Intrauterine Growth Restriction (IUGR) Not Due to Intrauterine Viral Infection or Chromosomal Abnormality
Each newborn infant should have his weight, length, and head circumference plotted by gestational age on the intrauterine growth curve. An infant whose weight is below the 10th percentile for his gestational age (see chart) may have intrauterine growth restriction and is at risk for hypoglycemia and polycythemia. These babies should be managed as follows:
- Do hematocrit by heel-stick in the first hour. If hematocrit is >65%, measure venous Hct.
- If >65%, the possibility of an exchange transfusion to treat polycythemia must be discussed with the attending physician (see Section on Polycythemia.)
- Do glucometer glucose determination upon arrival in Transition and then every 30 minutes x 2. Repeat at 3 and 6 hours. If glucose ≥ 40 mg/d may discontinue glucose measurements. If glucose < 40 mg/dl follow guidelines for treatment of hypoglycemia.
- Start oral feedings at age 2 hours if tolerated. These infants should start a feeding by 4 hours of age unless they have an IV.
- Review maternal history regarding possible etiology. As soon as possible, distinguish between IUGR due to maternal circulatory disease (such as PIH), chromosomal abnormalities, and intrauterine viral infections; these differences will dictate different forms of management.
- Send the placenta to pathology for examination.
Infants of more than 42 weeks gestation are considered to be post-term. Those who show the typical physical findings but are less than 42 weeks gestation should be regarded as post-mature.
Management should be the same as for IUGR with regard to Hct and blood glucose.
Post-mature infants are likely to have meconium in the amniotic fluid and are at risk for meconium aspiration (See Section on Meconium Aspiration).