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SMALL FOR GESTATIONAL AGE (SGA)
LARGE FOR GESTATIONAL AGE(LGA)
&
ADEQUATE FOR GESTATIONAL AGE (AGA)
SMALL FOR
GESTATIONAL AGE (SGA)
LOW BIRTH WEIGHT ( < 2.5 kg)

PRETERM
BABIES

SMALL FOR
AGE BABIES
SMALL
FOR DATE

PRETERM

LBW
HOW DO WE DEFINE ?

• SGA:

small for GA;
BIRTH WT <10th percentile
FOR THE PERIOD OF GESTATION

• LGA:

large for GA;
BIR...
• SGA : < 2SD FROM MEAN WEIGHT FOR THE
PERIOD OF GESTATION
• LGA : >2 SD FROM MEAN WEIGHT FOR THE
PERIOD OF GESTATION
SGA

< 10TH
PERCENTILE
OF BIRTH WT

< 2SD FROM
MEAN WT
Types of SGA

Malnourished
SGA

Hypoplastic
SGA

Mixed SGA
Malnourished SGA
Commonest type of SGA
Asymmetric IUGR
2/3 rd of IUGR
malnourishment during latter part of
gestation –...
MALNOURISHED SGA/ ASYMMETRIC IUGR
LONG,THIN & MARASMIC

Head Circumference,brain unaffected
Internal organs,liver grossly shrunken
HC > CC by 3cm
Loose ...
 ONLY DECREASE IN CELL SIZE, CELL NUMBER
NORMAL
 GROWTH POTENTIAL (+)
 NUTRITIONAL REHABILITATION
 NEONATAL PROGNOSIS ...
Hypoplastic SGA
 Symmetric IUGR
 1/3 rd of IUGR
 Growth retardation in early pregnancy a/w
intrauterine infection
genet...
FEATURES OF HYPOPLASTIC SGA
o
o
o
o
o

DECREASE IN CELL NUMBER
ALL ORGANS AFFECTED,INCLUDING BRAIN
ALL PARAMETERS ARE PROP...
MIXED SGA
 ADVERSE FACTORS DURING BOTH EARLY & MID PREGNANCY
 NEITHER OBVIOUS MALNOURISHED,NOR GROSSLY
HYPOPLASTIC
 DEC...
Causes of SGA
•
•
•
•

Maternal
Fetal
Placental
Environmental
MATERNAL
NUTRITION
POOR
WEIGHT
GAIN

PREVIOUS
HISTORY

MATERNAL
FACTORS

SMOKING

GRAND
MULTIPARA

TOBACCO

ALCOHOL
MATERN...
FIRST BORN

IU
INFECTIONS

FETAL
FACTORS

MULTIPLE
PREGNANCY

GENETIC
DEFECTS
ABRUPTION

VASCULAR
THROMBOSIS

PLACENTAL

STRUCTURAL
ABNORMALITY

PLACENTA
INFARCTS
Environmental factors
Ethnic/racial/geographic
Socio-economic status
Nutritional
COMMON PROBLEMS OF SGA BABIES
1.
2.
3.
4.
5.
6.
7.
8.

IUD
BIRTH ASPHYXIA
HYPOGLYCEMIA,HYPOCALCEMIA
HYPOTHERMIA
CONGENITAL...
THOSE 3 LETTER WORDS!!

•
•
•
•
•
•

RDS
ROP
IVH
PDA
NEC
BPD
MANAGEMENT OF SGA
•
•
•
•
•

Emergency CS – fetal distress
Screening for cong.malformations
Early and adequate breast feed...
LARGE FOR GESTATIONAL AGE
•
•
•
•
•

DEFINITION
CAUSES OF LGA
VARIOUS SYNDROMES a/w LGA
COMPLICATIONS DUE TO LGA BABIES
MANAGEMENT OF LGA
LGA babies have
• Birth wt > 90th percentile for their
gestational age
• birthweight >2 SD from the mean weight for
gestat...
CAUSES OF LGA
1.GENETICS
TALL & HEAVY MOTHERS

2. Maternal

BIG BABY

Diabetes

COMMONEST CAUSE for LGA babies
•

INFANT OF DIABETIC MOTHER

UTILISE LARGE AMOUNT OF TRANSPLACENTALLY TRANSMITTED GLUCOSE

ISLET CELL HYPERPLASIA & HYPER...
MACROSOMIA
•
ADIPOSITY
•
SKIN FOLD THICKNESS
• VISCEROMEGALY (LIVER)
OTHER PROBLEMS IN GDM??

1) Hypoglycemia,Hypocalcemia
2) Increased incidence of birth defects-TGA
3) RDS
4) Hyperbilirubin...
• 3. Cretinism
Mean birth wt is
higher in babies with
Congenital hypothyroidism
4.Hydrops fetalis
large size is due to generalised anasarca rather
than due to somatic growth
• Birth weight may also be related to the amount of
weight a mother gains during pregnancy.

