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SMALL FOR GESTATIONAL AGE,LARGE FOR GESTATIONAL AGE -SSJ, CALICUT MEDICAL COLLEGE
This document defines and describes small for gestational age (SGA), large for gestational age (LGA), and appropriate for gestational age (AGA) babies. SGA is defined as birth weight below the 10th percentile, and can be malnourished SGA with proportional growth restriction, hypoplastic SGA with decreased cell number and organ growth, or mixed. LGA is above the 90th percentile and is associated with maternal diabetes, genetics, and excessive weight gain. AGA is between the 10th-90th percentiles and considered normal size. The document outlines causes, features, and management considerations for SGA and LGA newborns.
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SMALL FOR GESTATIONAL AGE,LARGE FOR GESTATIONAL AGE -SSJ, CALICUT MEDICAL COLLEGE
- 1. SMALL FOR GESTATIONALAGE (SGA) LARGE FOR GESTATIONAL AGE(LGA) & ADEQUATE FOR GESTATIONAL AGE (AGA)
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- 3. LOW BIRTH WEIGHT( < 2.5 kg) PRETERM BABIES SMALL FOR AGE BABIES
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- 5. HOW DO WEDEFINE ? • SGA: small for GA; BIRTH WT <10th percentile FOR THE PERIOD OF GESTATION • LGA: large for GA; BIRTH WT>90th percentile
- 6. • SGA :< 2SD FROM MEAN WEIGHT FOR THE PERIOD OF GESTATION • LGA : >2 SD FROM MEAN WEIGHT FOR THE PERIOD OF GESTATION
- 7. SGA < 10TH PERCENTILE OF BIRTHWT < 2SD FROM MEAN WT
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- 9. Malnourished SGA Commonest typeof SGA Asymmetric IUGR 2/3 rd of IUGR malnourishment during latter part of gestation – placental dysfunction (uteroplacental insufficiency)
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- 11. LONG,THIN & MARASMIC HeadCircumference,brain unaffected Internal organs,liver grossly shrunken HC > CC by 3cm Loose skin folds Ponderal index ( g/cm3) < 2
- 12. ONLY DECREASEIN CELL SIZE, CELL NUMBER NORMAL GROWTH POTENTIAL (+) NUTRITIONAL REHABILITATION NEONATAL PROGNOSIS - BETTER
- 13. Hypoplastic SGA SymmetricIUGR 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. FEATURES OF HYPOPLASTICSGA 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
- 16. MIXED SGA ADVERSEFACTORS DURING BOTH EARLY & MID PREGNANCY NEITHER OBVIOUS MALNOURISHED,NOR GROSSLY HYPOPLASTIC DECREASE IN BOTH CELL SIZE AND COUNT
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- 22. COMMON PROBLEMS OFSGA BABIES 1. 2. 3. 4. 5. 6. 7. 8. IUD BIRTH ASPHYXIA HYPOGLYCEMIA,HYPOCALCEMIA HYPOTHERMIA CONGENITAL MALFORMATOINS INFECTIONS POLYCYTHEMIA POOR GROWTH POTENTIAL
- 23. THOSE 3 LETTERWORDS!! • • • • • • RDS ROP IVH PDA NEC BPD
- 24. MANAGEMENT OF SGA • • • • • EmergencyCS – fetal distress Screening for cong.malformations Early and adequate breast feeding (NGT/IVF) Correct hypoglycemia,hypocalcemia,polycythemia Control infections,temperature regulation
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- 26. • • • • • DEFINITION CAUSES OF LGA VARIOUSSYNDROMES a/w LGA COMPLICATIONS DUE TO LGA BABIES MANAGEMENT OF LGA
- 27. LGA babies have •Birth wt > 90th percentile for their gestational age • birthweight >2 SD from the mean weight for gestation
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- 29. 1.GENETICS TALL & HEAVYMOTHERS 2. Maternal BIG BABY Diabetes COMMONEST CAUSE for LGA babies
- 30. • INFANT OF DIABETICMOTHER 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)
- 31. MACROSOMIA • ADIPOSITY • SKIN FOLD THICKNESS •VISCEROMEGALY (LIVER)
- 32. OTHER PROBLEMS INGDM?? 1) Hypoglycemia,Hypocalcemia 2) Increased incidence of birth defects-TGA 3) RDS 4) Hyperbilirubinemia 5) polycythemia 6)Birth trauma
- 33. • 3. Cretinism Meanbirth wt is higher in babies with Congenital hypothyroidism
- 34. 4.Hydrops fetalis large sizeis due to generalised anasarca rather than due to somatic growth
- 35. • Birth weightmay also be related to the amount of weight a mother gains during pregnancy. • Excessive weight gain increased fetal weight.
- 36. Overgrown syndromes withadvanced maturation… a)Congenital adrenal hyperplasia b)Thyrotoxicosis c)Beckwith- Wiedemann syndrome d)Marshall Smith Syndrome e)Cerebral gigantism/ Sotos syndrome skeletal
- 37. Beckwith Wiedemann syndrome • • • • Visceromegaly Exomphalos Macroglossia Characteristicgroove in the ear lobes
- 39. Marshall Smith Syndrome craniofacialcharacteristics: large forehead, hypertelorism, micrognathia, long philtrum Advanced maturation of carpal bones
- 40. Sotos syndrome (cerebral gigantism) largebaby macrognathia large hands & feet mentally subnormal & lag in maturation of carpal bones
- 41. Why is LGAa concern…? • • • • Prolonged vaginal delivery time Difficult birth Birth injury Increased risk of caesarean delivery
- 42. How is LGAdiagnosed…? > Ultrasound > A mother's weight gain
- 43. Prevention of LGA Prenatalcare. Careful management of diabetes Proper weight gain.
- 44. AGA Appropriate for gestationalage (AGA) describes a fetus or newborn infant whose size is within the normal range for his or her gestational age
- 45. • AGA: Appropriate forGestational 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
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