Post-term and low birth weight:

 Post-term: Baby born after 42 weeks of gestation.

Post-mature: Baby born after 40 weeks gestation by 7 days or more.

Etiology:

  • Unknown (large-size parent, multi-gravity, or diabetic mother).
  • Association with Anencephaly due to defect pituitary adrenal axis or with trisomies.
Cinical manifestation:

*Mostly increase the birth weight with normal length and head for gestational age.

*Exception syndromes and degenerative changes in the placenta.

*small for gestational age.

1st stage: ➤ Pale wrinkled dry skin with absent lanugo hairs, and long nails.

               ➤ decrease subcutaneous fat.

                ➤ open-eyed baby.

2nd stage: with the above: 

                 ➤ meconium stain skin.

                 ➤perinatal depression.

3rd stage: with the above:

                 ➤ meconium stain of cord and nails.

                 ➤ increase incidence of death.

Management:

Prophylactic. 

Early feeding.

Evaluation of complications( perinatal depression, congenital anomalies, hypoglycemia, hypocalcemia. PPHV, and/or meconium aspiration).


*Low birth weight(LBW):

birth weight less than 2.500 gm

*Very low birth weight (VLBW):

birth weight < 1.500kg.

*Extremely low birth weight(ELBW) weight < 1000gm.

1-Prematurity :

gestational age before 37 weeks.

Causes:

  • Fetal: distress, multiple, erythroblastosis, and/or non-immune hydrops.
  • Placenta: previa or abruptio.
  • Utreus: deformity.
  • Maternal: chronic illness, infection, and /or preeclampsia.
  • Premature rupture of membrane.
  • Polyhydramnios.

Investigation:
  • CBC.
  • TORSH screen.
  • Glucose measurement.
  • Cranial sonar.
  • X-ray.
Management:
  • Resuscitation:
  • Feeding limitation to avoid NEC.
  • Developmental assessment.

2-IUGR:

Retraction of growth below 10th is usually 38-43 weeks gestational.

Causes:

  • Fetal: genetic, chromosomal disorders, congenital malformation, congenital infection, and /or IEM.
  • Maternal: Preclamsia, chronic illness, infection, malformation, and/or smoking.
  •  Placental: insufficiency, and/or umbilical vascular thrombosis.
The pattern of IUGR:

➤ Symmetric: (congenital infection, chromosomal )

➤Asymmetrical:(malformation, placental insufficiency).

*Problems:

  • Temperature instability:(decreased heat loss, low subcutaneous fat, large surface area, and reduced heat production).
  • Respiratory:(Decreased surfactant leads to RDS, aspiration due to (weak muscles and gag reflex), and/or apnea.
  • GIT: poor suckling, and swallowing, decreased intestinal motility, delayed gastric emptying, decreased digestion and absorption of fat-soluble vitamins, decreased lactase enzymes, decreased body stores of minerals and protein, increased risk of NEC, decreased vitamin K department clotting factors, and /or decrease conjugation and excretion of bilirubin.
  • Renal: electrolyte imbalance, metabolic acidosis, and /or renal elimination of drugs. 
  • Immune: increased infection due to (decreased IgG, decreased phagocytosis, and/or decreased complement factors).
  • Neurology: immature reflexes, decreased intestinal motility, retinopathy, recurrent apnea, ICH, HIE, hypotonia, and/or seizures).
  • CVS:(PDA, hypertension, or hypotension).
  • Metabolic: hypocalcemia, hypo, or hyperglycemia.
*Presentational problems:
  • Hypoxia 
    (PPHN , meconium aspiration, and /or perinatal asphyxia)
  • Hypothermia:  ( decrease subcutaneous fat, increase surface area, and/or hypoglycemia).
  • Polycythemia: (hypoxia leads to increased erythropoietin which leads to cerebral injury).
  • Developmental delay.
  • Immune depression.

Investigation:
  • CBC.
  • Glucose level,
  • X-ray.
  • electrolyte levels.
  • ABG.
  • Cranial sonar.
  • CRP.
  • TSB, DSB
  • Echo.
Management:
  • Resuscitation.
  • Oxygenation and warmth.
  • Glucose-electrode stabilization.
  • Fluid therapy.
  • Broad spectrum antibiotics.



        



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