IUGR workup

[feraszaman]

:confused:Hi All

it's a very simple question.

what's your protocol regarding the IUGR babies ? we know that the most common reasons for IUGR is maternal morbidities like hypertention, smoking bad diabetes and some other factors like multiple gestation, placental insufficency, TORCH infections and congenital anomalies.

The reason I'm asking this is because some reports are saying that it's so rare to have positive TORCH titers thesedays.. so is it a waste of time , money and Blood !

how aboout the head Ultrasound to check for calcification? to do or not to do?

so basically if you have someone with preeclampsia, and IUGR or a smoker with multiple gestation and IUGR..or any other scenario you can imagine, how would convince yourself that the reason of IUGR is what I mentioned above not TORCH infections?

Thank you much for your answers..

Feras

[Stefan Johansson]

This is not a simple question at all!

Actually, in my own work plave I have suggested for a long time that we should have written guidelines for investigations of IUGR/SGA infants.

I have seen tons of TORCH screens, and have never come across a positive results when taken in a well small baby.

Our current practise (no protocol there is...) is to investigate the smallest infants (typically less than -3 SD from expected BW or somewhat larger babies but in need of neonatal care) with TORCH, Urine-CMV, head ultrasound, chromosomes (regular karyotype). Infants between -2 and -3 SD, it depends. In well infants in maternity wards (normoglycemic, congruent birth weights in older children, normal maternal history ETC) nothing is usually done. But sometimes... TORCH

It would be great to hear more input. I am sure many people would be very grateful if someone would like to share structured written guidelines.

[rehman_naveed]

Depends on symmetrical or asymetrical IUGR. For asymetrical IUGR we do nothing, but for symmetrical we do head US, Urine for CMV and eye examination. we also have no written guidelines

[feraszaman]

It's getting more interesting now!! Thanks for the inputs, hopefully we'll here more ..

[Stefan Johansson]

Depends on symmetrical or asymetrical IUGR. For asymetrical IUGR we do nothing, but for symmetrical we do head US, Urine for CMV and eye examination. we also have no written guidelines

I completely agree. We are more likely to make to investigate infants born symmetrically SGA.

But one needs to keep in mind, this is also the group where we find infants who are constitutionally small.

[herbertobu]

In our setting we do cranial ultrasound as part of our workup and not much more investigation-wise. We however rely a lot on clinical acumen, particularly maternal, pregnancy, family and other relevant histories to guide us. A good physical examination with a view to determining if the IUGR is symmetric or not and if there are dysmorphic features or other obvious congenital abnormalities is also emphasized.

[ctestolin]

To determine the IUGR is important at first (when possible) to talk with the gynecologist: an early IUGR (second trimester) suggests a fetus problem (chromosomal) and rarely infection (but usually a good obstetric have just done all the infection screening panels to the mother), while a late IUGR (therd trimester) is more linked to mathernal problems (infection, smoke, placental problem).

Since TORCH screen is (quite) always done in pregnancy, we perform brain echo scan and urine CMV-PCR; chromosome analysis: if the baby has some clear signs of syndrome, it's correct to perform (usually it's a early IUGR), but if absent, we can wait to perform genetic analysis untill something comes out during the follow-up. I think that initially it's important to talk to the mother and to her obstetrician (an obstetric history could be interesting!). By the way: CMV screening for mother: it would be a miracle to have for all pregnancy a CMV Ig screening plus avidity index at the beginning of the pregnancy (how many exams will be eliminated!!!)