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Ashworth A & Feachem RG (1985): Interventions for the control of diarrhoeal diseases among young children: prevention of low birth weight. Bull. World Health Organ. 63, 165-184.

Ayeni O & Oduntan SO (1978): The effects of sex, birthweight, birth order and maternal age on infant mortality in a Nigerian community. Annals Human. Biol. 5, 353-358.

Balcazar H & Haas J (1990): Classification schemes of small-for-gestational age and type of intrauterine growth retardation and its implications to early neonatal mortality. Early Hum. Dev. 24, 219-230.

Barros FC, Huttly SRA, Victora CG, Kirkwood BR & Vaughan JP (1992): Comparison of the causes and consequences of prematurity and intrauterine growth retardation: a longitudinal study in southern Brazil. Pediatrics 90, 238-244.

Barros FC, Victora CG, Vaughan JP, Teixeira AMB & Ashworth A (1987): Infant mortality in southern Brazil: a population based study of causes of death. Arch. Dis. Child 62, 487-490.

Bartlett AV, de Bocaletti MEP & Bocaletti MA (1991): Neonatal and early postneonatal morbidity and mortality in a rural Guatemalan community: the importance of infectious diseases and their management. Pediatr. Infect. Dis. J. 10, 752-757.

Becerra JE, Atrash HK, Perez N & Saliceti JA (1993): Low birthweight and infant mortality in Puerto Rico. Am. J. Public Health 83, 1572-1576.

Behrman RE, Babson GS & Lessel R (1971): Fetal and neonatal mortality in white middle class infants. Amer. J. Dis. Child 121, 486-489.

Binkin NJ, Williams RL, Hogue CJR & Chen PM (1985): Reducing black neonatal mortality. Will improvement in birth weight be enough? JAMA 253, 372-375.

Buehler JW, Kleinman JC, Hogue CJR, Strauss LT & Smith JC (1987): Birth weight-specific infant mortality, United States, 1960 and 1980. Public Health Reports 102, pp 151-161.

Buekens P, Wilcox AJ, Kiely J & Masuy-Stroobant G (1995): Birthweight, preterm births and neonatal mortality in Belgium and the United States. Paediatr. Perinatal. Epidemiol. 9, 273-280.

Bukenya GB, Barnes T & Nwokolo N (1991): Low birthweight and acute childhood diarrhoea: evidence of their association in an urban settlement of Papua New Guinea. Ann. Trop. Paediatr. 11, 357-362.

Campbell S (1974): Physical methods of assessing size at birth. In: Size at birth. Ciba Foundation Symposium 27. Elsevier: Amsterdam, pp 275-293.

Caulfield LE, Haas JD, Belizan, JM, Rasmussen KM & Edmonston B (1991): Differences in early postnatal morbidity risk by pattern of fetal growth in Argentina. Paediatr. Perinat. Epidemiol. 5, 263-275.

Chandra RK (1981): Serum thymic hormone activity and cell-mediated immunity in healthy neonates, preterm infants, and small-for-gestational age infants. Pediatrics 67, 407-411.

Chase HC (1969): Infant mortality and weight at birth: 1960 United States birth cohort. Am. J. Public Health 59, 1618-1628.

Cuttini M, Cortinovis I, Bossi A & de Vonderweid U (1991): Proportionality of small for gestational age babies as a predictor of neonatal mortality and morbidity. Paediatr. Perinat. Epidemiol. 5, 56-63.

Das BK, Mishra RN, Mishra OP, Bhargava V & Prakash A (1993): Comparative outcome of low birthweight babies. Indian Pediatrics 30, 15-21.

Datta N, Kumar V, Kumar L & Singhi S (1987): Application of case management to the control of acute respiratory infections in low-birth weight infants: a feasibility study. Bull Health Organ. 65, 77-82

Douglas JWB & Mogford C (1953): Health of premature children from birth to four years. BMJ 748-754.

Erickson JD & Bjerkedal T (1982): Fetal and infant mortality in Norway and the United States. JAMA 247, 987-991.

Fonseca W, Kirkwood BR, Victora CG, Fuchs SR, Flores JA & Misago C (1996): Risk factors for childhood pneumonia among the urban poor in Fortaleza, Brazil: a case-control study. Bull World Health Organ. 74, 199-208.

Ghosh S, Ramanujacharyulu TKTS, Hooja V & Madhavan S (1979): Mortality pattern in an urban birth cohort. Indian J. Med. Res. 69, 616-623.

Gibson JJ & Alexander GR (1985): Correlates of infant death from infectious diarrhea in the southeastern United States. Southern Med. J. 78, 26-30.

Hoffman HJ & Bakketeig LS (1984): Heterogeneity of intrauterine growth retardation and recurrence risks. Semin. Prenatol. 8, 15-24.

Hortal M, Benitez A, Contera M, Etorena P. Montano A & Meny M (1990): A community-based study of acute respiratory tract infections in children in Uruguay. Rev. Infect. Dis. 12, S966-973.

