Background: Screening for TORCH infections among infants with IUGR continues to be a common practice in the neonatal period

Background: Screening for TORCH infections among infants with IUGR continues to be a common practice in the neonatal period. IUGR is seldom seen as a sole manifestation of intrauterine infection.

Objective: To evaluate the yield and costs associated with screening for TORCH infections among infants with IUGR. Methods: We reviewed the medical charts of all infants born between January 1, 1996 and December 31, 1997, with diagnosis of IUGR who had a workup for TORCH infections. Maternal charts and reports of placental pathology were reviewed for identifying maternal illnesses and placental causes associated with IUGR. Neonatal charts were reviewed for the presence of clinical findings or laboratory abnormalities associated with intrauterine infections.

Results: 75 out of 182 infants (41%) with a diagnosis of IUGR had a work up for TORCH infections. The following maternal conditions were noted among the mothers of babies: pregnancy induced hypertension (19%), tobacco use (43%), alcohol abuse (21%), illicit drug use (24%), chronic hypertension, diabetic vasculopathy and collagen vascular disease (12%), and multiple gestation (3%). Placental pathology was available in 53/75 cases, 36/53 (67%) placentae had evidence of various abnormalities associated with IUGR including placental infarcts (22/36 with 11 having multiple infarcts), vasculitis/villitis (15/36), placenta previa (1/36), abruptio placenta (2/36), velamentous insertion of umbilical cord (1/36). The number of infants with clinical findings associated with TORCH infections included: hepatosplenomegaly, cataract or rash (1/75), thrombocytopenia and/or neutropenia and/or direct hyperbilirubinemia (11/75). Seven out of 75 infants had dysmorphic features: 2/7 infants had abnormal karyotype (Trisomy 21), 1/7 infants had Ellis Van Creveld syndrome and 1/7 infants had Sheldon Freedman syndrome. The number of infants with positive test results for TORCH infections: Toxoplasma IgM titers (0/75), Rubella IgM titers (0/75), CMV IgM titers (0/75), HSV IgM titers (0/75), total IgM titers (0/43) and urine culture for CMV (1/57). The costs associated with work up for TORCH infections among 75 infants included: TORCH titers determination: $17,816.25, total IgM titers: $1,317.95, urine culture for CMV: $5,734.20.

Conclusion: Conditions associated with IUGR can be mostly identified by maternal history, placental and neonatal examination. The yield for measuring TORCH titers among infants with IUGR in the absence of significant clinical findings is very poor and does not justify the incurred costs