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

  1. Every newborn infant should have his weight, length, and head circumference plotted against gestational age on the Lubchenco curves or other standard curves (Fenton). Those infants whose weights fall below the 10th percentile for gestational age may have experienced intrauterine growth restriction. The following is suggested management of these infants.
  2. Hematocrit should be monitored in the first hour of life and repeated at six hours. If the value is greater than 65% on a venous or arterial sample, the possibility of a dilutional phlebotomy (“partial exchange transfusion”) should be considered and discussed with the fellow or staff neonatologist. This procedure, which is sometimes undertaken in an effort to prevent complications of hyperviscosity syndrome, is done by removing whole blood and replacing it with an equal volume of normal saline
  3. Plasma or blood glucose determinations should be monitored during the first 24 hours. If the glucose is less than 40 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 40 and 50 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 restriction. If possible, a description of the placenta should be obtained. The two most common causes of intrauterine growth restriction are placental insufficiency and intrauterine viral infection (the TORCH complex: toxoplasmosis, rubella, cytomegalovirus and herpes).

Luchenco LO, Hansman C, Boyd E. Intrauterine growth in length and head circumference as estimated from live births at gestational ages from 26 to 42 weeks. Pediatrics 1966;37:403-408.

Fenton TR. A new growth chart for preterm babies: Babson and Benda's chart updated with recent data and a new format. BMC Pediatr. 2003 Dec 16;3:13.