Ittiravivongs A, Songchitratna K, Ratthapalo S & Pattara-Arechachai J (1991): Effect of low birth weight on severe childhood diarrhea. Southeast Asian J. Trop. Med. Public Health 22, 557-562.

Jarai I, Mestyan J, Schultz K, Lazar A, Halasz M & Krassy I (1977): Body size and neonatal hypoglycaemia in intrauterine growth retardation. Early Hum. Dev. 1, 25-38.

Kebede A & Larson C (1994): The health consequences of intrauterine growth retardation in southwestern Ethiopia. Tropical Doctor 24, 64-69.

Koops BL, Morgan LJ & Battaglia FC (1982): Neonatal mortality risk in relation to birth weight and gestational age: Update. J. Pediatr. 101, 969-977.

Kramer MS, Olivier M, McLean FH, Willis DM & Usher RH (1990): Impact of intrauterine growth retardation and body proportionality on fetal and neonatal outcome. Pediatrics 86, 707-713.

Kusin JA, Kardjati S & de With C (1989): Infant mortality in Madura, Indonesia. Implications for action. J. Trop. Pediatr. 35, 129-132.

Lira PIC, Ashworth A & Morris SS (1996): Low birth weight and morbidity from diarrhea and respiratory infection in northeast Brazil. J. Pediatr. 128, 497-504.

Lubchenco LO, Searls DT & Brazie JV (1972): Neonatal mortality rate: relationship to birth weight and gestational age. J. Pediatr. 81, 814-822.

Mata LJ (1975): Malnutrition-infection interactions in the tropics. Am. J. Trop. Med. Hyg. 24, 564-573.

Mata LJ (1978): The children of Santa Maria Cauque: A prospective field study of health and growth. MIT Press: Cambridge.

McCormick MC (1985): The contribution of low birth weight to infant mortality and childhood morbidity. NEJM 312, 82-90.

Mertens TE, Cousens SN & Feachem RG (1987): Evidence of a prolonged association between low birthweight and paediatric diarrhoea in Sri Lanka (abstract). Trans. R. Soc. Trop. Med. Hyg. 81, 196.

Miller HC (1981): Intrauterine growth retardation: an unmet challenge. Am. J. Dis. Child 135, 944-948.

Patterson R & Pouillot MR (1987): Neonatal morphometrics and perinatal outcome: who is growth retarded? Am. J. Obstet. Gynecol. 157, 691-693.

Platt MJ & Pharoah POD (1995): Child health statistical review, 1995. Arch. Dis. Child 70, 541-548.

Rao PSSS & Inbaraj SG (1978): A prospective study of infant mortality and congenital malformations in relation to intra-uterine growth rates in south India. Indian J. Med. Res. 67, 245-254.

Read JS, Clemens JD & Klebanoff MA (1994): Moderate low birth weight and infectious disease mortality during infancy and childhood. Am. J. Epidemiol. 140, 721-733.

Rosso P & Winick M (1974): Intrauterine growth retardation: a new systematic approach based on clinical and biochemical characteristics of this condition. J. Perinat. Med. 2, 147-160.

Rosso P (1989): Morbidity and mortality in intrauterine growth retardation. In: Senterre J (ed). Intrauterine growth retardation. Nestle Nutrition Workshop Series vol. 18. Raven Press: New York, pp 123-142.

Saha K, Kaur P, Srivastava G & Chaudhury DS (1983): A six-months' follow-up study of growth, morbidity and functional immunity in low birth weight neonates with special reference to intrauterine growth retardation in small-for-gestational-age infants. J. Trop. Pediatr. 29, 278-282.

Sappenfield WM, Buehler JW, Binkin NJ, Hogue CJR, Strauss LT & Smith JC (1987): Differences in neonatal and postneonatal mortality by race, birth weight, and gestational age. Public Health Reports 102, pp 182-192.

Scott KE & Usher R (1966): Fetal malnutrition: its incidence, causes and effects. Am. J. Obstet. Gynecol 94, 951-963.

Starfield B. Shapiro S. McCormick M & Bross D (1982): Mortality and morbidity in infants with intrauterine growth retardation. J. Pediatr. 101, 978-983.

Victora CG, Barros FC, Huttly SRA, Teixeira AMB & Vaughan JP (1992): Early childhood mortality in a Brazilian cohort: the roles of birthweight and socioeconomic status. Int. J. Epidemiol. 21, 911-915.

Victora CG, Barros FC, Kirkwood BR & Vaughan JP (1990): Pneumonia, diarrhea, and growth in the first 4 y of life: a longitudinal study of 5914 urban Brazilian children. Am. J. Clin. Nutr. 52, 391-396.

Victora CG, Barros FC, Vaughan JP & Teixeira AMB (1987): Birthweight and infant mortality: a longitudinal study of 5914 Brazilian children. Int. J. Epidemiol. 16, 239-245.

