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Patterns Of Growth
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Patterns Of Growth


Different Patterns of growth in Children

Different Patterns of growth in Children

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  • 1. Patterns of Growth Crisbert I. Cualteros, M.D.
  • 2. Classification by weight groups:
    • Low birth weight (LBW)
    • BW < 2,500 g
    • 2. Very low birth weight (VLBW)
    • BW < 1,500 g
    • Extremely low birth weight (ELBW)
    • BW < 1000 g
  • 3. Classification by weight groups:
    • Objective:
    • Establish level of risk for neonatal and long-term morbidity and mortality
  • 4. Measurement Techniques
    • Crown-heel length
      • Infant supine, neck neutral, leg fully extended and the ankle flexed
      • Most subject to variability
    • Head circumference
      • Occipital frontal circumference
      • Largest dimension around the head, tape placed snugly above the ears
      • Predictably falls on the same percentile curve as the length
  • 5. Interpretation of Growth Curves
    • Appropriate for Gestational Age (AGA)
      • Birth weight falls between the 10 th and the 90 th percentiles for a given gestational age
    • Small for Gestational Age (SGA)
      • less than the 10 th percentile
    • Large for Gestational Age (LGA)
      • more than the 90 th percentile
  • 6. Interpretation of Growth Curves
    • 4. IUGR ( Intrauterine Growth Restriction)
      • Slowing of intrauterine growth rate documented by serial fetal sonography or a presumed slowing by very low weight for length measurements
  • 7. Types of IUGR
      • a. Symmetric IUGR
        • if the 3 parameters of weight, length and head circumference fall on the same curve
      • b. Asymmetric IUGR
        • if the parameters are on different curves, usually with the weight on a curve lower than those of the head circumference or length
  • 8.  
  • 9. IUGR
    • In general:
      • Factors intrinsic to the fetus cause symmetric growth restriction
      • External factors cause asymmetric growth restriction
  • 10. Patterns of Growth
    • Symmetric growth restriction
    • Develop early during fetal life (intrinsic nature)
    • Factors that limit growth of both the fetal brain and body:
      • Chromosomal anomalies (trisomy conditions)
      • Congenital infections -(CMV, toxoplasma, rubella)
      • Dwarf syndromes
      • IEM
      • Some drugs
        • Mechanisms by which these factors limit fetal growth are MULTIFACTORIAL
  • 11. Patterns of Growth
    • Asymmetric growth restriction
    • Develop as early as 2 nd trimester
    • Classically develops during the late 2 nd and 3 rd trimesters
    • Reductions of energy substrate supply to the fetus limit fat and glycogen storage and the growth of skeletal muscle, but allow for continued brain and bone growth
  • 12. Clinical significance
    • AGA born at term are at lowest risk for problems associated with neonatal mortality and morbidity
    • SGA, IUGR, LGA are at risk for perinatal and long term problems
  • 13. Clinical significance
    • Symmetric growth restriction
      • May have little chance for postnatal catch-up growth after an early, global disruption of growth
    • Asymmetric growth restriction
      • Has a reasonable potential for catch-up growth and normal development
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