Gestational Age

An appropriate for gestational age

AGA

a fetus or newborn infant whose size is within the normal range for height, weight, head size, and developmental level for a child of the same gestational age and gender.

full-term infant is heavier than 2,5kg (about 5.5 lbs.) and lighter than 4 kg (about 8.75 lbs.).

• . The gestational age can be determined by physical criteria & neurological criteria according to estimated NBS score…

• An AGA baby tends to have the lowest risk for any problems. AGA babies have lower rate of disease and death than babies that are small or large for their gestational age

• The mortality rate of full term babies is 0.69 per 1,000 live births.

The main cause of death: congenital anomalies (64.5%), specifically

cardiac anomalies. chromosomal anomalies or syndromes

(12.9%)labor complications (12.9%) infections (3.2%) congenital diseases (3.2%) and metabolic disorders (3.2%).

Small for gestational age

• Infant born at weight less than the 10th percentile for age .

• low birth weight (LBW), an infant with a weight less than 2500 g regardless of gestational age at time of birth.

• very low birth weight infants, weighting less than 1500g .

• 6-7% of all births and 70% of neonatal death

CausesGenetic (down syndrome – renal agenesis – congenital heart disease )Fetal rubella infectionreduce fetal production of insulin and insulin like growth factor IUGR is the most common cause Maternal factors associated with LBW caused by premature birth or

IUGR include : previous low birth weight low socioeconomic status low level of maternal education no antenatal care maternal age younger than 16years or older than 35years short interval between pregnancies cigarette smoking, alcohol and illicit drug use psychological stresses(poor social support) poor weight gain during pregnancy(less than10Ib) low prepregnancy weight(lessthan45kg) African-american women

complication

Birth asphyxia . Respiratory distress syndrome .  hypoglycemia. Failure-to-Thrive. Infection (sepsis, pneumonia, gastroenteritis ) Jaundice Cardiac (PDA) Neurologic (hemorrhage , seizures )

Large for gestationel Age

Infant born at weight greater than the 90th percentile for age .

Macrosomia confused with LGA . 1 out of 10 women .

causes

Gestational age; beyond 40 weeks Fetal sex; male infant Excessive maternal weight gain Multiparity (3 times risk than primparus ) Congenital anomalies (transposition of great

vessels) Erythroblastosis fetalis - Hydrops fetalis Use antibiotics (amoxicillin, pivampicillin) during

pregnancy Genetic disorders of overgrowth (e.g. Beckwith–

Wiedemann syndrome, Sotos syndrome)

complication

Metrnal :reason for an induction (16%), and for C-S(9%)

Child:shoulder dystocia .hypoglycemia .Meconium aspiration syndrome .Congenital heart disease .3% risk for diabetes

Diagnosis

us Fundal height

DiagnosisUsUS not good informative about weight so cannot be diagnosed until after birth .

Fundal heightMore than 2 cm larger than expected ….LGALess than 2 cm smaller than expected ….SGA

1 of 3 is accurate

Assessments for newborn babies

1- Apgar score .

2- weight .

2- Ballard criteria .

Apgar score Asses the need for resuscitation at intervals 1-5 minutes

Apgar score 0 - 3 Cardiopulmonary arrest Sever bradycardia , hypoventilation , CNS depression

4 - 7Close monitoring

>8normal

Weight

Macrosomic . > 4000 g

LBW . < 2500 g

VLBW . < 1500 g

Must apply on chart .

Ear—The preterm infant’s ear cartilages are poorly developed,and the ear may fold easily; the hair is fine andfeathery, and lanugo may cover the back and face. Themature infant’s ear cartilages are well formed, and thehair is more likely to form firm, separate strands.

Sole—The sole of the foot of the preterm infant appearsmore turgid and may have only fine wrinkles. The matureinfant’s sole (foot) is well and deeply creased.

Female genitalia—The preterm female infant’s clitoris isprominent, and labia majora are poorly developed andgaping. The mature female infant’s labia majora are fullydeveloped, and the clitoris is not as prominent.

Male genitalia—The preterm male infant’s scrotum is undevelopedand not pendulous; minimal rugae are present,and the testes may be in the inguinal canals or in the abdominalcavity. The term male infant’s scrotum is welldeveloped, pendulous, and rugated, and the testes arewell down in the scrotal sac.

Grasp reflex—The preterm infant’s grasp is weak; theterm infant’s grasp is strong, allowing the infant to be lifted up from the mattress.