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Management of infants with intra-uterine growth restriction
A K Deorari1, R Aggarwal, V K Paul
1Division of Neonatology, Sciences, Ansari Nagar, New Delhi, India.
Insights
Intra-uterine growth restriction (IUGR) is a major cause of low birth weight infants in India. Management guidelines differ for neonates below the 3rd percentile versus those between the 3rd and 10th percentiles.
Area of Science:
- Neonatology
- Pediatric Growth and Development
- Public Health Nutrition
Background:
- Intra-uterine growth restriction (IUGR) and prematurity are primary causes of low birth weight (LBW) infants.
- IUGR accounts for nearly two-thirds of LBW infants in India, often linked to maternal malnutrition and frequent pregnancies.
- Growth restriction can be symmetrical or asymmetrical, influenced by the timing of prenatal insults.
Purpose of the Study:
- To outline management protocols for Intra-uterine growth restriction (IUGR) neonates.
- To differentiate management strategies based on percentile groups (<3rd and 3rd-10th).
Main Methods:
- Review and synthesis of existing guidelines for IUGR neonate management.
- Categorization of IUGR neonates based on growth percentiles.
Main Results:
- Asymmetrical IUGR, occurring later in pregnancy, exhibits a brain-sparing effect.
- Neonates in the <3rd percentile group experience more frequent morbidities compared to the 3rd-10th percentile group.
- Distinct management guidelines are established for these two IUGR percentile groups.
Conclusions:
- Effective management of IUGR neonates requires stratification based on growth percentiles.
- Tailored protocols for <3rd and 3rd-10th percentile IUGR infants are crucial for optimizing outcomes.
Abstract:
Intra-uterine growth restriction (IUGR) and prematurity are the two causes for delivery of low birth weight infants. In India, IUGR contributes to almost two-thirds of infants in this category. Poor nutritional status and frequent pregnancies are common pre-disposing conditions in addition to obstetric and medical problems during pregnancy. Growth restriction may be symmetrical or asymmetrical depending on the time of insult during pregnancy. The pathological insult in an asymmetrical IUGR occurs during the later part of the pregnancy and has a brain-sparing effect. Common morbidities are more frequent in <3rd percentile group as compared to 3rd-10th percentile group. Guidelines for management of IUGR neonates in these two groups have provided in the protocols.