Iowa Neonatology Handbook: General

Intrauterine Growth Retarded (IUGR) Infants

Edward F. Bell, MD
Peer Review Status: Internally Peer Reviewed

  1. 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.
  2. 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.
  3. 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.
  4. 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).
  5. 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.

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