1. SMALL FOR GESTATIONAL AGE (SGA)
LARGE FOR GESTATIONAL AGE(LGA)
&
ADEQUATE FOR GESTATIONAL AGE (AGA)

2. SMALL FOR
GESTATIONAL AGE (SGA)

3. LOW BIRTH WEIGHT ( < 2.5 kg)
PRETERM
BABIES
SMALL FOR
AGE BABIES

4. SMALL
FOR DATE
PRETERM
LBW

5. HOW DO WE DEFINE ?
• SGA:
small for GA;
BIRTH WT <10th percentile
FOR THE PERIOD OF GESTATION
• LGA:
large for GA;
BIRTH WT>90th percentile

6. • SGA : < 2SD FROM MEAN WEIGHT FOR THE
PERIOD OF GESTATION
• LGA : >2 SD FROM MEAN WEIGHT FOR THE
PERIOD OF GESTATION

7. SGA
< 10TH
PERCENTILE
OF BIRTH WT
< 2SD FROM
MEAN WT

8. Types of SGA
Malnourished
SGA
Hypoplastic
SGA
Mixed SGA

9. Malnourished SGA
Commonest type of SGA
Asymmetric IUGR
2/3 rd of IUGR
malnourishment during latter part of
gestation – placental dysfunction
(uteroplacental insufficiency)

10. MALNOURISHED SGA/ ASYMMETRIC IUGR

11. LONG,THIN & MARASMIC
Head Circumference,brain unaffected
Internal organs,liver grossly shrunken
HC > CC by 3cm
Loose skin folds
Ponderal index ( g/cm3) < 2

12.  ONLY DECREASE IN CELL SIZE, CELL NUMBER
NORMAL
 GROWTH POTENTIAL (+)
 NUTRITIONAL REHABILITATION
 NEONATAL PROGNOSIS - BETTER

13. Hypoplastic SGA
 Symmetric IUGR
 1/3 rd of IUGR
 Growth retardation in early pregnancy a/w
intrauterine infection
genetic defects,
chromosomal aberrations
 Incidence of anomalies 10 – 20 times higher

14. FEATURES OF HYPOPLASTIC SGA
o
o
o
o
o
DECREASE IN CELL NUMBER
ALL ORGANS AFFECTED,INCLUDING BRAIN
ALL PARAMETERS ARE PROPORTIONATELY SMALL
PONDERAL INDEX - NORMAL
POOR PROGNOSIS
PERMANENT PHYSICAL & MENTAL RETARDATION

16. MIXED SGA
 ADVERSE FACTORS DURING BOTH EARLY & MID PREGNANCY
 NEITHER OBVIOUS MALNOURISHED,NOR GROSSLY
HYPOPLASTIC
 DECREASE IN BOTH CELL SIZE AND COUNT

17. Causes of SGA
•
•
•
•
Maternal
Fetal
Placental
Environmental

18. MATERNAL
NUTRITION
POOR
WEIGHT
GAIN
PREVIOUS
HISTORY
MATERNAL
FACTORS
SMOKING
GRAND
MULTIPARA
TOBACCO
ALCOHOL
MATERNAL
DISEASES

19. FIRST BORN
IU
INFECTIONS
FETAL
FACTORS
MULTIPLE
PREGNANCY
GENETIC
DEFECTS

20. ABRUPTION
VASCULAR
THROMBOSIS
PLACENTAL
STRUCTURAL
ABNORMALITY
PLACENTA
INFARCTS

21. Environmental factors
Ethnic/racial/geographic
Socio-economic status
Nutritional

22. COMMON PROBLEMS OF SGA BABIES
1.
2.
3.
4.
5.
6.
7.
8.
IUD
BIRTH ASPHYXIA
HYPOGLYCEMIA,HYPOCALCEMIA
HYPOTHERMIA
CONGENITAL MALFORMATOINS
INFECTIONS
POLYCYTHEMIA
POOR GROWTH POTENTIAL

23. THOSE 3 LETTER WORDS!!
•
•
•
•
•
•
RDS
ROP
IVH
PDA
NEC
BPD

24. MANAGEMENT OF SGA
•
•
•
•
•
Emergency CS – fetal distress
Screening for cong.malformations
Early and adequate breast feeding (NGT/IVF)
Correct hypoglycemia,hypocalcemia,polycythemia
Control infections,temperature regulation

25. LARGE FOR GESTATIONAL AGE

26. •
•
•
•
•
DEFINITION
CAUSES OF LGA
VARIOUS SYNDROMES a/w LGA
COMPLICATIONS DUE TO LGA BABIES
MANAGEMENT OF LGA

27. LGA babies have
• Birth wt > 90th percentile for their
gestational age
• birthweight >2 SD from the mean weight for
gestation

28. CAUSES OF LGA

29. 1.GENETICS
TALL & HEAVY MOTHERS
2. Maternal
BIG BABY
Diabetes
COMMONEST CAUSE for LGA babies

30. •
INFANT OF DIABETIC MOTHER
UTILISE LARGE AMOUNT OF TRANSPLACENTALLY TRANSMITTED GLUCOSE
ISLET CELL HYPERPLASIA & HYPERINSULINEMIA
INCREASE IN GROWTH FACTORS IGF-1 , IGF-2
INCREASED GROWTH & ADIPOSITY IN INSULIN DEPENDENT AREAS
(FETAL TRUNK,SHOULDERS)

31. MACROSOMIA
•
ADIPOSITY
•
SKIN FOLD THICKNESS
• VISCEROMEGALY (LIVER)

32. OTHER PROBLEMS IN GDM??
1) Hypoglycemia,Hypocalcemia
2) Increased incidence of birth defects-TGA
3) RDS
4) Hyperbilirubinemia
5) polycythemia
6)Birth trauma

33. • 3. Cretinism
Mean birth wt is
higher in babies with
Congenital hypothyroidism

34. 4.Hydrops fetalis
large size is due to generalised anasarca rather
than due to somatic growth

35. • Birth weight may also be related to the amount of
weight a mother gains during pregnancy.
• Excessive weight gain
increased fetal weight.

36. Overgrown syndromes with advanced
maturation…
a)Congenital adrenal hyperplasia
b)Thyrotoxicosis
c)Beckwith- Wiedemann syndrome
d)Marshall Smith Syndrome
e)Cerebral gigantism/ Sotos syndrome
skeletal

37. Beckwith Wiedemann syndrome
•
•
•
•
Visceromegaly
Exomphalos
Macroglossia
Characteristic groove in the
ear lobes

39. Marshall Smith Syndrome
craniofacial characteristics:
large forehead,
hypertelorism,
micrognathia,
long philtrum
Advanced maturation of carpal bones

40. Sotos syndrome
(cerebral gigantism)
large baby
macrognathia
large hands & feet
mentally subnormal
&
lag in maturation of carpal
bones

41. Why is LGA a concern…?
•
•
•
•
Prolonged vaginal delivery time
Difficult birth
Birth injury
Increased risk of caesarean delivery

42. How is LGA diagnosed…?
> Ultrasound
> A mother's weight gain

43. Prevention of LGA
Prenatal care.
Careful management of diabetes
Proper weight gain.

44. AGA
Appropriate for gestational age
(AGA) describes a fetus or newborn
infant whose size is within the
normal range for his or
her gestational age

45. • AGA:
Appropriate for Gestational Age;
birthweight b/w 10th & 90th percentile
An appropriate for gestational age full-term
infant is heavier than 2500 grams and lighter
than about 4000 grams

46. THANK YOU