SMALL BABIES

Question 1

outline how the rate of normal foetal growth changes throughout pregnancy?

Answer 1

growth is very slow in the embryonic period and in the foetal period this speeds up

Question 2

what causes the weight gain in the early and late foetal stages?

Answer 2

in the early foetal stage the weight gain is due to protein deposition and in the late foetal stage it is due to adipose deposition

Question 3

what is the Crown Rump length?

Answer 3

the length of the embryo/foetus from the top of its head to the bottom of its torso

Question 4

outline how the body proportions change during the foetal period?

Answer 4

by week 9 the head is approximately half the crown-rump length and then body length and lower limb growth accelerates

Question 5

what factors should you consider when calculating the optimal weight for a newborn?

Answer 5

gestational age, foetal gender, parity, maternal weight, maternal height, ethnic group and altitude

Question 6

how does altitude affect the size of the newborn?

Answer 6

at higher altitudes there is lower pO2 so the baby will tend to be smaller

Question 7

why do babies lose weight after birth?

when should they have regained weight by?

Answer 7

physiological weight loss due to fluid reduction

they should be back at their birth weight within 2 weeks

Question 8

insulin-like growth factors 1 and 2 mainly

Question 9

at what weight do we consider the baby to have growth restrictions?

Answer 9

<2500g

Question 10

at what weight do we consider the baby macrosomia?

Answer 10

> 3500g

Question 11

what is the crown-rump length for?

Answer 11

a primary measure of gestational age between 6-13 weeks. After 13 weeks it become more useful measurements for assessing fetal growth.

Question 12

what is used to date pregnancies after 13 weeks?

Answer 12

head and abdominal circumferences

Question 13

what is an umbilical arterial doppler ultrasound used for?

Answer 13

surveillance of fetal well-being in the third trimester of pregnancy

Question 14

what does abnormal umbilical arterial doppler ultrasound findings mean?

Answer 14

placental insufficiency, marker of IUGR, suspected pre-eclampsia

Question 15

what is intrauterine growth restriction?

Answer 15

a baby <10th percentile of birth weight for its gestational age

Question 16

what is symmetrical IUGR?

Answer 16

where all fetal biometric parameters tend to be less than expected for the given gestational age.

Question 17

what is asymmetrical IUGR?

Answer 17

where some fetal biometric parameters are disproportionately lower than others, as well as falling under the 10th percentile. The parameter classically affected is the abdominal circumference because growth is head sparing

Question 18

what causes you to get either asymmetrical or symmetrical IUGR?

Answer 18

if a risk factor for IUGR occurs in the early pregnancy when growth is driven by hyperplasia then it will have symmetrical impacts whereas if this risk factor occurs later in development, when growth is driven by hypertrophy, then we see asymmetrical IUGR

Question 19

at what weeks is hyperplasia the dominant growth type? and hypertrophy/

Answer 19

hyperplas- 0-20 weeks

hypertrophy 28 weeks - term

Question 20

what are some maternal risk factors for IUGR?

Answer 20

smoking, alcohol, anaemia, medical disease like CVD, poor nutritional status, pollution exposure

Question 21

what are some foetal risk factors for IUGR?

Answer 21

structural abnormalities, chromosomal abnormalities, multiple gestations, in utero infections

Question 22

what are some in-utero infections which can cause IUGR?

Answer 22

TORCHS
toxoplasmosis
rubella
cytomegalovirus
herpes
syphilis

Question 23

what are some placenta risk factors for IUGR?

Answer 23

abruptio placenta, placenta preva, thrombosis or infarction, vasculitis, cord abnormalities

Question 24

what are some uterine risk factors for IUGR?

Answer 24

decrease uterine blood flow, pre-eclampsia, structural anomalies, atherosclerosis of uterine spiral arteries

Question 25

what is placenta previa?

Answer 25

a condition in which the placenta lies very low in the uterus and covers all or part of the cervix.

Question 26

what are the manifestations of IUGR?

Answer 26

Baby is small all over or malnourished.
Thin, pale, loose and dry skin.
Umbilical cord is thin and often stained with meconium.
(note: the head may look normal size but the body disproportionately small)

Question 27

whats the treatment for IUGR?

Answer 27

observing before 34 weeks during doppler ultrasound and giving steroids to prep baby’s lungs for preterm delivery
after 34 weeks arrange a safe delivery (C-section if doppler shows poor blood flow through placenta or induction is doppler is normal)

Question 28

what are some consequences of IUGR?

Answer 28

metabolic and hematological disturbances
 disrupted thermoregulation respiratory distress 
necrotizing enterocolitis 
retinopathy of prematurity
 may contribute to perinatal morbidity.

Question 29

what is the Barker hypothesis?

Answer 29

adverse nutrition in early life, including prenatally as measured by birth weight, increases susceptibility to the metabolic syndrome which includes obesity, diabetes, insulin insensitivity, hypertension, and hyperlipidemia and complications that include coronary heart disease and stroke.