Showing papers on "Small for gestational age published in 1977"

Velocity of head growth during the perinatal period.

Abstract: Growth velocity of head circumference was studied longitudinally in different gestational age groups of 222 appropriate-weight-for-dates (AFD) and 94 small-for-dates (SFD) healthy infants during the first 5 months of life. Term AFD and SFD infants showed a steady slowing of growth rate of head circumference from birth. In contrast, preterm AFD infants of less than 36 weeks' gestation showed an increasing velocity of growth followed by slowing, with maximum velocity occurring between 30 and 40 days after birth. The shorter the postconceptional age at birth the later maximum velocity occurred. However, those preterm AFD infants of between 30 and 33 weeks' gestation who were given a high caloric feed showed a similar velocity curve to that of infants of 34-37 weeks of gestation. Cross-sectional data were used to estimate growth velocity of head circumference in the fetus. Two conclusions emerged. First, there is a slowing of head growth velocity from 31 weeks' gestation in utero, and second, term infants show a marked increase in volocity after birth. Though the occurrence of maximum velocity of head growth is delayed in the preterm infant, the net effect is such that at a given postconceptional age his head circumference is greater than that of the term infant, at least within the first 5 postnatal months.

Palmar Crease Variants and Their Clinical Significance: A Study of Newborns at Risk

Abstract: An analysis of palmar crease variants was carried out in a group of "at risk" newborns, without any evident congenital anomalies. This group consisted of 108 prematures, 74 infants who were small for gestational age, 62 newborns with history of gestational complications, and 46 newborns with a history of intrauterine methadone exposure. A system of classification was developed based on observations of 500 normal newborns as control subjects, 466 normal mothers, and 200 normal children. The palmar crease variants can be divided into four main groups, schematically presented as normal variants, simian crease and its variants, Sydney line and its variants, and another group of unusual variants which do not fit into the other groups. A study of these groups revealed that familial components, race, sex, and age are factors that can influence the expression of palmar crease patterns. There is an increased frequency of abnormal creases in each of the groups of "at risk" newborns. Moreover, there is an apparent association of interrupted transrerse creases and intrauterine methadone exposure.

Born Too Soon or Born Too Small

Abstract: Too small or too soon, which is better? Or, more precisely, how does a group of 5- to 7-year-old children who were small for gestational age at birth compare with a group of children born after a short gestation, and how does each compare with a group born neither too small or too soon? These are the questions addressed in this monograph from Newcastle-Upon-Tyne. On the basis of an elegant analysis of extensive and carefully gathered data, the authors conclude that survivors of both small-for-dates (

Pituitary-thyroid responsiveness to thyrotropin-releasing hormone in preterm and small-for-gestational age newborns.

Abstract: . A dose of 40 μg TRH was injected intravenously in 12 preterm (PT) and 15 small-for-gestational age (SGA) babies (with advanced gestational ages) between 5 and 167 hours after birth. Serum-thyrotropin (TSH) was measured prior to and 30 and 180 min after TRH; serum-thyroxine (T4) and serum-triiodothyronine (T3) were measured prior to and 180 min after TRH. The percentage increase in serum-TSH in PT and SGA babies was comparable to that of fullterm newborns. The serum-TSH 30 min after TRH in SGA newborns was significantly correlated to basal TSH values, such a correlation could not be shown in the preterms. One SGA and four PT babies had a repeat TRH-test performed later in infancy: In all but one PT with a gestational age of 27 weeks the TSH rise was lower than in the neonatal period. The thyroid hormone responses after TRH were similar in the two groups of babies. The percentage increase above basal levels were: Median serum-T3 increase about 46% and median serum-T4 increase about 14%. It is concluded that in low-birth-weight newborn babies the pituitary TSH response to exogenous TRH was like that detected in fullterm newborns and more pronounced than later in infancy. The effect of endogenous TSH as measured by thyroid hormone increases was of the same magnitude as observed in fullterms and in adults.

Assessment of gestational age by examination of the anterior vascular capsule of the lens

Abstract: One hundred infants between 27 and 34 weeks gestational age assessed by maternal dates and Dubowitz Scoring were studied with the direct ophthalmoscope following dilation of the pupil. The disappearance of the anterior vascular capsule of the lens was arbitrarily divided into four grades. Grade four was assigned when the anterior vascular capsule was complete with progressive decrease in grade as the vascular capsule atrophied. Before the 27th week, the cornea was too opaque to allow good visualization of this vascular system. After the 34th week, these vessels had generally atrophied completely. There were 24 infants scored grade 4, 22 infants scored grade 3, 20 infants scored grade 2 and 28 infants scored grade 1. Six infants had no significant anterior vascular capsule. There was a significant negative correlation between gestational age and grade of anterior vascular capsule (r = -0.877, t = 18.1, p < 0.001). Of the twelve preterm infants in the study estimated to be small for gestational age, one was grade 4, five were grade 2 and six were grade 1. There was significant negative correlation (r = -0.93, t = 7.08, p < 0.001). It is recommended that this simple technique be added to the initial newborn physical examination as an adjunct to gestational aging.

