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Small Babies

Small Babies. IUGR and SGA. Small-for-gestational-age. A baby whose birth weight or estimated fetal weight is below a specified centile for its gestation. Usually 10 th centile (2.7kg at 40 weeks). Normal constitutionally small babies (50 – 70%) + growth restricted babies.

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Small Babies

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  1. Small Babies IUGR and SGA

  2. Small-for-gestational-age • A baby whose birth weight or estimated fetal weight is below a specified centile for its gestation. • Usually 10th centile (2.7kg at 40 weeks). • Normal constitutionally small babies (50 – 70%) + growth restricted babies.

  3. Intrauterine Growth Restriction • A fetus who has failed to reach its growth potential. • May or may not be small for gestational age. • Implies a pathological process.

  4. Aetiology-Fetal factors • Genetic: Maternal ethnicity Maternal size • Chromosomal: Trisomy • Fetal anomaly • Fetal infection: CMV Rubella Toxoplasmosis Malaria Symmetrical Growth

  5. Maternal Factors • Nutrition (extreme starvation) • Drugs/Smoking • Maternal Disease: Renal disease SLE Hypertension

  6. Placental Factors • Failure of the second wave of trophoblastic invasion uteroplacental insufficiency decrease in nutrient supply Assymetrical Growth

  7. Screening & Diagnosis • Symphsio-fundal height measurement: Low sensitivity and high false-positive rates. • Ultrasound – of no value in normal low-risk women. • SGA suspected on examination – ultrasound to confirm.

  8. Management SGA confirmed on ultrasound Assess for chromosomal/structural defects Assess liquor volume and umbilical artery Dopplers Assess growth velocity

  9. Surveillance • Fortnightly ultrasound for growth • Twice-weekly Dopplers, liquor volume estimation and biophysical profile • Management of maternal conditions • CTG – no long term predictive value

  10. Deliver at the appropriate time. • When Dopplers normal – delay until 37 weeks. • Abnormal Dopplers – consider delivery depending on gestation. • Steroids and discussion with neonatologists.

  11. Implications of IUGR • Fetal abnormality • Perinatal hypoxia long-term neurological morbidity • Perinatal death • Neonatal hypoglycaemia • Necrotising enterocolitis • Adult Type II diabetes and coronary artery disease • Operative delivery

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