To compare the perinatal outcome of IUGR infants with abnormal and normal antenatal umbilical artery Doppler flow in the immediate neonatal period

Shivaprasad B., Devendrakumar Sharma


Background: Intrauterine growth restriction (IUGR) is one of the cause of perinatal mortality and morbidity and affects approximately 7-15% of worldwide pregnancies. IUGR is the failure of the fetus to achieve intrinsic growth potential, due to disorders and diseases in the feto–placental–maternal unit. Doppler indices from the fetal circulation can reliably predict adverse perinatal outcome. Aim of the study was to determine perinatal outcome of IUGR infants with abnormal antenatal umbilical artery Doppler flow versus IUGR infants with normal Doppler flow.

Methods: All Preterm and term IUGR infants with abnormal and normal antenatal umbilical artery Doppler scan admitted in NICU of St Martha’s Hospital were included in the study. 30 in each group with total sample size of 60. Study was conducted from March 2015 to February 2016. Primary outcome measure will be neonatal mortality and secondary outcome measure will be neonatal morbidities like perinatal asphyxia, hypoglycemia, NEC, polycythemia, sepsis, hyperbilirubinemia etc.

Results: IUGR infants with abnormal antenatal umbilical artery Doppler scan were included as cases and those with normal antenatal umbilical artery Doppler scan as control. At birth resuscitation rate and therefore perinatal asphyxia was observed more in case group, 11 out of 30 (36.6%), compared to 1 out of 30 (3.3%) in control group, statistically significant (P <0.05). Hypoglycemia was noticed in 19 infants in case group (63.3%) compared to 2 infants (6.6%) in control group, statistically significant. NEC, polycythemia, sepsis was noticed more in case group, but statistically not significant.

Conclusions: Infants with abnormal antenatal Doppler flow are at increased risk of perinatal complications than infants with normal antenatal umbilical artery Doppler and needs extra care during this period.


Antenatal Doppler flow, IUGR, Neonatal outcome

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World Health Organization, WHO report: Reducing risks, promoting health life. Geneva, Switzerland, World Health Organization, 2002.

Battaglia FC, Lubchenco LO. A practical classification of newborn infants by weight and gestational age. J Pediatr. 1967;71:159-63.

Boulet SL, Alexander GR, Salihu HM, Kirby RS, Carlo WA. Fetal growth risk curve-Defining levels of fetal growth restriction by neonatal death risk. Am J Gynecol. 2006;195(6):1571-7.

Rosenberg A. The IUGR newborn. Perinatology. 2008;32:219-24.

Deonis M, Blossner M, Villar J. Levels and patterns of intrauterine growth retardation in developing countries. Eur J Clin Nutr. 1998;52:83-93.

United Nations childrens fund and World Health Organization, Low Birth weight: country, regional and global estimates. UNICEF, New York, USA. 2004.

Fanaroff AA, Hack M, Walsh MC. The NICHD neonatal research network: changes in practice and outcomes during the first 15 years. Semin Perinatol. 2003;27:281-7.

Cunningham FG, Williams JW, Williams. Obstetrics. McGraw-Hill. Medical Publishing Division, New York, USA. 2010.

Zhang J. Defining normal and abnormal fetal growth: promises and challenges. Am J Obstet Gynecol. 2009;10:889.

Mari G, Piconi J. Doppler vascular changes in IUGR. Perinatology. 2008;32(3):182-9.

Gonzalez JM, Stamilio DM, Ural S, Macones GA, Odibo AO. Relationship between abnormal fetal testing and adverse perinatal outcomes in intrauterine growth restriction. Am J Obst Gynecol. 2007;196(5):48-51.

Padmagirison R, Rai L. Fetal doppler versus NST as predictors of adverse perinatal outcome in severe preeclampsia and fetal growth restriction. J Obstet Gynecol. 2006;56:134-8.

Briana DD, Puchner AM. Intrauterine growth restriction and adult disease: the role of adipocytokines. European J Endocrinol. 2009;160(3):337-47.

Barker DJ, Gluckman PD, Godfrey KM, Harding JE, Owens JA, Robinson JS. Fetal nutrition andcardiovascular disease in adult life. 1993;41(8850):938-41.

lfirevic Z, Neilson JP. Biophysical profile for fetal assessment in high risk pregnancies. Cochrane Database Syst Rev. 2000;CD000038.

Katz J, Lee AC, Kozuki N, Lawn JE, Cousens S, Blencowe H et al. Mortality risk in preterm and small-for gestational-age infants in low-income and middle-income countries: a pooled country analysis. Lancet. 2013;382:417-25.

Deorari AK, Agarwal R, Paul VK. Management of infants with intra-uterine growth restriction. Indian J Pediatr. 2008;75:171-4.

Dogra S, Mukhopadhyay K, Narang A. Feed intolerance and necrotizing enterocolitis in preterm small-for-gestational age neonates with normal umbilical artery Doppler flow. J Trop Pediatr. 2012;58:513-6.

Nezar MA, Baky AM, Soliman OA, Hady HA, Hammad AM, Haggar MS. Endothelin-1 and leptin as markers of intrauterine growth restriction. Indian J Pediatr. 2009;76:485-8.

Florio P, Marinoni E, Iorio R, Bashir M, Ciotti S, Sacchi R et al. Urinary S100B protein concentrations are increased in intrauterine growth retarded newborns. Pediatrics. 2006;118:747-54.

Sparks JW, Cetin I. Intrauterine growth and nutrition. In: Polin RA, Fox WW eds. Fetal and Neonatal Physiology, WB Saunders, Philadelphia, 1998.

Widdowson EM. Changes in body proportions and composition during growth. Scientific Foundations of Pediatrics. WB Saunders Co, Philadelphia, 1974;155-63.

Lakshmi CV, Pramod G, Geeta K, Subramaniam S, Rao MB, Kallapur S, et al. Outcome of very low birth weight infants with abnormal antenatal Doppler flow pattern. Indian Pediatr. 2013;50:847-52.

Deorai AK, Agarwal R, Paul VK. Anagement of infants with intrauterine growth restriction. Indian J Pediatr. 2008;75:171-4.

Malhotra N, Chanana C, Kumar S, Roy K, Sharma JB. Comparison of perinatal outcome of growth-restricted fetuses with normal and abnormal umbilical artery Doppler waveforms. Indian J Med Sci. 2006;60(8):311-7.