Low concentration of plasma amino acids in newborn babies of diabetic mothers.

Abstract: Plasma amino acid concentrations were measured in maternal peripheral vein and in umbilical vein and artery at birth (caesarean section) in 6 diabetic and 5 non-diabetic pregnancies. The mean birth weight in the control group amounted to 3.9 kg as oversize of the foetus in three cases contributed to the indication for caesarean section. The infants in the diabetic group consisted of "small for gestational age" babies (mean weight 2.8 kg). Free amino acid levels in the normal group and in diabetic maternal blood were in agreement with previous investigations. No difference in amino acid concentrations in the maternal plasma was found, but the concentrations of the umbilical vein plasma were significantly lower in the diabetic group. Foetal hyperinsulinaemia may be a cause of the low amino acid concentrations. Besides, abnormalities of the placenta and maternal vascular complications increase and the mean birth weights decrease significantly through the White classes. Conditions of impairment of placental transfer of amino aicds may thus be present. Characteristics features of the foetus may be consistent with the hypothesis as follows: The foetus in diabetic pregnancy is in varying degree exposed to an oversupply of glucose, hyperinsulinaemia, imbalanced uptake and a slightly diminished supply of amino acids.

Influence of folic acid on birthweight and growth of the erythroblastotic infant. I. Birthweight.

Abstract: The birthweights of 100 infants with erythroblastosis were carefully matched as to sex, gestational age, and parity with the birthweights of 200 control infants born during the same period. At all gestational ages the average birthweight of the affected infants was below that of the controls, the average reduction being 227 g. The more severely affected infants tended to be at a lower centile for birthweight than were the mildly affected ones. The relationships between maternal serum folate, cord blood serum folate, and centile for birthweight among affected infants were also studied. There was a strong correlation between low maternal serum folate and the incidence of small-for-dates babies among the affected infants. There was also a strong correlation between maternal and cord blood serum folate values. There was a lack of correlation between maternal serum folate and cord blood haemoglobin. It is concluded that infants with erythroblastosis are lighter than controls and that the reason for this may be a shortage of folic acid available for fetal growth.

Concentrations of triglycerides, free fatty acids and glycerol in cord blood of newborn infants with a birth weight of ≤2700 grams

Abstract: Concentrations of triglycerides, free fatty acids (FFA) and glycerol were measured in umbilical venous blood from 99 infants with a birth weight of between 1100-2700 g and a gestational age of 27-41 weeks. Thirty infants were small for gestational age (SGA), 58 were appropriate (AGA) and 11 were of uncertain gestational age. In AGA infants with a gestational age of less than or equal to 35 weeks. FFA values were lower than in those with a gestational age of less than 35 weeks; otherwise concentrations of triglycerides, FFA and glycerol were independent of birth weight and gestational age in AGA infants. In SGA infants, higher FFA values were found compared with both AGA and term infants of normal birth weight. Triglyceride values were higher in SGA than in AGA infants. In SGA infants, a significant positive correlation was found between gestational age and concentrations of both FFA and triglycerides. No differences in FFA, glycerol and triglyceride concentrations were seen between asphyxiated and non-asphyxiated AGA infants.

Hyperviscosity in the small-for-gestational age infant

Abstract: SGA infants are prone to hyperviscosity but the precise incidence is unknown. A prospective survey was conducted on 4,794 consecutive livebirth for hyperviscosity in SGA infants. SGA is defined as birth weight below the 10th percentile of intrauterine growth curve and signs of malnutrition; and hyperviscosity as venous blood viscosity (measured by micro-viscometer) above the 2 S.D. of the norm. 79 infants were identified as SGA and of these, 14 were hyperviscous (HV) and 65 were normal viscous (NV). The venous hematocrit range from 64-70% in HV and 37-62% for NV. A pre-defined symptom complex referable to cardiovascular, respiratory, gastrointestinal, and central nervous systems were assessed by 2 unbiased observers; 57% of HV and 25% of NV infants were symptomatic (p 64%) is predictive of HV; and that in spite of a positive correlation between symptom complex and HV, there is a lack of specificity for the clinical manifestation of HV.

Aortic arch interruption type A with aortopulmonary fenestration in an offspring of a chronic alcoholic mother ("fetal alcohol syndrome").

Abstract: A case is described of a newborn infant, small for gestational age, with the features of the "fetal alcohol syndrome", who presented a murmur within the first few days of life, and died at age 7 days in heart failure. Autopsy revealed interruption of the aortic arch, type A, an aortopulmonary window and intact interventricular septum. The association of "fetal alcohol syndrome" and cardiac malformation is discussed, with reference to other cases described in the literature.

