Intrauterine Growth Retarded (IUGR) Infants
Edward F. Bell, M.D.
Peer Review Status: Internally Peer Reviewed
- Every newborn infant should be evaluated for gestational age by
the Ballard method and have his head circumference, weight and length plotted
against gestational age on the Lubchenco curves. Those infants whose weights
fall below the 10th percentile for gestational age may have intrauterine
growth retardation. The following is suggested management of these infants.
- Hematocrit by heelstick should be monitored in the first hour of
life and repeated at six hours. If the value is greater than 65%, a
venous or arterial hematocrit should be obtained. If this value is also
greater than 65%, the possibility of a partial exchange transfusion with
removal of red cells and replacement with plasma to prevent complications of
hyperviscosity syndrome should be considered and discussed with the
fellow or staff neonatologist.
- Plasma glucose determinations should be monitored during the first 24
hours, especially if the infant is not yet receiving intravenous glucose or
enteral feeds. If the true blood glucose is less than 30 mg/dl, an
infusion of D10W, 2 ml/kg, should be given IV over one minute, followed by an
infusion of D10W or D10/0.2 NS at a rate of 100 ml/kg/day (7 mg/kg/minute).
If the true glucose is between 30 and 40 mg/dl and the infant's condition
allows, enteral feedings should be given. Refer to guidelines for management
of hypoglycemia.
- The maternal history should be reviewed for possible etiologies of the
growth retardation. If possible, a description of the placenta should be
obtained. The two most common causes of intrauterine growth retardation are
placental insufficiency and intrauterine viral infection (the TORCH complex:
toxoplasmosis, rubella, cytomegalic virus and herpes).
- Titers may be sent to aid in the diagnosis of syphilis and the TORCH
complex if intrauterine infection is suspected. The best screening test for
CMV infection is a urine culture for CMV.