2. Abnormal Weight in the Newborn Flashcards
1
Q
Name the most important risk factor for infant mortality and is a significant determinant of infant and childhood morbidity.
A
Low Birth Weight
2
Q
Name Complications of abnormal weight: Small for gestational age (SgA) (7)
A
- Difficult cardiopulmonary transition: beware perinatal asphyxia, meconium aspiration, or PPHN
- Complications of prematurity (e.g., respiratory distress syndrome (RDS), retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH))
- Impaired thermoregulation
- Hypoglycemia: Risk correlates with severity of growth restriction.
- Polycythemia: risk ↑ with severity of growth restriction (hypoxia → ↑ EPO)
- Impaired immune function
- Perinatal mortality: ↑ as growth restriction becomes more severe; congenital malformations, perinatal asphyxia, transitional cardiopulmonary disorders
3
Q
Name Complications of abnormal weight: Large for gestational age (LgA) (9)
A
- ↑ Risk cesarean delivery, severe postpartum hemorrhage, and vaginal lacerations
- Birth injury: brachial plexus injury ± shoulder dystocia, clavicular fractures
- Respiratory distress: RDS (if born to diabetic mother), TTN (if born by C/S), and meconium aspiration syndrome (2o to perinatal depression)
- Perinatal asphyxia
- Hypoglycemia (due to hyperinsulinemia)
- Polycythemia: hyperinsulinemia → oxidative demands → fetal hypoxia → ↑ EPO
- ↑ Perinatal mortality
- Minor congenital anomalies: talipes calcaneovalgus, hip subluxation
- May have propensity for adult obesity
4
Q
Name Infant Growth Facts (67)
A
- Up to 10% of birth weight (BW) may be lost in first week of life.
- Should return to BW by 10d of life
- Weight gain:180g/wkuntil4to
- 5 mo
- 2× BW by 4 to 5 mo
- 3× BW by 1 yr
- 4× BW by 2 yr
5
Q
Name signs of umbilical cord infection (omphalities) (5)
A
- Fever
- Purulent discharge
- Redness and swelling
- Foul odor
- Bleeding (more than a few drops)
6
Q
Differentiate IUGR, LGA and SGA
A
- IUGR: fetus that has not reached its growth potential because of genetic or environmental factors, results in birth of SGA infant
- LGA: infant with BW > 90th percentile for gestational age
- SGA: infant with BW < 10th percentile for gestational age
7
Q
Describe: Barker hypothesis (1)
A
adverse stimuli or events occurring in utero and during infancy can permanently change the body’s structure, physiology, and metabolism, which can influence the occurrence of many diseases that will develop in adulthood.
8
Q
Name Maternal Factors for SGA/IUGR (7)
A
- Malnutrition
- Chronic hypoxemia (e.g., cyanotic cardiac or pulmonary disease, severe anemia)
- Medical conditions (e.g., renal disease, hypertension, sickle cell disease, chronic illness)
- Obstetrical complications (e.g., preeclampsia) associated with vasculopathy
- Viruses and parasites (e.g., TORCH)
- Drugs and toxins (e.g.,cocaine,alcohol,cigarettes,anticonvulsants,antimetabolites)
- Demographic variables: First Nations, pregnancy at the extremes of reproductive life, young maternal age at first childbirth, nulliparity or grand multiparity, and previous delivery of SGA newborn
9
Q
Name Placental Factors (Insufficiency) for SGA/IUGR (5)
A
- Abnormal uteroplacental vasculature/infarction
- Villous placentitis (e.g., bacterial, viral, parasitic)
- Placental abruption
- Structural anomalies (e.g., single umbilical artery, velamentous umbilical cord insertion, tumors)
- Rare: twin-to-twin transfusion syndrome
10
Q
Name Fetal Factors for SGA/IUGR (5)
A
- Chromosomal disorders (e.g., trisomies, aneuploidy)
- Genetic syndromes (e.g., dwarfism)
- Major congenital anomalies
- Chronic infection (e.g., CMV, congenital rubella, syphilis)
- Multiple gestation
11
Q
Name Maternal Factors for IGA (6)
A
- Familial
- Poorly controlled diabetes: excessive delivery of nutrients to the fetus, resulting in fetal hyperglycemia → hyperinsulinemia = ↑ growth, particularly of insulin-sensitive tissues
- Maternal obesity or excessive weight gain during pregnancy (normal is 25–35 lb)
- Multiparity: occurs more often as parity ↑
- Previous delivery of LGA infant
- Race and ethnicity: Hispanic and white newborns larger than black infants
12
Q
Name Fetal Factors for IGA (4)
A
- Genetic syndromes (e.g., Beckwith-Wiedemann syndrome, Sotos syndrome)
- Postterm gestation
- Male fetus
- Rare: twin-to-twin transfusion syndrome
13
Q
Describe Fundal Height (1)
A
Fundal height in centimeter = Weeks of gestation ± 2 (this rule only applies after 12 wk gestation)
14
Q
Describe history of abnormal weight in the Newborn (3)
A
Prenatal
- Maternal: social demographics, drug/teratogen exposure, PMHx, chronic illnesses, obstetrical Hx (previous and current: gestational hypertension, preeclampsia/ HELLP, GDM, preterm bleeding, etc.), FHx of genetic abnormalities or early neo-natal demise
- Fetal: single or multiple gestation, results of prenatal screening (GBS status, etc.), fundal height measurements
Delivery/Postnatal
- Gestational age at delivery, method of delivery (spontaneous vs. induced, C/S vs. vaginal, emergent vs. planned), rupture of membranes (length of time), use of instrumentation (forceps, vacuum), complications during delivery (maternal fever, hypoxia, birth trauma), Apgar scores, postdelivery course (how many days with mom vs. in nursery, time of discharge from hospital, complications after birth)
15
Q
Describe physical exam of abnormal weight in the Newborn (6)
A
- Weight, length, head circumference in relation to gestational age on growth chart
- Gestational age assessment (Ballard scoring system is accurate to within ± 2 wk)
- Vital signs, respiratory stability, levels of alertness
- Assess for dysmorphic features and/or anatomic defects
- SGA infants with IUGR: symmetric or asymmetric
- LGA infants: assess for birth-related trauma and congenital anomalies; assess for possible hypoglycemia (e.g., jitteriness, lethargy, apnea)