Significance of obstetric factors in prognosis of low birthweight children

Abstract: . Obstetric factors were studied in ah unselected series of mothers of LBW-children and compared with those in a corresponding control series. Both groups consisted of 161 women with single pregnancies and 16 with twin pregnancies. Of the 188 LBW-children, 14% were twins. Of the single infants, 42% were appropriate for gestational age (AGA), i.e. within the 10th to 90th percentile according to Swedish curves for intrauterine growth, and 58% small for gestational age (SGA). The commonest causes of low birthweight (LBW) in the AGA-group were bleeding (34%) and premature rupture of the membranes (28%). In the SGA-group toxaemia was found in 15%, but in 50% of the SGA-group no cause of LBW was demonstrable. In this latter group the average placental weight was low. The mortality was noted and 89% of the living children were examined neurologically at 5 years of age. The prognosis of the child depended on the duration of pregnancy. Bleeding during pregnancy was a prognostically unfavourable sign, but even serious bleeding complications did not exclude a normal development of the child. The prognosis was best for those infants in whom no cause of LBW was demonstrable.

Nutrition in small for gestational age infants (sga): in vivo measurements of bone mineralization

Abstract: In vivo quantitation of bone mineral content (BMC, gm/cm) by direct photon absorptiometry was used to evaluate the bone nutritional status in 24 SGA (26-42 wks, 880-2360 gms). Formula (1 batch) was fed and Vit D was standardized at 300-500 IU/day. Measurements were made at birth, 2, 4, 6, 8 and 12 wks. BMC at birth in SGA did not correlate with gestational age, weight, length, or head circumference, whereas in appropriate for gestational age infants (AGA) there was a significant correlation of BMC at birth with gestational age and birth weight (p<.001). BMC at birth in 34-36 wk SGA (.054±gm/cm±.005, mean ±SE) were comparable to 34-36 wk AGA. Postnatal bone mineralization in SGA was significantly less than intrauterine mineralization (covariance analysis) reaching .092±.004 at 12 wks, equivalent to term AGA birth values, .090±.009. In term SGA, BMC at birth was decreased .067±.008 vs term AGA (t test p<.01). 12 wks of postnatal life were needed to reach term AGA birth BMC (.090±.005). Thus, the postnatal increase of BMC for term SGA infants was less than for 34-36 wk SGA, .023 vs .038 gm/cm over a 12-wk period. Delayed bone mineralization in SGA occurred in spite of excellent weight gain. Mean Ca intakes in 34-36 wk and term SGA averaged 110-130 mg/kg/day, comparable to term AGA. Thus postnatal bone mineralization in SGA infants is decreased. Term SGA infants have decreased bone mineralization at birth, and require a prolonged period to achieve normal bone mineralization.

Hyperahmonemia in premature infants

Abstract: Plasma levels of ammonium, glutamine, glutamate, alanine, α-ketoglutarate and urinary excretion of orotate were measured in full-term, n=41, premature small for gestational age (SGA), n=9, and premature appropriate for gestation age (AGA), n=27, infants. At 0-3 days of Hfe there was a significant difference (p<.001) in plasma ammonium concentrations in the premature SGA and AGA infants (mean±SEM) 45±3. 47±2 μM as compared to the full-term infants, 27±1 μM (adult normal <30 μM). When the two premature groups reacned term by weight or gestational age they were still hyperammonemic (39±3, 47±3 μM). It was not until 6-8 weeks of postnatal age that plasma ammonium levels became normal in all the prematures (29±1 μM). Associated with the hyperammonemia was a significant (p<.01) decrease of plasma α-keto-glutarate concentration, 12±1 μM, in premature AGA (n=13), compared to 22±1 μM in full-term (n=17) infants and an increase (p<.05) in urinary orotate excretion, 9±2 as compared to 4±1 μg/mg creatinine. There was a significant, p<.001, relationship between birth weight and plasma ammonium concentration (r=-0.65) and between α-keto-glutarate and plasma ammonium levels (r=-0.86). There were no differences in the plasma concentrations of glutamine, glutamate or alanine. Both premature groups were α-symptomatic. Possible mechanisms responsible for these abnormalities include development delay of one or more of the enzymes related to the urea cycle or urea cycle substrate deficiency.

[Risk of prematurity and reported bleeding in pregnancy (author's transl)]

Abstract: The analysis of 5.139 cases from the prospective study "Pregnancy and Childdevelopment" (supported by the Deutsche Forschungsgemeinschaft) showns that time and frequency of bleeding in pregnancy influence the risk of premature delivery. Every additional bleeding will increase the risk, especially if bleeding occurs in the second trimester. For example the risk of prematurity exceedes 25%, if bleeding occurs four times or more. After bleeding in early pregnancy the frequency of small for gestational age infants is not increased.