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

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 DAT

E

PRETERM

LBW

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

• 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

Malnourished SGA

Hypoplastic SGA

Mixed SGA

Types of SGA

Malnourished SGA

Commonest type of SGAAsymmetric IUGR2/3 rd of IUGRmalnourishment during latter part of gestation – placental dysfunction (uteroplacental insufficiency)

MALNOURISHED SGA/ ASYMMETRIC IUGR

LONG,THIN & MARASMIC

Head Circumference,brain unaffectedInternal organs,liver grossly shrunkenHC > CC by 3cmLoose skin folds

Ponderal index ( g/cm3) < 2

ONLY DECREASE IN CELL SIZE, CELL NUMBER NORMAL

GROWTH POTENTIAL (+)

NUTRITIONAL REHABILITATION

NEONATAL PROGNOSIS - BETTER

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

FEATURES OF HYPOPLASTIC SGA

o DECREASE IN CELL NUMBERo ALL ORGANS AFFECTED,INCLUDING BRAINo ALL PARAMETERS ARE PROPORTIONATELY SMALLo PONDERAL INDEX - NORMALo POOR PROGNOSIS PERMANENT PHYSICAL & MENTAL RETARDATION

MIXED SGA ADVERSE FACTORS DURING BOTH EARLY & MID PREGNANCY

NEITHER OBVIOUS MALNOURISHED,NOR GROSSLY HYPOPLASTIC

DECREASE IN BOTH CELL SIZE AND COUNT

Causes of SGA

• Maternal• Fetal• Placental• Environmental

MATERNAL NUTRITION

PREVIOUS

HISTORY

GRAND MULTIP

ARAMATERN

AL DISEASES

SMOKING TOBACCOALCOHOL

POOR WEIGHT

GAIN

MATERNALFACTORS

FIRST BORN

GENETIC DEFECTS

MULTIPLE PREGNANC

Y

IU INFECTION

S

FETAL FACTORS

ABRUPTION

PLACENTA INFARCTS

STRUCTURAL

ABNORMALITY

VASCULAR THROMBO

SISPLACENTAL

Environmental factors

Ethnic/racial/geographicSocio-economic statusNutritional

COMMON PROBLEMS OF SGA BABIES

1. IUD2. BIRTH ASPHYXIA3. HYPOGLYCEMIA,HYPOCALCEMIA4. HYPOTHERMIA5. CONGENITAL MALFORMATOINS6. INFECTIONS7. POLYCYTHEMIA8. POOR GROWTH POTENTIAL

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 feeding (NGT/IVF)• Correct hypoglycemia,hypocalcemia,polycythemia• Control infections,temperature regulation

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

gestation

CAUSES OF LGA

1.GENETICS

TALL & HEAVY MOTHERS BIG BABY

2. Maternal Diabetes

COMMONEST CAUSE for LGA babies

• 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)

MACROSOMIA• ADIPOSITY• SKIN FOLD THICKNESS• VISCEROMEGALY (LIVER)

OTHER PROBLEMS IN GDM??

1) Hypoglycemia,Hypocalcemia 2) Increased incidence of birth defects-TGA 3) RDS 4) Hyperbilirubinemia 5) polycythemia 6)Birth trauma

• 3. Cretinism Mean birth wt is higher in babies withCongenital 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 increased fetal weight.

Overgrown syndromes with advanced skeletal maturation…

a)Congenital adrenal hyperplasiab)Thyrotoxicosisc)Beckwith- Wiedemann syndromed)Marshall Smith Syndromee)Cerebral gigantism/ Sotos syndrome

Beckwith Wiedemann syndrome

• Visceromegaly• Exomphalos• Macroglossia• Characteristic groove in the

ear lobes

Marshall Smith Syndrome craniofacial characteristics:

large forehead,hypertelorism,micrognathia,long philtrum

Advanced maturation of carpal bones

Sotos syndrome(cerebral gigantism)

large babymacrognathia

large hands & feetmentally subnormal

& lag in maturation of carpal

bones

• Prolonged vaginal delivery time• Difficult birth• Birth injury• Increased risk of caesarean delivery

Why is LGA a concern…?

How is LGA diagnosed…?

> Ultrasound> A mother's weight gain

Prevention of LGA

Prenatal care.

Careful management of diabetes

Proper weight gain.

A G A

Appropriate for gestational age (AGA) describes a fetus or newborn infant whose size is within the normal range for his or her gestational age

• 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

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