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PathophysiologyPathophysiology
3) Placental Factors: Placental insufficiency ( most imp in 3rd trimester) Anatomic problems:
– Multiple infarcts– Aberrant cord insertions– Umbilical vascular thrombosis & hemangiomas– Premature placental separation– Small Placenta
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Postnatal AssessmentPostnatal Assessment
Growth parameters: weight, height, HCAssess GA with Ballard score.Plotted growth parameters in growth chart
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Physical AppearancePhysical Appearance
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Physical appearance:Physical appearance:
• Heads are disproportionately large for their trunks and extremities
• Facial appearance has been likened to that of a “wizened old man”.
• Long nails.• Scaphoid abdomen
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• Signs of recent wasting - soft tissue wasting - diminished skin fold thickness - decrease breast tissue - reduced thigh circumference
• Signs of long term growth failure - Widened skull sutures, large fontanelles - shortened crown – heel length - delayed development of epiphyses
• Comparison to premature infants,IUGR has brain and heart larger in proportion to the body weight, in contrast the liver, spleen, adrenals and thymus are smaller.
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ComplicationComplicationHypoxia
- Perinatal asphyxia- Persistent pulmonary hypertension- meconium aspiration
Thermoregulation- Hypothermia due to diminished subcutaneous fat and elevated surface/volume ratio
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ComplicationsComplications
Metabolic - Hypoglycemia
- result from inadequate glycogen stores.- diminished gluconeogenesis.- increased BMR
- Hypocalcemia- due to high serum glucagon level, which
stimulate calcitonin excretion
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ComplicationsComplicationsHematologic
- hyperviscosity and polycythemia due to increase erythropoietin level sec. to hypoxia
Immunologic- IUGR have increased protein catabolism and decreased in protein, prealbumin and immunoglobulins, which decreased humoral and cellular immunity.
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ManagementManagementAntenatal diagnosis and management is the
key to proper management of IUGRDelivery and Resuscitation
- appropriate timing of delivery- skilled resuscitation should be available- prevention of heat loss
Hypoglycemia- close monitoring of blood glucose- early treatment ( IV dextrose, early feeding )
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ManagementManagement Hematological Disorder
- central Hct to detect polycythemia- CBC with diff to r/o leukopenia or thrombocytopenia
Congenital infection- infant should be examined for signs of congenital infection (eg.rash, microcephaly hepatosplenomegaly, lymphadenopathy, cardiac anomalies etc….)- TORCH titer screening- Viral cx of urine, nasopharynx- Head CT to r/o calcification
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ManagementManagementGenetic anomalies
- screening as indicated by physical exam- chromosomal analysis (infant with dysmorphic features)
Others- serum calcium to r/o hypocalcemia- fractionated bilirubin sec to polycythmia, congenital infection- urine, meconium tox for substance abuse
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ManagementManagement
Early feeding and caloric intake should be 100-120 kcal/kg/d
Developmental and growth f/u in all IUGR infants
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OutcomeOutcome
Symmetric vs. Asymmetric IUGR- symmetric has poor outcome compare to asymmetric
Preterm IUGR has high incidence of abnormalities IUGR with chromosomal disease has 100%
incidence of handicap Congenital infection has poor outcome - handicap
rate > 50% IUGR has higher rate of learning disability.
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Thank YouThank You