Please enable JavaScript.
Coggle requires JavaScript to display documents.
Small for gestational age (Aetiology (Maternal (Vascular HTN, Drugs …
Small for
gestational age
Definitions
SGA
Birth weight <10th centile
for gestational age
IUGR
Failure to reach
growth potential,
may result in SGA
Epidemiology
10% of births!
Pathophysiology
Asymmetrical/disproportional
Head circumference normal, length and weight reduced
Restricted oxygen or glucose supply
Usually insult in late pregnancy e.g. pre-eclampsia, substance misuse
Symmetrical/proportional
All growth parameters symmetrically small
Suggests constitutional/chromosomal disorder, maternal illness,
constitutionally small parents
Aetiology
Maternal
Vascular
HTN
Drugs
Smoking
Alcohol
Illicit drugs
Idiopathic
Maternal illness
Genetic
Constitutionally small
Foetal
Genetic
Chromosomal disorders
Developmental
Congenital anomalies/syndromes
Multiple pregnancy
Infection
Congenital infection
Uteroplacental
Vascular
Placental dysfunction
Diagnosis
Examination
Newborn examination
Measurements (head circ: reduced if symmetrical; length: reduced if symmetrical; weight: reduced in both types)
General: colour (polycythaemia/jaundice), temperature,
signs of congenital disorder/syndrome
Abdominal
Small SFH
History
Pregnancy
Scans, bloods, foetal movements,
consultant or midwife led, complications
POH
Gravity/parity, previous SGA,
conception, deliveries, complications
PGH
Known disorders, menses,
contraception, STIs, smears
PMH
Chronic disease, surgery
DH
Medications during preg,
allergies
FH
Constitutionally small
Chromosomal/congenital disorders
SH
Smoking, alcohol, social support
Investigations
Bloods
FBC (polycythaemia, pancytopenia, infection)
U+Es, LFTs, clotting (derangement)
TORCH screen (infection)
Genetic screen (if not known at birth)
Bedside
Foetal obs (hypoxia, infection)
BM (hypoglycaemia)
Management
Conservative
Postnatal ward, neonatal unit if <1800g
Identify cause
Thermal care
Encourage feeding
Monitoring (BMs, obs, weight)
Discharge once feeding 3-4h, satisfactory weight gain, maintaining temp at RT, mother capable of care
Complications
Metabolic
Hypoglycaemia (reduced glycogen stores)
Hypothermia (reduced fatty insulation)
Necrotising enterocolitis, meconium aspiration (chronic hypoxia)
Haematological
Polycythaemia (chronic hypoxia)
Thrombocytopenia/neutropenia (BM compromise)
Coagulopathy (liver compromise)
Infection
Toxoplasmosis, others, rubella, CMV, HSV (TORCH)
Prognosis
Neurodevelopmental impairment
Cardiovascular disease
IUGR infants with placental insufficiency
CHD, stroke, obesity, HTN
Small height
Symmetrical SGA infants