Showing papers on "Small for gestational age published in 1982"

Abilities of children who were small-for-gestational-age babies

Abstract: A follow-up study of 51 small-for-gestation-age babies, whose intrauterine growth was monitored by serial ultrasonic cephalometry, was carried out at a mean age of 5.1 years. The developmental abilities of the children were assessed by using the McCarthy Scales of Children's Abilities and the results were compared with those of a group of matched control subjects. Children whose head growth began to slow before 26 weeks' gestation had significantly lower scores for the general cognitive index than control children. This did not occur in children whose head growth began to slow later in gestation. Scores for Perceptual-performance and Motor scales in the McCarthy scales were also lower for the children whose head growth slowed before 26 weeks' gestation, when compared with those of control children. There were no differences in the developmental scores of the children when they were divided into groups according to birth-weight percentiles. We conclude that prolonged slow growth in utero affects a child's later development and abilities, in particular, perceptual performance and motor ability.

Abilities of children who were small-for-gestational-age babies

Abstract: A follow-up study of 51 small-for-gestation-age babies, whose intrauterine growth was monitored by serial ultrasonic cephalometry, was carried out at a mean age of 5.1 years. The developmental abilities of the children were assessed by using the McCarthy Scales of Children's Abilities and the results were compared with those of a group of matched control subjects. Children whose head growth began to slow before 26 weeks' gestation had significantly lower scores for the general cognitive index than control children. This did not occur in children whose head growth began to slow later in gestation. Scores for Perceptual-performance and Motor scales in the McCarthy scales were also lower for the children whose head growth slowed before 26 weeks' gestation, when compared with those of control children. There were no differences in the developmental scores of the children when they were divided into groups according to birth-weight percentiles. We conclude that prolonged slow growth in utero affects a child's later development and abilities, in particular, perceptual performance and motor ability.

Enzymatic and Immunologic Quantitation of Erythrocyte Superoxide Dismutase in Adults and in Neonates of Different Gestational Ages

Abstract: Human erythrocyte superoxide dismutase (SOD) was purified and specific antiserum was raised in rabbits. Enzyme preparations from adults and from newborns were shown to be indistinguishable in their immunologic and electrophoretic properties. Erythrocyte SOD was quantitated in blood specimens from adults and in cord blood specimens from neonates of different gestational ages, using both an immunologic and an activity assay. The mean values of SOD concentration and SOD activity for adults and for newborns of average size for gestational age (AGA) showed no significant difference. Adult red cells contained 28.0 +/- 8.3 SOD units/mg hemoglobin (Hgb) whereas AGA neonatal red cells had 28.5 +/- 8.3 SOD units/mg Hgb. Immunologic quantitation by single radial immunodiffusion revealed 0.69 +/- 0.07 micrograms SOD/mg Hgb in adults and 0.70 +/- 0.14 micrograms SOD/mg Hgb in the AGA neonates; however, the SOD concentrations from both small for gestational age (SGA) and large for gestational age (LGA) neonates were significantly lower than those of the AGA neonates and the adults (SGA: 0.57 +/- 0.24 micrograms SOD/mg Hgb, P less than 0.05; LGA: 0.59 +/- 0.16 micrograms SOD/mg Hgb, P less than 0.05).

Humoral regulation of erythropoiesis and thrombopoiesis in appropriate and small for gestational age infants

