seven-year-old children (N = 4535) who were enrolled prenatally during the 1960s and born at term in the Boston sector of the National Collaborative Perinatal Project (NCPP) have been used to study the association of 7-year neurological morbidity with symmetric and asymmetric intrauterine growth-retardation (IUGR), head circumference at birth, and perinatal hypoxia-related factors (PHRF). In the absence of hypoxia-related factors, symmetric and asymmetric IUGR children were not at higher risk for neurological morbidity compared to nonIUGR children. In the presence of perinatal hypoxia-related factors, IUGR children were more likely to be neurologically abnormal compared to non-IUGR children, and the more severe form of IUGR (symmetric) appeared to be associated with a slightly higher risk than was the asymmetric form. Small head circumference was associated with increased risk of neurological abnormality regardless of the presence of PHRF. Potential metabolic and neurodevelopmental explanations for these findings are discussed.
The body proportions for small-for-dates infants
1984, Early Human Development
Measurements of weight, head circumference, crown-heel length, crown-rump length, rump-heel length and limb lengths were made in 514 neonates. From these measurements the differences in trunk and limb growth and their relations with head growth and body weight were examined in small-for-gestation (SGA) and appropriate grown (AGA) infants, and in different ethnic groups. We found that Asian infants had different body proportions from blacks and whites, with shorter trunks and forearms. SGA infants as a whole showed little difference in proportions from AGA infants except in their ponderal indices and the ratio of head size to body weight. However there was a preponderance of thin, relatively well-grown infants among them. When very short SGA infants were compared with AGA infants significant differences emerged, the short infants of all ethnic groups having shorter trunks and forearms in relation to their other measurements. We found no evidence of relative sparing of head growth. The results suggest that infants with prolonged intrauterine growth retardation are most likely to have disturbed skeletal proportions.
Patterns of retarded fetal growth
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The measurement of weight, length and head circumference at birth was used to document the size and shape of infants born at term in a population where mothers are relatively short and underweight. Different patterns of intrauterine growth are proposed to explain the variation in the infant's appearance at birth. Most of the small-for-gestational-age infants were proportionately stunted. This pattern of fetal growth is probably characteristic of infants born to undernourished mothers in economically developing communities, and reflects prolonged intrauterine growth retardation.
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Body size and neonatal hypoglycemia in intrauterine growth retardation

Abstract

Pediatr. Clin. North Am.

Pediatr. Clin. North Am.

Lancet

Lancet

Pediatr. Clin. North Am.

Br. Med. J.

J. Pediatr.

Studies of carbohydrate metabolism in the newborn infant. VI. Levels of glucose in blood in premature infants

Pediatrics

Studies on hypoglycemia in small-for-dates newborns

Arch. Dis. Child.

Diagnosis and treatment of hypoglycemia in the newborn

Arch. Dis. Child.

Hypoglycemia and temporary hyperglycemia in infants of low birth weight for maturity

Arch. Dis. Child.

Blood glucose in the neonate and its clinical significance

N. Engl. J. Med.

Disorders of Carbohydrate Metabolism in Infancy

Symptomatic neonatal hypoglycemia. VII. Studies of carbohydrate metabolism in the newborn infant

Pediatrics

Growth of the foetus in the third trimenon. II. Completed foetal weight-, length- and head circumference growth curves for the 28–43 gestational weeks

Gyermekgyógyászat