Sga iugr
Download
1 / 17

SGA/IUGR - PowerPoint PPT Presentation


  • 309 Views
  • Updated On :

SGA/IUGR. Sue Ann Smith, MD Neonatologist Doernbecher Neonatal Care Center. Intrauterine Growth Restriction (IUGR). No universal definition Any baby who does not achieve intrauterine growth potential Usually defined as < 2 SD below the mean for weight. Small for Gestational Age (SGA).

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'SGA/IUGR' - adamdaniel


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Sga iugr l.jpg

SGA/IUGR

Sue Ann Smith, MD

Neonatologist

Doernbecher Neonatal Care Center


Intrauterine growth restriction iugr l.jpg
Intrauterine Growth Restriction (IUGR)

  • No universal definition

  • Any baby who does not achieve intrauterine growth potential

  • Usually defined as < 2 SD below the mean for weight.


Small for gestational age sga l.jpg
Small for Gestational Age (SGA)

  • Usually defined as <2SD or <10th % for growth parameters

  • Babies <3% are at greatest risk of morbidity and mortality.

  • Babies who are constitutionally small are at less risk of complications than those who are SGA from pathologic process.


Etiology of sga l.jpg
Etiology of SGA

  • Maternal Factors

  • Placental Factors

  • Fetal Factors


Maternal factors l.jpg
Maternal Factors

  • Genetic size

  • Demographics

    • Age (extremes of reproductive age)

    • Race

    • Socioeconomic status

  • Underweight before pregnancy or malnutrition

  • Chronic disease

  • Exposure to teratogens (EtOH, drugs, radiation, etc.)


Maternal factors cont l.jpg

Heart disease

Renal disease

Hypertension

Pulmonary disease

Hemoglobinopathies

Collagen-vascular disease

Diabetes

Postmaturity

Multiple gestation

Uterine anomalies

Thrombotic disease

High altitude environment

Smoking

Cocaine

Maternal Factors (cont.)

Factors that interfere with placental flow and function


Placental factors l.jpg

Malformations – vascular

Chorioangioma

Infarction

Abruption

Previa

Abnormal trophoblast invasion

Placental Factors


Fetal factors l.jpg
Fetal Factors

  • Constitutional – genetically small, but genetically normal

  • Chromosomal abnormality – only about 5% of SGA babies

  • Malformations – CNS, skeletal, gastroschisis

  • Congenital infections – CMV, rubella


Characteristics of iugr l.jpg

Characteristics of IUGR

Symmetric

Early onset

Constitutional or “normal” small

Decreased growth potential

Normal ponderal index

Lower risk for transitional problems

Brain symmetrical to body

Examples

Genetic causes, chromosomal

TORCH infections

Anomalad Syndromes


Characteristics of iugr10 l.jpg
Characteristics of IUGR

  • Asymmetric

  • Late onset

  • Environmental

  • Growth arrest

  • Higher risk for transitional problems

  • Brain sparing

    Examples

  • Chronic hypoxia

  • Preeclampsia (PIH, PET)

  • Chronic hypertension

  • Malnutrition


Neonatal complications of iugr l.jpg
Neonatal Complications of IUGR

  • Mortality rate 5-20x that of AGA

  • Perinatal asphyxia

  • Abnormal temperature regulation

  • Hypoglycemia

  • Hyperviscosity-polycythemia syndrome

  • Altered immunity

  • Thrombocytopenia


Neonatal complications of iugr cont l.jpg
Neonatal Complications of IUGR(cont)

  • Pulmonary hemorrhage

  • PPHN

  • Hypocalcemia


Evaluation of sga newborn l.jpg

Evaluation of SGA Newborn

Careful physical examination

Measure & plot head circumference & length

CBC with differential and platelet count

Monitor glucose carefully

Further evaluation?

Urine for CMV

TORCH titers

Liver function tests

Head Ultrasound


Long term morbidity of iugr l.jpg

“Long term” Morbidity of IUGR

Factors associated with abnormal outcome ?

Microcephaly

Hypoxic ischemic encephalopathy

Symptomatic hypoglycemia

Symptomatic hyperviscosity


Slide15 l.jpg

50

50

40

40

30

30

20

20

10

10

<10

10-50

50-90

>90

<10

10-50

50-90

>90

Term AGA

Term SGA

Preterm SGA

Growth Consequences of IUGR

Height at 4 years

Weight at 4 years

Percent

Percent

Percent

Percent


Slide16 l.jpg

50

40

30

20

10

<10

10-50

50-90

>90

Term AGA

Term SGA

Preterm SGA

Growth Consequences of IUGR

Head Circumference at 4 years

Percent


Fetal origins of adult diseases l.jpg
Fetal Origins of Adult Diseases ?

  • Coronary artery disease correlates inversely with birth weight

  • Rate of non-insulin dependent diabetes mellitus is highest in the “thinnest” babies at birth (low ponderal index)

  • High serum cholesterol are linked to disproportionate size at birth (body smaller than head)

  • Increased rate of hypertension in infants who were thin, short, &/or proportionately small at birth


ad