• Excessive weight gain

incr...
Overgrown syndromes with advanced
maturation…

a)Congenital adrenal hyperplasia
b)Thyrotoxicosis
c)Beckwith- Wiedemann syn...
Beckwith Wiedemann syndrome

•
•
•
•

Visceromegaly
Exomphalos
Macroglossia
Characteristic groove in the
ear lobes
Marshall Smith Syndrome
craniofacial characteristics:
large forehead,
hypertelorism,
micrognathia,
long philtrum
Advanced ...
Sotos syndrome
(cerebral gigantism)

large baby
macrognathia
large hands & feet
mentally subnormal
&
lag in maturation of ...
Why is LGA a concern…?

•
•
•
•

Prolonged vaginal delivery time
Difficult birth
Birth injury
Increased risk of caesarean ...
How is LGA diagnosed…?
> Ultrasound
> A mother's weight gain
Prevention of LGA

Prenatal care.
Careful management of diabetes
Proper weight gain.
AGA
Appropriate for gestational age
(AGA) describes a fetus or newborn
infant whose size is within the
normal range for hi...
• AGA:
Appropriate for Gestational Age;
birthweight b/w 10th & 90th percentile
An appropriate for gestational age full-ter...
THANK YOU
SMALL FOR GESTATIONAL AGE,LARGE FOR GESTATIONAL AGE -SSJ, CALICUT MEDICAL COLLEGE
SMALL FOR GESTATIONAL AGE,LARGE FOR GESTATIONAL AGE -SSJ, CALICUT MEDICAL COLLEGE
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SMALL FOR GESTATIONAL AGE,LARGE FOR GESTATIONAL AGE -SSJ, CALICUT MEDICAL COLLEGE

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SMALL FOR GESTATIONAL AGE,LARGE FOR GESTATIONAL AGE -SSJ, CALICUT MEDICAL COLLEGE