Abstract: Fourteen infants with birth weight appropriate for gestational age (AGA) and 16 small for gestational age (SGA) infants were investigated for haemoglobin concentration, haematocrit level and thrombocyte count on the first day of life. Cord serum was tested for erythropoietin (ESF) and thrombopoietin (TSF) activity. The same investigations were performed on venous blood and serum from 18 healthy adult individuals. SGA infants had higher haemoglobin concentration and haematocrit level (p less than 0.05), and lower platelet count (p less than 0.001) than AGA infants. Significant ESF activity was present in cord serum, but was not detectable in serum from adults. Significant TSF activity was present in cord serum as well as in serum from adults, with higher levels in the newborn infants (p less than 0.05). An inverse relationship was found between serum TSF activity and the number of platelets in adults, which was not demonstrable in newborn infants. Long-term intrauterine hypoxia because of placental dysfunction may be the reason for polycythemia and thrombocytopenia in SGA infants. Thrombocytopenia may be caused by competitive mechanisms on common stem cells for erythropoiesis and thrombopoiesis, shunting stem cells in direction of erythropoiesis during hypoxic exposure. Normal serum TSF activity in SGA infants indicates that lack of the humoral factor for platelet production is not the reason for the thrombocytopenia in these infants. A negative feed-back mechanism may exist between platelet number and TSF production.

International comparisons of postnatal growth of low birthweight infants with special reference to differences between developing and affluent countries.

Abstract: At this time about 21 million children are born with low birthweight (LBW) below 2500 g corresponding to 17% of all births. 19 million of these LBW or 90% are born in developing countries. Applying 2250 gm instead of 2500 gm as a limit for LBW which many claim would be more nearly defining the high risk for LBW infant would bring the percentage of LBW in South East Asia down to 5 from 10 million infants. The lowest rates in Asia are to be found in East Asia where most countries in particular China and Japan have rates comparable to the lowest in Europe. The proportion of full term small for gestational age (SGA) of the LBW varies between 24-57% in developed countries. In Sweden and in the US it is 45%. In Africa it is about the same as in Europe while it is higher in Asia. For example in India it is 75%. During the past few decades there has been a successively improved prognosis for the LBW. By 1950 the neonatal mortality of infants below 1000 gm was more than 90% and 50-60% of those below 1500 gm developed major handicaps. By now the neonatal mortality of infants below 1000 gm has decreased to 50-60% and for the 1000-1500 gm infants it is only about 15%. Of the survivors only some 10-30% will have major handicaps. An extensive literature reveiw yielding about 350 recent articles concerning the future growth and fate of LBW infants disclosed only a few articles from developing countries with very brief follow-up periods. Most were from the US Canada Australia and a few European countries mainly England. It is difficult to make a fair comparison between published studies. A few studies with follow-up periods ranging between 3 months and 8 years are reported. On a global basis maternal malnutrition and infections are the most important factors influencing fetal growth. The difference in birth weight between different socioeconomic groups depends to a great extent on these factors. The postnatal growth of any infant is influenced by its nutritional intake and infection rate. In developing countries both these factors are operating negatively on the child and in particular if the infant cannot be breastfed. Breastfeeding is a must for survival both in the short-term and in the longterm perspective. There are clear indications that in general the appropriate for gestational age (AGA) infants catch up better than the SGA of the same weight. A particularly poor catch up growth is shown by full-term SGA indicating that if a fetal growth retardation is diagnosed delivery should be induced prematurely.

Head size and intelligence.

Abstract: We would like to raise some of the more obvious questions about the procedures and conclusions in the article by Lipper et al (Pediatrics 67:502, 1980) relating head circumference at birth to neurobehavioral outcome. One criterion stated for inclusion of an infant in the study was a birth weight less than the tenth percentile. How then can the authors proceed to divide their population into those who were below the tenth percentile (small for gestational age [SGA]) and those who were above the tenth percentile (appropriate for gestational age [AGA])?

Screening Small for Gestational Age Babies for Congenital Infection

Abstract: The widespread practice in newborn nurseries of screening asymptomatic small for gestational age (SGA) babies for TORCH infection has been evaluated. In a retrospective review, we found that, in 1979, in our nursery 23 (35%) of the sixty-six SGA babies were investigated for TORCH infection. No asymptomatic baby was investigated adequately to exclude infection. The two proven cases of congenital infection were both apparent on other clinical grounds, and neither would have been detected by our routine serologic screening. A review of published information on asymptomatic TORCH infections showed that, in the absence of other clinical signs of infection, intrauterine growth retardation is an unusual manifestation. Clinical investigation of TORCH infection should be confined to those babies with other clinical evidence of infection.

