CONCLUSIONS
The group of infants described in this paper constitutes a growing and important population in the NICU. These infants born prematurely who are also severely IUGR have higher neonatal morbidity and mortality when compared to normally grown infants of similar gestational age, and a unique pattern of morbidity and mortality when compared to those of similar birth weight. It is important to note that these infants have gastrointestinal and hepatic pathology, which is consistent with the metabolic and pathologic findings found in experimental IUGR. Additionally, despite a lower mean number of ventilator and oxygen days, there was a higher incidence of chronic lung disease in the IUGR infants compared to the less mature birth weight group. These complications of their IUGR most likely account for the prolonged hospitalization. We speculate that the higher morbidity is due to end-organ damage in utero from chronic placental insufficiency. Knowing the expected clinical course of the severely growth-restricted preterm infants will be important in enabling more accurate counseling of parents, and anticipation of the complications encountered in the NICU. As we gain deeper insight into the complex interaction of the in utero environment and the underlying genetic potential of the fetus, we may be better able to address the prevention and treatment of these specific complications seen in this high-risk group of infants.