Assessment of vitamin status; A, E and D in Egyptian neonates with IUGR: a cross sectional study.

BACKGROUND: Neonates with intrauterine growth retardation (IUGR) may present with fatal complications and permanent serious consequences. Vitamin status may influence fetal development. In this study we assessed vitamin A, E and D concentrations in umbilical cord blood in newborns with IUGR. METHODS: Maternal data were obtained. Neonatal assessment included; age of gestation calculated from last menstrual period, Ultrasound (U/S), new Ballard, Apgar scores and anthropometric measurements including; Head circumference, length and weight. WHO growth percentile curves were used. Vitamin A, E and D in cord blood samples were measured by high performance liquid chromatography (HPLC) and ELISA consecutively. RESULTS: A total of 86 full term newborns were enrolled in this study, 42 (48.8%) with IUGR with gestational age (33.59 ± 1.20) week by U/S and 44 (51.2%) appropriate for gestational age neonates with gestational age (38.70 ± 1.50). Ballard and Apgar scores (p < 0.05) and Z scores for weight, length and head circumference (p < 0.001) at birth were significantly lower in neonates with Intrauterine growth retardation (IUGR) than appropriate for gestational age (AGA) neonates. The levels of Vitamin A, E and D were significantly lower in the IUGR group than the AGA (p < 0.05) for all. Significant positive correlations of weight with vitamin A, and E cord blood levels were found (p < 0.05), while length was significantly positively correlated only with vitamin A (p < 0.05). Head circumference showed significant positive correlations with the three vitamins (p < 0.05) for all. CONCLUSION: Neonates with IUGR had significantly lower levels of Vitamin A, E and D than AGA neonates. Significant positive correlations of weight with vitamin A, and E cord blood levels was detected, while neonatal length was associated only with vitamin A level. The present study highlights the significance of nutritional policies for inhibiting deficiency of these vitamins during pregnancy and childhood.

Routine third-trimester ultrasound assessment for intrauterine growth restriction.

Intrauterine growth restriction significantly impacts perinatal outcomes. Undetected IUGR escalates the risk of adverse outcomes. Serial symphysis-fundal height measurement, a recommended strategy, is insufficient in detecting abnormal fetal growth. Routine third-trimester ultrasounds significantly improve detection rates compared with this approach, but direct high-quality evidence supporting enhanced perinatal outcomes from routine scanning is lacking. In assessing fetal growth, abdominal circumference alone performs comparably to estimated fetal weight. Hadlock formulas demonstrate accurate fetal weight estimation across diverse gestational ages and settings. When choosing growth charts, prescriptive standards (encompassing healthy pregnancies) should be prioritized over descriptive ones. Customized fetal standards may enhance antenatal IUGR detection, but conclusive high-quality evidence is elusive. Emerging observational data suggest that longitudinal fetal growth assessment could predict adverse outcomes better. However, direct randomized trial evidence supporting this remains insufficient.

Avaliação da artéria cerebral média na restrição do crescimento fetal de início tardio / Assessment of middle cerebral artery in late fetal growth restriction

Desde a última década, a restrição do crescimento fetal tem sido classificada em duas formas: de início precoce e tardio. Este último, em geral, tem início após 32 semanas e cursa com maior morbidade perinatal. Um grande desafio nos dias atuais consiste na diferenciação dos fetos pequenos constitucionais dos restritos de início tardio. Apesar do Doppler da artéria umbilical ser normal em ambos os casos, nas formas tardias de restrição de crescimento fetal, outros parâmetros podem estar associados a resultados perinatais adversos e à morbidade neurológica. Entre eles, destacam-se as alterações do Doppler da artéria cerebral média e a relação cérebro-placentária. Vários estudos foram publicados utilizando estes parâmetros no seguimento de fetos com restrição de crescimento fetal tardia, mas ainda as evidências não se mostram suficientes para a sua incorporação na prática clínica.(AU)

Since the last decade, fetal growth restriction has been classified in two ways: early or late beginning. The last one generally starts after 32 weeks and is followed by higher perinatal death rates. A great challenge nowadays consists in the differentiation of constitutional small fetuses from late growth restriction ones. Even though the Doppler of the umbilical artery is normal in both cases, in the late fetal growth restriction other parameters could be associated with adverse perinatal results and neurological morbidity. Among these, the most relevant are the alterations of the Doppler of the middle cerebral artery and the cerebroplacental ratio. Several studies have been published using these parameters in the follow-up of fetuses with late growth restriction, but the evidences are still not enough for their incorporation into clinical practice.(AU)

Valoración nutricional del neonato

Existen dos hechos que influyen sobre el peso al nacer, la duración del período en que el feto permanece en el útero y la velocidad del crecimiento fetal. La reducción de cualquiera de las dos conducirá a alguna forma de prematuridad, la primera a un nacimiento pretérmino y la segunda a un retardo del crecimiento fetal; simultáneamente pueden existir las dos situaciones. Por todos es bien conocido los problemas de esos neonatos, entre los que se encuentra: disminución de los reflejos de succión y deglución, la reducida capacidad gástrica, la incompetencia del cardias y en algunas ocasiones íleo paralítico. Esta inmadurez se complica con las altas necesidades energéticas y de nutrientes para un rápido crecimiento, lo cual es difícil de lograr debido a una lenta respuesta de las hormonas gastrointestinales, y a una disminución en la absorción de nutrientes. Por lo anteriormente descrito no cabe duda de que el objetivo de la nutrición neonatal es asegurar la transición adecuada del proceso de crecimiento del período prenatal al postnatal. Este es un reto altamente significativo para el recién nacido, especialmente en los de bajo peso y en los prematuros. El propósito de esta revisión es sugerir algunas consideraciones prácticas sobre la valoración nutricional en el neonato que logre el objetivo de la nutrición neonatal.

Síndrome do crescimento intra-uterino retardado: I. Consideraçöes sobre o conceito, etiologia e diagnóstico / Intrauterine growth retardation syndrome: I. Considerations on concept, etiology and diagnosis

Os autores reviram, extensivamente, os principais aspectos referentes à síndrome do crescimento intra-uterino retardado. Apresentam os critérios para elaboraçäo de curva de crescimento e discutem os fatores etiológicos segundo sua incidência nos vários períodos gestacionais. Comentam sobre as anomalias congênitas, as infecçöes congênitas, os fatores placentários e maternos, a nutriçäo materna e as condiçöes sócio-econômicas, a altitude e o efeito de drogas. Estudam o diagnóstico da entidade, nos seus vários aspectos: diagnóstico de suspeita, de probabilidade e de tipo de crescimento retardado