In vitro aromatization of androgens into estrogens in placental insufficiency.

Abstract: We perfused in vitro the placentas of the mothers of 3 small for gestational age (SGA) and 3 adequate for gestational age (AGA) infants. After a systemic injection of 10 mg of dehydroepiandrosterone s

Plasma copper in foetal malnutrition.

Abstract: . Plasma copper in the cord blood of 20 small for gestational age (SGA) term infants was studied. Twenty-five appropriate for gestational age (SGA) term infants were taken as control and another group of 20 preterm AGA infants for comparison. The plasma concentration of copper in term SGA infants was significantly lower than values obtained for the controls, while there was no significant difference from the levels observed in preterm infants. This lowering in the plasma copper levels was possibly because of decreased liver synthesis of caeruloplasmin as a result of foetal malnutrition. There was a marked foeto-maternal difference in the plasma copper levels in all three groups which was due to much higher levels of non-diffusible caeruloplasmin in the mothers compared to the neonates.

The major determinants of perinatal mortality in a large metropolitan hospital. Results of a retrospective study.

Abstract: We reviewed the records of all perinatal deaths that occurred at Mount Sinai Hospital, New York, from 1975 to 1978. The perinatal mortality rate was 20 per 1,000 births. Most potentially preventable perinatal deaths occurred in association with low birth weight. We noted that fetal deaths that occurred prior to the onset of labor were usually associated with small-for-gestational-age (SGA) or growth-retarded fetuses, whereas deaths occurring during labor were usually the result of trauma to the very small third-trimester fetus, one weighing less than 1,500 gm. Neonatal deaths most commonly resulted from prematurity-related complications (mainly the idiopathic respiratory distress syndrome) in appropriately grown, very-low-birth-weight fetuses, those weighing less then 1,500 gm at birth.

The Outcome of Twin Pregnancies in Dunedin 1968–1978

Abstract: Summary: Of 14,473 pregnancies in Dunedin City between 1968 and 1978, 1.07% were twin (1 in 93.4 pregnancies). Perinatal mortality has decreased over this period for both twins and singletons. To examine the hypothesis that the tendency for twins to be preterm and small for gestational age explained their increased mortality and morbidity, groups of twins and singletons of like birth-weight and gestational age were compared. No significant differences were found, suggesting that birth-weight and gestational age are the major determinants of outcome, and that a twin should fare no worse than a singleton of similar birth-weight and gestational age.

Correlation of postnatal regression of the anterior vascular capsule of the lens to gestational age.

Abstract: The AVC of the lens was examined and graded at birth and prospectively at weekly intervals, in 30 preterm infants of gestational age between 27 and 34 weeks. Influence of postnatal age, postnatal nutrition, subsequent development of retinopathy of prematurity as well as intrauterine growth retardation, multiple gestation and prenatal maternal steroid administration on regression of AVC was analyzed. We conclude that examination of the AVC of the lens can reliably be used to estimate gestational age between 27th and 34th weeks, in appropriate as well as small for gestational age infants. Such an examination can be used postnatally, provided that the infant's corrected gestational age is between 27 and 34 weeks. Prenatal steroid administration, postnatal nutritional status or subsequent development of retinopathy of prematurity do not appear to be correlated with the rate of AVC regression.

Detection of the small-for-gestational age twin fetus by a two-stage ultrasound examination schedule.

Abstract: Serial ultrasonic measurement of the biparietal diameter is an unsatisfactory means of detecting the small-for-gestational age (SGA) fetus in twin pregnancies. A new two-stage ultrasound examination schedule, highly effective in detecting the SGA singleton fetus, has been evaluated prospectively in 31 twin pregnancies. The schedule comprises ultrasonic assessment of gestational age in early pregnancy, followed by measurement of the product of the crown-rump length and trunk area of both fetuses at 34-36 weeks. All Nineteen SGA twin fetuses were detected using this schedule; the technique offers several other advantages over serial biparietal cephalometry.

