IUGR BABIES

Triana Rahmanita
Source
• Sharma, D., Shastri, S., & Sharma, P. (2016). Intrauterine Growth
Restriction: Antenatal and Postnatal Aspects. Clinical medicine
insights. Pediatrics, 10, 67–83.
https://doi.org/10.4137/CMPed.S40070
Name/Age/ Consultant in
Diagnosis Management Complication Transfer
Medrec Charge
Mrs. Rahma P2A0 spontaneous Spontaneous Spontaneous Alamanda ZV
Aulia Bracht delivery; Bracht delivery Bracht delivery;
17 y.o previous caesarean previous
10-10-2004 section; syill birth caesarean section;
0001869529 syill birth
Definition
• Intrauterine growth restriction
(IUGR) has been defined as the rate
of fetal growth that is below normal
as per the race and gender of the
fetus
• “normal” neonate is the one whose
birth weight is between the 10th
and 90th percentile as per the
gestational age, gender and race
with no feature of malnutrition and
growth retardation
 IUGR VS SGA
IUGR (intrauterine growth
restriction)
• is a clinical definition and applies to
neonates born with clinical features
of malnutrition and in-utero growth
retardation, irrespective of their birth
weight percentile
SGA (small for gestational age)
• neonates whose birth weight is less
than the 10th percentile for that
particular gestational age or two
standard deviations below the
population norms on the growth charts
• considers only the birth weight without
any consideration of the in-utero
growth and physical characteristics at
birth
Gestational age

• Also called menstrual age or menstrual dating, estimated in completed

weeks from the date of the mother's last menstrual period (LMP)
• Accurate menstrual dating depends upon certain maternal knowledge of last
menstrual period (LMP) and regular 28-day cycle length
• Also can be measured using sonography performed before 22 weeks of
gestation (if available)
Prenatal Diagnosis of IUGR
• Should be done for high-risk mothers who are susceptible of having IUGR
fetus
• Component :
• risk factor assessment in maternal and familial history
• maternal anthropometry with maternal pre-pregnancy weight and height
• maternal nutritional status
• exact gestational dating
• fundal height with fetal palpation
• cardiotocography (CTG)
• accurate fetal weight measurement estimated using biometric measures (abdominal
circumference [AC], head circumference [HC], biparietal diameter, and femur length
[FL]).
Staging of intrauterine growth-restricted fetuses
• Stage 0: Fetuses with an EFW or an AC ,10th percentile. Doppler of
the UA and MCA is normal.
• Stage I: Fetuses whose EFW or AC is ,10th percentile plus abnormal
Doppler flow of the UA or MCA.
• Stage II: Fetuses whose EFW or AC is ,10th percentile plus absent or
reversed Doppler flow of the UA
• Stage III: Fetuses whose EFW or AC is ,10th percentile plus absent or
reversed Doppler flow of the DV
 Postnatal
Assessment of
Gestational Age

Dubowitz Method
• The revised Dubowitz scoring
system incorporates 34 physical
and neurologic assessments
• Divided into six categories
(tone, tone patterns, reflexes,
movements, abnormal signs, and
behaviors)
 Postnatal
Assessment of
Gestational Age
New Ballard score (NBS)
• combines physical and neurologic criteria
• an accurate examination requires that the infant is
in an alert and rested state
Postnatal Assessment of
Gestational Age
Eye examination
• The disappearance of the anterior vascular capsule of
the lens occurs in an orderly sequence between 27
and 34 weeks gestation. As a result, examination with
a direct ophthalmoscope after dilation of the pupil
can be used to estimate gestational age
• The correlation between the grade and gestational
age is highly significant and is independent of
intrauterine growth restriction
Postnatal Assessment of Gestational Age
Electroencephalogarphy
• A characteristic developmental sequence of electroencephalographic
(EEG) patterns occurs with increasing postconceptual age, beginning
at 21 to 22 weeks
• patterns of regional and hemispheric electrical activity that appear at
specific times during maturation can be used to estimate gestational
age
Clinical Examination
• Large head when compared to rest of the body (brain
sparing effect)
• Large and wide anterior fontanelle (poor formation of
membranous bones)
• Absent buccal fat (old man look)
• Small or scaphoid abdomen
• Thin umbilical cord often stained with meconium
• Decreased skeletal muscle mass and subcutaneous fat
tissue
• Loose, dry, and easy peelable skin
• Long fingernails
• Relatively large hands and feet compared to body
• Skin having a loose fold of skin in the nape of neck, axilla,
inter-scapular area, and gluteal region (more than three
folds)
• Anxious and hyper alert infant
• Poor breast bud formation and immature female genitalia
Ponderal Index
• Ponderal index can also be used
to determine the degree of fetal
malnutrition. It is calculated as
ratio of body weight in grams to
length in cm expressed as (PI =
[weight {in gram} × 100] ÷
[length {in cm}3]).
Mid-arm Circumference and Mid-
Arm/Head Circumference Ratios
(Kanawati and McLaren’s Index)
• The normal value of
mid-arm/head circumference
ratios (MAC/HC) is 0.32–0.33
and in a term IUGR infant, a
value less than 0.27 is
considered features of fetal
malnutrition.60