What to expect if your newborn had fetal growth restriction
July 13, 2021
When a pregnant patient hears that her baby is smaller than expected during pregnancy, a million questions may run through her mind:
- Is my baby going to be OK?
- How premature will the baby be?
- Will I be able to breastfeed?
In many cases, smaller-than-expected babies have good outcomes and go home with their parents after delivery – or after a short stay in the neonatal intensive care unit (NICU).
Babies diagnosed with fetal growth restriction (FGR) face additional, unique challenges that can make their early lives a little more complicated. FGR is characterized by slow or halted fetal growth, and it is associated with an increased risk of premature birth, development problems, and stillbirth.
Babies with FGR are less than the 10th percentile for estimated fetal weight – they are smaller than 90 percent of babies conceived around the same time and typically measure 2-3 weeks smaller than expected during pregnancy. Generally, only the smallest 3 percent truly have growth restriction, typically measuring 2-3 weeks behind. In extreme cases, babies may measure 4-8 weeks behind.
Most babies diagnosed with FGR are delivered at least a few weeks early, and some arrive by emergency cesarean (C-section). Our neonatology team is available to provide specialized or emergency care, such as breathing support, heart-rate monitoring, or resuscitation.
Often, these babies need specialized care in the days and weeks after delivery. Depending on the cause, babies with FGR may just be very small or they may have other abnormalities or genetic conditions that can result in complex health issues. If so, that might require long-term to lifelong specialized care at an integrated health center,
The Thrive Program at Children’s Health offers care for the tiniest babies (smaller than 1,500 grams) which gives families a one-location option for primary care and developmental follow-up appointments through age five. Infants with multiple anomalies or an expectation for lifelong chronic illness can get expert specialty care through Complex Care Medical Services at Children’s Health.
Most babies have positive outcomes when they get timely care after delivery and appropriate follow-up. Still, an FGR diagnosis can be scary. To help prepare for that possibility, here are a few of the common conditions that babies with FGR have after delivery, as well as general recommendations for follow-up care.
Related reading: 5 unexpected advantages of having a baby in the NICU
Common FGR-related health issues after delivery
Also known as low sugar, this condition often appears in the first 24 hours after delivery. The sugar levels usually regulate within four to five days but can persist for several weeks in severe cases.
Chronically low blood sugar levels can damage the brain tissue, leading to cognitive deficits that may affect lifelong learning. So, these babies need to receive a constant intake of sugar either through feedings or IV fluid to maintain a stable blood sugar level. Some infants need additional calories to help maintain their sugar level, as well as improve their growth.
Hypoglycemia can be frustrating for parents who hoped to exclusively breastfeed. Newborns with FGR often need more calories and nutrients, such as protein, than is present in breastmilk alone. Breastmilk may need to be pumped and fortified with additional calories and fed to the baby in a bottle.
We try to come up with a plan for exclusively breastfeeding mothers to allow 2 or 3 breastfeeding opportunities a day with the remainder of feeds being fortified and given by bottle. As the infant grows and matures, fortified feeds can be decreased until eventually the infant is exclusively breastfeeding.
Remember: a fed baby is a happy baby. Most babies who can bottle-feed will be able to latch and breastfeed once they gain the strength. We encourage moms who want their baby to have breastmilk to start pumping after delivery to help build and maintain their milk supply.
High blood count
Some babies with FGR develop polycythemia, which is the opposite of anemia. The blood becomes too thick (or viscous) due to the high number of red blood cells, which can cause problems with how blood flows through the vessels. Sometimes these babies need IV fluid to safely reduce their blood viscosity.
Immature lungs due to premature birth
Many babies who are born prematurely have trouble getting enough oxygen in their blood due to immature lungs. The lungs are among the last organs to fully develop, so the earlier a baby arrives, the higher the risk of having breathing difficulties. Some babies who have severe growth restriction may also have poor lung development, which can lead to breathing difficulties after birth and the need for breathing support.
Many babies FGR who are born a few weeks early need oxygen or respiratory support for a few days after delivery. However, very premature babies may need several weeks of respiratory support in the hospital before going home.
Answers to frequently asked questions
Not all babies with FGR need to stay in the NICU. Babies with mild growth restriction whose breathing and blood sugar levels are normal often can stay in the mother’s room or the well-baby nursery if they have no other complications.
Babies with moderate to severe growth restriction typically need to stay in the NICU for closer surveillance. More severe growth restriction or other health needs typically result in a longer stay. Babies must meet three criteria to be considered healthy enough to go home. They must:
- Gain enough weight to maintain their body temperature. At UT Southwestern, babies must weigh at least 1.8 kilograms (approximately 4 pounds) to be eligible for discharge.
- No longer have apnea spells (where they stop breathing) or drops in their heart rate or oxygen levels – all of which are common in premature babies.
- Be able to adequately feed from a bottle or breast and maintain stable blood sugar levels for at least four to five hours between feedings. This is important to support infant growth and parental well-being. Newborns with glucose issues often need to be fed every three hours in the hospital, which is not conducive to healthy, restorative sleep for new mothers healing from delivery and managing her own health concerns associated with FGR.
Even full-term babies sometimes have a tough time grasping the mechanics of breast- or bottle-feeding. Often, feeding is what keeps newborns in the hospital, despite achieving other milestones.
Our NICU is equipped with a secure camera system, which gives families 24/7 access to see their babies. This is a great option for siblings and grandparents to enjoy the baby if they can’t have visitors just yet.
Parents also are welcome to join us during rounds in the NICU. Rounds give you a chance to see and hear all that goes into your baby’s care, and it’s a perfect time to ask questions of the multidisciplinary team. If a parent is unable to attend rounds, they will be updated by one of the providers later in the day, or they can always call their nurse to check on their baby.
Our NICU rounding team includes a pharmacist, dietitian, bedside nurse, nurse practitioner, and neonatologist. The neonatologists work two- to four-week rotations, which means you will see a familiar face day-to-day and a consistent flow of communication from providers who understand your baby’s needs.
Babies with mild to moderate FGR typically do not need any additional screenings. They will get the regular newborn Apgar scoring to determine their health baseline right after delivery; erythromycin eye ointment to protect against infection; newborn vaccines; and a newborn hearing screening.
Babies who stay in the NICU for longer than five days may need an early hearing screening around six months after birth because many problems that require a NICU stay, such as congenital infections or genetic conditions, may also affect hearing later in life.
Data regarding long-term outcomes for small newborns are often lumped together, making it difficult to separate long-term outcomes for FGR-related complications from other factors that affect prematurity and birthweight.
Specialized follow-up care is highly dependent on the cause of your baby’s growth restriction. For example, babies with Down syndrome will need different care than babies whose mothers struggled with substance use during pregnancy.
Some long-term cognitive problems, such as speech or critical thinking skills, will not be readily identified until the child is older. If your baby’s doctor recommends follow-up care, make those visits a priority. Early intervention can have lasting, positive effects on the baby’s future health.
The Thrive Program at Children’s Health offers primary care along with developmental screenings and follow-up for those infants who weigh less than 1,500 grams at birth. Parents who choose a pediatrician outside of THIRIVE can use the developmental screening services alone if their baby meets eligibility criteria.
Many babies with FGR who get specialized neonatal and pediatric care have successful outcomes. With advanced support and personalized care, many small-but-mighty babies diagnosed with FGR before birth can have bright, healthy futures.