[Incidence and fetal impact of hypertension in pregnancy: study of 2996 pregnancies].

Abstract: To evaluate the incidence and the foetal effects of gestational hypertension, we studied 2 996 pregnancies with a single live birth in mothers selected on the basis of 1) a documented diastolic blood pressure (DBP) less than 90 mmHg before the 16th week of amenorrhea and 2) no history of hypertension or kidney disease. In 38,4% of the gravidas, the highest DBP during pregnancy was greater than or equal to 90 mmHg, and in 15,4% this level was reached twice or more. Gestational hypertension (two DBP readings greater than or equal to 90 mmHg) was more frequent in nullipara than in mothers with previous pregnancies (17,9 versus 12,4%, p less than 0,01) and its incidence tended to decrease with increasing maternal age. Irrespective of parity or maternal age, a significant increase in the percentage of small for gestational age infants was associated with increasing DBP levels: 3,2, 6,4 and 8,5% when the highest recorded DBP was less than 90 mmHg, equal to 90 mmHg (even at one single reading), or greater than or equal to 100 mmHg respectively (p less than 0,001). Very similar percentages were obtained in non-proteinuric pregnancies: 3,3, 6,5 and 7,8 respectively (p less than 0.001). Non-proteinuric gestational hypertension, even mild or transitory, is indicative of a high risk pregnancy and requires close medical supervision.

Early discharge of low birth weight babies and their outcome.

Abstract: The effects of early discharge of low birth weight (LBW) infants on increased morbidity and mortality were studied. 84 infants weighing 2.45 kg or less were delivered by 82 mothers at Zanana Hospital Udaipur. Their gestational ages were determined from the 1st day of the last menstrual period and they were grouped as small or appropriate for gestational age by weight. Head and midarm circumference were measured and Usher scoring done. Criteria for nursery placement included: outcome of a high risk pregnancy and requiring observation high risk newborn vital signs are unstable in a room environment significant medical problems feeding problems and maternal inadequacy. Infants without any of the above conditions were given directly to their mothers in the ward. Babies were discharged according to the following criteria without necessarily attaining a particular weight level: vital signs are stable in a room environment feeding is adequate medical problems are treated mother is well enough to care for the infant and parents are instructed in infant care. Followup occurred at 15 day intervals for 2-4 months. 60 infants were small for gestational age and 24 were appropriate. 45 mothers had high risk pregnancies. 31 infants were initially kept in the nursery. Of these 22 were observed for 2 hours to 2 days only 4 were kept more than 6 days. Of the 53 babies with no initial problems most required some treatment for a problem which developed during the hospital ward stay. 55 infants were discharged within 7 days only 15 stayed more than 9 days due to maternal problems. The length of stay ranged from 3-33 days. 68 infants weighed within 2.25 kg at discharge 35 weighed 2 kg or less. 79 infants were followed up. Their anthropometric measurements showed steady linear progression. 20 had minor infections and 8 had occasional regurgitation of milk. None required hospitalization nor died during the followup period. The results indicate that not all LBW infants require nursery care and that early discharge according to the above criteria is not detrimental to the infants health.

Cardiomegaly in hypoglycaemic small-for-gestational-age infants.

Abstract: The chest X-rays of 15 hypoglycaemic small-for-gestational-age infants showed cardiomegaly in 10 infants, 4 had heart failure. None of the infants had respiratory distress syndrome, congenital heart disease, septicaemia, anaemia or polycythaemia; infants of diabetic mothers were excluded. Cardiomegaly disappeared with the normalization of blood glucose in most of the cases. The cause of the cardiomegaly and heart failure might be related to insufficient cardiac energy substrates in small-for-gestational-age infants. This condition should also be considered in the differential diagnosis of cardiomegaly and heart failure.