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Poor growth of the foetus in-utero Birth weight below the 10th percentile for gestational age is said to be Small for Gestational age (SGA) or Small for Date. Includes 3 categories of neonates: 1.due to foetal malnutrition 2.other intrauterine events 3. Normal but lighter than 90% of the population. Majority of these neonates are normal but small

Classically 2 groups ASYMMETRICAL GROWTH RETARDATION -More common -weight or abdominal circumference lies on a lower centile than that of the head -occurs when there is inadequate placental supply of nutrition late in pregnancy

-Brain growth is relatively spared at the expense of liver glycogen and skin fat -Associated with maternal pre-eclampsia, cardiac or renal disease, multiple gestation OR Idiopathic -Infants rapidly put on weight after birth,(catch-up weight) usually from age 3mths

Head circumference is equally reduced Suggests a prolonged period of poor IU growth Causes: -small but normal baby -foetal chromosomal disorder -congenital infection -maternal smoking, drug and alcohol abuse, chronic medical condition or malnutrition Likely to remain small permanently.

IN UTERO: Intrauterine hypoxia and death Birth asphyxia AFTER BIRTH Hypothermia due to relatively large surface area Hypoglycaemia from poor fat and glycogen stores Hypocalcaemia Polycythaemia

INTRAUTERINE Maternal history and clinical exam-eg.manual estimation of feotal size and weight,foetal activity,serial fundal height measurements Ultrasound studies eg.vol of amniotic fluid etc. Foetal heart rate monitoring-late decelerations etc. Biochemical and biophysical tests of feotoplacental function

NEONATAL Mainly physical signs -low birth weight for gestational age -wasted, tissue wasting -decreased skin-fold thickness -decreased breast tissue, -head circumference may be low - Peeling of skin, long nails

INTRAUTERINE Early diagnosis and monitoring is key for decisions -feotal size assessment, -Antenatal cardiotocography (CTG) - serial ultrasound measurements of growth,activity, breathing and amniotic fluid volume - Doppler ultrasound for blood flow studies

BIRTH RISKS: -Intrapartum death, Low Apgar scores, Meconium staining and aspiration syndrome -SKILLED RESUSCITATION -Prevention of heat loss -Monitoring for hypoglycaemia and treatment

Increased risk for long term neurological and behavioural handicaps for survivors SGAs are more vulnerable to perinatal complications than others Morbidity and mortality are increased More likely to be readmitted to hospital within 2 yrs of birth Many will ultimately be slimmer and shorter than their peers.