  1. 1. SMALL FOR GESTATIONAL AGE (SGA) LARGE FOR GESTATIONAL AGE(LGA) & ADEQUATE FOR GESTATIONAL AGE (AGA)
  2. 2. SMALL FOR GESTATIONAL AGE (SGA)
  3. 3. LOW BIRTH WEIGHT ( < 2.5 kg) PRETERM BABIES SMALL FOR AGE BABIES
  4. 4. SMALL FOR DATE PRETERM LBW
  5. 5. HOW DO WE DEFINE ? • SGA: small for GA; BIRTH WT <10th percentile FOR THE PERIOD OF GESTATION • LGA: large for GA; BIRTH WT>90th percentile
  6. 6. • SGA : < 2SD FROM MEAN WEIGHT FOR THE PERIOD OF GESTATION • LGA : >2 SD FROM MEAN WEIGHT FOR THE PERIOD OF GESTATION
  7. 7. SGA < 10TH PERCENTILE OF BIRTH WT < 2SD FROM MEAN WT
  8. 8. Types of SGA Malnourished SGA Hypoplastic SGA Mixed SGA
  9. 9. Malnourished SGA Commonest type of SGA Asymmetric IUGR 2/3 rd of IUGR malnourishment during latter part of gestation – placental dysfunction (uteroplacental insufficiency)
  10. 10. MALNOURISHED SGA/ ASYMMETRIC IUGR
  11. 11. LONG,THIN & MARASMIC Head Circumference,brain unaffected Internal organs,liver grossly shrunken HC > CC by 3cm Loose skin folds Ponderal index ( g/cm3) < 2
  12. 12.  ONLY DECREASE IN CELL SIZE, CELL NUMBER NORMAL  GROWTH POTENTIAL (+)  NUTRITIONAL REHABILITATION  NEONATAL PROGNOSIS - BETTER
  13. 13. Hypoplastic SGA  Symmetric IUGR  1/3 rd of IUGR  Growth retardation in early pregnancy a/w intrauterine infection genetic defects, chromosomal aberrations  Incidence of anomalies 10 – 20 times higher
  14. 14. FEATURES OF HYPOPLASTIC SGA o o o o o DECREASE IN CELL NUMBER ALL ORGANS AFFECTED,INCLUDING BRAIN ALL PARAMETERS ARE PROPORTIONATELY SMALL PONDERAL INDEX - NORMAL POOR PROGNOSIS PERMANENT PHYSICAL & MENTAL RETARDATION
  15. 15. MIXED SGA  ADVERSE FACTORS DURING BOTH EARLY & MID PREGNANCY  NEITHER OBVIOUS MALNOURISHED,NOR GROSSLY HYPOPLASTIC  DECREASE IN BOTH CELL SIZE AND COUNT
  16. 16. Causes of SGA • • • • Maternal Fetal Placental Environmental
  17. 17. MATERNAL NUTRITION POOR WEIGHT GAIN PREVIOUS HISTORY MATERNAL FACTORS SMOKING GRAND MULTIPARA TOBACCO ALCOHOL MATERNAL DISEASES
  18. 18. FIRST BORN IU INFECTIONS FETAL FACTORS MULTIPLE PREGNANCY GENETIC DEFECTS
  19. 19. ABRUPTION VASCULAR THROMBOSIS PLACENTAL STRUCTURAL ABNORMALITY PLACENTA INFARCTS
  20. 20. Environmental factors Ethnic/racial/geographic Socio-economic status Nutritional
  21. 21. COMMON PROBLEMS OF SGA BABIES 1. 2. 3. 4. 5. 6. 7. 8. IUD BIRTH ASPHYXIA HYPOGLYCEMIA,HYPOCALCEMIA HYPOTHERMIA CONGENITAL MALFORMATOINS INFECTIONS POLYCYTHEMIA POOR GROWTH POTENTIAL
  22. 22. THOSE 3 LETTER WORDS!! • • • • • • RDS ROP IVH PDA NEC BPD
  23. 23. MANAGEMENT OF SGA • • • • • Emergency CS – fetal distress Screening for cong.malformations Early and adequate breast feeding (NGT/IVF) Correct hypoglycemia,hypocalcemia,polycythemia Control infections,temperature regulation
  24. 24. LARGE FOR GESTATIONAL AGE
  25. 25. • • • • • DEFINITION CAUSES OF LGA VARIOUS SYNDROMES a/w LGA COMPLICATIONS DUE TO LGA BABIES MANAGEMENT OF LGA
  26. 26. LGA babies have • Birth wt > 90th percentile for their gestational age • birthweight >2 SD from the mean weight for gestation
  27. 27. CAUSES OF LGA
  28. 28. 1.GENETICS TALL & HEAVY MOTHERS 2. Maternal BIG BABY Diabetes COMMONEST CAUSE for LGA babies
  29. 29. • INFANT OF DIABETIC MOTHER UTILISE LARGE AMOUNT OF TRANSPLACENTALLY TRANSMITTED GLUCOSE ISLET CELL HYPERPLASIA & HYPERINSULINEMIA INCREASE IN GROWTH FACTORS IGF-1 , IGF-2 INCREASED GROWTH & ADIPOSITY IN INSULIN DEPENDENT AREAS (FETAL TRUNK,SHOULDERS)
  30. 30. MACROSOMIA • ADIPOSITY • SKIN FOLD THICKNESS • VISCEROMEGALY (LIVER)
  31. 31. OTHER PROBLEMS IN GDM?? 1) Hypoglycemia,Hypocalcemia 2) Increased incidence of birth defects-TGA 3) RDS 4) Hyperbilirubinemia 5) polycythemia 6)Birth trauma
  32. 32. • 3. Cretinism Mean birth wt is higher in babies with Congenital hypothyroidism
  33. 33. 4.Hydrops fetalis large size is due to generalised anasarca rather than due to somatic growth
  34. 34. • Birth weight may also be related to the amount of weight a mother gains during pregnancy. • Excessive weight gain increased fetal weight.
  35. 35. Overgrown syndromes with advanced maturation… a)Congenital adrenal hyperplasia b)Thyrotoxicosis c)Beckwith- Wiedemann syndrome d)Marshall Smith Syndrome e)Cerebral gigantism/ Sotos syndrome skeletal
  36. 36. Beckwith Wiedemann syndrome • • • • Visceromegaly Exomphalos Macroglossia Characteristic groove in the ear lobes
  37. 37. Marshall Smith Syndrome craniofacial characteristics: large forehead, hypertelorism, micrognathia, long philtrum Advanced maturation of carpal bones
  38. 38. Sotos syndrome (cerebral gigantism) large baby macrognathia large hands & feet mentally subnormal & lag in maturation of carpal bones
  39. 39. Why is LGA a concern…? • • • • Prolonged vaginal delivery time Difficult birth Birth injury Increased risk of caesarean delivery
  40. 40. How is LGA diagnosed…? > Ultrasound > A mother's weight gain
  41. 41. Prevention of LGA Prenatal care. Careful management of diabetes Proper weight gain.
  42. 42. AGA Appropriate for gestational age (AGA) describes a fetus or newborn infant whose size is within the normal range for his or her gestational age
  43. 43. • AGA: Appropriate for Gestational Age; birthweight b/w 10th & 90th percentile An appropriate for gestational age full-term infant is heavier than 2500 grams and lighter than about 4000 grams
  44. 44. THANK YOU

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