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Dr Giridhar Sethuraman
Associate Professor, Department of Neonatology
Chettinad Hospital and Research instituteChennai, Tamilnadu
D.M. (Neonatology)
Non – nutritional causes of Failure to thrive
Dr. S. Giridhar M.D;D.M Associate Professor of Neonatology
Chettinad Hospital and Research Institute, Chennai, India
+919841027228
Identifying FTT
Different presentations of FTT
Underlying etiologies and their identification
Approach
Overview
Baby girl S
• Delivered to a primigravida mother at term.
• Normal delivery
• Birth Weight 3.2 kg
• Length 49 cm
• Head circumference 34.5 cm
4
• Back on Day 15 for complaint of loose stools
• Weight 3 kgIS THIS FAILURE TO THRIVE ?
“Definition”
Defining FTT Use growth charts
Weight decrease of ≥ 2 major centiles
Daily increase is less than expected
Weight for length < 10th centile
Organic 30%
Types of FTT
Non – Organic 70%
Failure to Thrive
What we must do?
Approach
Failure to thrive
Rapid Weight Loss
Progressive Weight loss or not gaining weight
Rapid Weight Loss
Life – threatening conditions
• Acute decompensation in the neonatal period with lethargy, vomiting, seizures,
consanguinity and unexplained sib deaths
Inborn error of metabolism
• Recurrent non-bilious/ bilious vomiting
Pyloric stenosis / Malrotation
• History of ambiguous genitalia in a female infant or a positive screen for congenital
adrenal hyperplasia
CAH
• Fever, vomiting, loose stools, feed refusal with fever
Dehydration
• Tachypnea, diaphoresis, or cyanosis with feeding
• Congenital Heart Disease
When do we think Metabolic ?
If the child:
• Looks bad
• Smells bad
• Feels bad
• Tastes bad
• Sounds bad
Neonatal screen help us a lot…
Clues are always there
Salt – Losing CAH
Persistent, moderate
weight loss
Antenatal Clues
Some causes are obvious…
Post NEC – Short Gut Syndrome
Diligent clinical examination…
Vomiting – Never Ignore
Hypertrophic pyloric stenosis
What does this 4 week old with FTT have ?
Congenital Hyperthyroidism
3 ½ wk old with not gaining weight and “cold”
Stridor
Usually associated with GERD
2 neonates with FTT & Hypoplastic mandible with Microstomia
Treacher CollinsPierre Robin
10 weeks old with FTT
Neonatal Cholestasis
Investigations
Rule 1
• If Hx and Exam is negative – Mostly inadequate nutrition
• Do not investigate if well
Rule 2
• No Fishing
• Hx and Exam should guide investigations
Rule 3
• Start with simple & non invasive
• Proceed to complex & invasive
Copyrights apply
Baby S
Mother was reassured
regarding loose stools
Feeding assessed, reinforced
She was seen at vaccination visits
• 6 weeks 4 kg
• 10 weeks 4.9 kg
• 14 weeks 5.4 kg
• 6 m 1 w 6.2 kg
• 8 m 3 w 7.0 kg
97th
50th
3rd
1st
Baby S
Take Home Messages
Growth charts help us to suspect and monitor FTT
History and physical exam are the most valuable tool
Use labs to supplement history and physical examination
Routine Neonatal Screening could help in avoiding catastrophies
Thank you