Victora CG, Fuchs SC, Flores JAC, Fonseca W & Kirkwood B (1994): Risk factors for pneumonia among children in a Brazilian metropolitan area. Pediatrics 93, 977-985.

Victora CG, Fuchs SC, Kirkwood BR, Lombardi C & Barros FC (1992): Breast-feeding, nutritional status, and other prognostic factors for dehydration among young children with diarrhoea in Brazil. Bull. World Health Organ. 70, 467-475.

Victora CG, Smith PG, Vaughan JP, Nobre LC, Lombardi C, Teixeira AMB, Fuchs SM, Moreira LB, Gigante LP & Barros FC (1988): Influence of birth weight on mortality from infectious diseases: a case-control study. Pediatrics 81, 807-811.

Villar J & Belizan, JM (1982): The timing factor in the pathophysiology of the intrauterine growth retardation syndrome. Obstet. Gynecol. Surv. 37, 499-506.

Villar J, Belizan, J & Smeriglio V (1989): Postnatal experiences of intrauterine growth-retarded infants. In: Senterre J (ed): Intrauterine growth retardation. Nestle Nutrition Workshop Series vol. 18. Raven Press: New York, pp 261-280.

Villar J, de Onis M, Kestler E, Bolanos F, Cerezo R & Bernedes H (1990): The differential neonatal morbidity of the intrauterine growth retardation syndrome. Am. J. Obstet. Gynecol. 163, 151-157.

Villar J, Smeriglio V, Martorell R. Brown CH & Klein RE (1984): Heterogeneous growth and mental development of intrauterine growth-retarded infants during the first 3 years of life. Pediatrics 74, 783-791.

Walters FJ & Rameckers LHJ (1982): The ponderal index as a measure of the nutritional status at birth and its relation to some aspects of neonatal morbidity. J. Perinat. Med. 10, 42-47.

Williams RL & Chen PM (1982): Identifying the sources of the recent decline in perinatal mortality rates in California. N. End J. Med. 306, 207-214.

Williams RL, Creasy RK, Cunningham GC, Hawes WE, Norris FD & Tashiro M (1982): Fetal growth and perinatal viability in California. Obstet. Gynecol. 59, 624-632.

World Health Organization (1995): Physical status: the use and interpretation of anthropometry. WHO Technical Report Series 854. World Health Organization: Geneva.


The association between IUGR and increased mortality extends into the postneonatal period, but the slope of the relationship between birthweight and mortality is steeper in the neonatal period than later. At least in part, this reflects different causes of death in the two periods; in the neonatal period complications of delivery and congenital abnormalities predominate, whereas infections are more frequent later.

When examining effects of body proportionality at birth on morbidity and mortality one has to take account of the fact that definitions of proportionality and disproportionality, for instance cutoffs in ponderal index, differ among studies.

Differences in body proportionality of IUGR babies at birth are generally assumed to be a reflection of the timing, duration and severity of fetal growth retardation. A widely held assumption is that symmetrically small babies must reflect the influence of a growth inhibiting factor active over a longer period of time and primarily early in pregnancy, whereas asymmetrically small babies were exposed to a growth inhibiting influence over a shorter period of time and mainly towards the end of pregnancy. In developed countries, like Canada, proportionality tends to be highly confounded with severity of growth retardation in the sense that most of the proportionally growth retarded newborns are mildly growth retarded and have a good prognosis, whereas the disproportionally growth retarded babies are more severely growth retarded and their prognosis is less favorable. Severity of growth retardation in turn has a greater effect on morbidity and mortality measures than symmetry. In developing countries other etiologic factors may lead to symmetric and/or asymmetric growth retardation, and the risks implied by these indicators may therefore be different. In Guatemala, for instance, IUGR infants with an adequate ponderal index had higher diarrheal rates during the first few months of life than IUGR infants with low ponderal index, but the risk of morbidity was increased also in infants with low ponderal index, even if their birthweight was > 2500 g.

The etiology of IUGR is certainly an important determinant of risk and prognosis, but unfortunately it is difficult to ascertain in most cases. Different etiologies of growth retardation can result in great variability in risk among newborns that look alike. Bakketeig mentioned that there are mothers who, for no obvious reasons, tend to give birth to small babies repeatedly. The babies of such mothers are at much lower risk than babies who have the same size and appearance for other reasons, e.g., because their mothers are smokers. There are situations in which being born with IUGR even appears to be an advantage; e.g. IUGR infants born to hypertensive mothers seem to have a lower risk of mortality than infants of adequate birth weight born to hypertensive mothers. Knowing the etiology of IUGR is therefore extremely useful, not only for predicting outcome (including chronic noncommunicable disease risk in adulthood), but also for deciding on the most appropriate intervention.

Smoking reduces birthweight by 100 to 400 g and increases the risk of having; an IUGR baby by about 2.5. Smoking is not yet very common in women in developing countries, but many of them are exposed to smoke in their house or kitchen; it would be interesting to know what risk this entails and whether IUGR in smokers is primarily due to nicotine, low oxygen concentration or other factors.

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