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The newborn dysmature infant
776
The ]ournal o[ P E D I A T R I C S
Letters to the Editor
The newborn dysmature in[ant
To the Editor:
PERMANENTE
Wagner, 1 in his observations on the newborn dysmature infant, seems to suggest that the infant with intrauterine growth retardation ( I U G R ) should be classified as a dysmature infant. Placental hypofunction seems to be the etiologic factor in dysmaturity, 2-4 whereas Warkany 5 reported both genetic and environmental etiologic agents in the infant with I U G R . Differentiation of the two syndromes may he possible clinically; the dysmature infant is of low weight but normal body length at birth 2-4 whereas the infant with I U G R has a short body length as well as low weight2 -s Wagner states there is a need for clarification and standardization of the clinical criteria for the diagnosis of dysmaturity; however, the inclusion of patients with I U G R in the syndrome of dysmaturity will only lead to further confusion.
HARBOR CITYn CALIF.
GLENN
C. SZALAY, M.D.
SOUTHERN
CALIFORNIA
MEDICAL G RO U P
REFERENCES 1. Wagner, M. G." Observations on the newborn dysmature infant and his development during the first 9 months, J. PEBIAT. 63: 335, 1963. 2. Sjostedt, S., et al.: Dysmaturity, Arch. Dis. Childhood 33: 123, 1958. 3. Clifford, S. H.: Postmaturity, Adv. Pedlar. 9: 13, 1957. 4. Clifford, S. H.: Dysmaturity--a plea for recognition, Ob-Gyn Observer, July-August, 1963. 5. Warkany, J., et al.: Intrauterine growth retardation, A. M. A. J. Dis. Child. 102: 249, 1961. 6. Szalay, G. C.: Dwarfism with skin manifestation, J. PEDIAT. 62: 686, 1963. 7. Szalay, G. C.: Pseudohydrocephalus in dwarfs: the Russell dwarf, J. PEDIAT. 63: 622, 1963. 8. Szalay, G. C.: Intrauterine growth retardation versus Silver's Syndrome, J. PEDIAT. 64: 234, 1964.
Reply To the Editor: I appreciate Dr. Szalay's comments because I would not want readers to think infants with intrauterine growth retardation ( I U G R ) might be classified as dysmature infants, and because he again points out a serious confusion in terms, a confusion which likely arises from an attempt to separate closely related phenomena clinically before the etiologic bases of them are clear. The work of Clifford, 1 Sjostedt, 2 Warkanyfl Gruenwald, 4 and others suggests a tentative hypothesis for the etiology of growth retardation in utero
which might be diagrammed as shown on the following page. If this hypothesis is correct, it would be possible to distinguish between the dysmature syndrome and I U G R by measurements of length as Dr. Szalay suggests. If, however, I U G R is defined simply as birth weight below 2,000 grams at termfl it would include, as seen in the diagram, several etiologic entities which would he more difficult to distinguish. Such differentiation may well be important for, as is gradually becoming clear with prematurity, such etiologic
The ]ournal o[ P E D I A T R I C S
Letters to the Editor
The newborn dysmature in[ant
To the Editor:
PERMANENTE
Wagner, 1 in his observations on the newborn dysmature infant, seems to suggest that the infant with intrauterine growth retardation ( I U G R ) should be classified as a dysmature infant. Placental hypofunction seems to be the etiologic factor in dysmaturity, 2-4 whereas Warkany 5 reported both genetic and environmental etiologic agents in the infant with I U G R . Differentiation of the two syndromes may he possible clinically; the dysmature infant is of low weight but normal body length at birth 2-4 whereas the infant with I U G R has a short body length as well as low weight2 -s Wagner states there is a need for clarification and standardization of the clinical criteria for the diagnosis of dysmaturity; however, the inclusion of patients with I U G R in the syndrome of dysmaturity will only lead to further confusion.
HARBOR CITYn CALIF.
GLENN
C. SZALAY, M.D.
SOUTHERN
CALIFORNIA
MEDICAL G RO U P
REFERENCES 1. Wagner, M. G." Observations on the newborn dysmature infant and his development during the first 9 months, J. PEBIAT. 63: 335, 1963. 2. Sjostedt, S., et al.: Dysmaturity, Arch. Dis. Childhood 33: 123, 1958. 3. Clifford, S. H.: Postmaturity, Adv. Pedlar. 9: 13, 1957. 4. Clifford, S. H.: Dysmaturity--a plea for recognition, Ob-Gyn Observer, July-August, 1963. 5. Warkany, J., et al.: Intrauterine growth retardation, A. M. A. J. Dis. Child. 102: 249, 1961. 6. Szalay, G. C.: Dwarfism with skin manifestation, J. PEDIAT. 62: 686, 1963. 7. Szalay, G. C.: Pseudohydrocephalus in dwarfs: the Russell dwarf, J. PEDIAT. 63: 622, 1963. 8. Szalay, G. C.: Intrauterine growth retardation versus Silver's Syndrome, J. PEDIAT. 64: 234, 1964.
Reply To the Editor: I appreciate Dr. Szalay's comments because I would not want readers to think infants with intrauterine growth retardation ( I U G R ) might be classified as dysmature infants, and because he again points out a serious confusion in terms, a confusion which likely arises from an attempt to separate closely related phenomena clinically before the etiologic bases of them are clear. The work of Clifford, 1 Sjostedt, 2 Warkanyfl Gruenwald, 4 and others suggests a tentative hypothesis for the etiology of growth retardation in utero
which might be diagrammed as shown on the following page. If this hypothesis is correct, it would be possible to distinguish between the dysmature syndrome and I U G R by measurements of length as Dr. Szalay suggests. If, however, I U G R is defined simply as birth weight below 2,000 grams at termfl it would include, as seen in the diagram, several etiologic entities which would he more difficult to distinguish. Such differentiation may well be important for, as is gradually becoming clear with prematurity, such etiologic