Small for Gestational Age

We also excluded male individuals who were born with congenital malformations. Although the overall con- scription rate was high (94%), conscription rates varied slightly by gestational age and anthropometry at birth: slightly lower conscription rates were obtained among preterm- compared with term-born male individuals and among male individuals who were born small for gestational age compared with their appropriate peers. These and other findings suggest that we may have a bias toward a healthy population and, if anything, could have underestimated the associations among preterm birth, fetal growth restriction, and risks for low intellec- tual performance.

Methodology. Comparison of two historical cohorts of small-for-gestational age (SGA) and appropriate-for- gestational age (AGA) infants born between 24 and 26 6/7 weeks of gestation (gestational age estimated by early ultrasound at 16 to 18 weeks). Data were collected retro- spectively on 191 successive admissions to the neonatal intensive care unit between January 1, 1983, and Decem- ber 31, 1992. These included: demographic and maternal information, delivery mode and condition at birth, mor- tality, neonatal intensive care unit morbidities (respira- tory distress syndrome, intraventricular hemorrhage, patent ductus arteriosis [PDA], chronic lung disease [CLD], retinopathy of prematurity [ROP], necrotizing en- terocolitis, infection), nutrition, and length of hospital- ization.

The etiology of most nonsyndromic CHDs is un- known but likely involves a complex interaction be- tween multiple environmental exposures and genetic susceptibilities. Similarly, the etiology of small for gesta- tional age is complex. The temporal relationship be- tween CHDs and small for gestational age cannot be discerned from case series or case-control studies. It is possible that both CHDs and small for gestational age occur independently but share common risk factors. For example, maternal periconceptional smoking is the lead- ing cause of small for gestational age in developed coun- tries. 17–21 Similarly, some case-control studies provide

Being born SGA does not necessarily mean that IUGR has occurred, and infants who are IUGR are not inevitably SGA at birth. Unfortunately, the terms IUGR and SGA have been used interchangeably, creating confusion on the topic. In the absence of congenital malformations or chromosomal abnormalities, small fetal size could be the consequence of two distinct processes: constitutional smallness or pathological growth restriction. Distinguishing one process from the other is challenging, but such distinc- tions have profound implications toward understanding quality and robustness of evidence provided by available trials. Patients enrolled in the studies are usually selected according to their birth weight (below the 10th or the 3rd percentile) without checking if a growth restriction really occurred. So SGA is a term that is often used as a proxy for restricted growth, thereby combining both constitution- ally small and pathologically growth restricted fetuses. It is known that growth restricted fetuses are small because of some underlying pathological conditions (smoking during pregnancy, uteroplacental dysfunction, hypertensive disor- ders, etc.), and they are therefore at increased risk for neonatal morbidity and mortality. On the other hand, constitutionally small infants can easily have morbidity and mortality very similar to appropriate for gestational age,

with Appropriate-for-Gestational-Age Infants: Normal Serum 25-Hydroxyvitamin D Decreased Bone Mineral Content in Small-for-Gestational-Age Infants Compared. http://pediatrics.aappublica[r]

Board, have presented a complete guide for management of short children born small for gesta- tional age (SGA). This project received research sup- port from Pharmacia Corporation (Peapack, NJ). This suggested clinical pathway addresses those infants born SGA as defined by birth weight and/or length at least 2 standard deviations (SD) below the mean for gestational age (less than or equal to ⫺2 SD), who remain short at 2 to 3 years of age.

Serum thymic hormone activity in 1-month-old healthy neonates, preterm appropriate-for-gestational age infants, small-for-gestational age infants, and healthy adults.. 408 SERUM THYMIC H[r]

RESULTS. In the appropriate for gestation age group, the systolic and diastolic diam- eters of the common carotid artery and abdominal aorta, as well as the stiffness index, increased with the gestational age at birth. In the small for gestational age group, the arterial diameters and blood pressure were also within the reference range. Using the arterial stiffness index values from the appropriate for gestation age group, the small for gestational age group was divided into 3 subgroups: 18 infants with normal stiffness index values for both arteries, 19 infants with a high stiffness index of the abdominal aorta, and 10 infants with a high stiffness index for both arteries. The clinical outcome was significantly worse in the latter 2 sub- groups compared with the normal infants and was also worse in the infants with a high stiffness index for both arteries compared with the high abdominal aorta subgroup.

Methods. We studied 136 small for gestational age (SGA) and 34 appropriate for gestational age (AGA) term neonates who were born in Santiago, Chile. Prefeeding venous blood was obtained 48 hours after birth for de- termination of glucose, free fatty acids, ␤ -hydroxy bu- tyrate, insulin, C-peptide, leptin, sex hormone-binding globulin, insulin-like growth factor-binding protein-1 (IGFBP-1), and cortisol.

Infant Through Age 6: Comparison by Birth Weight and Gestational Age Cognitive and Neurologic Development of the Premature, Small for Gestational Age. http://pediatrics.aappublications.o[r]

Conclusion. These findings on a national sample of US-born non-Hispanic white, non-Hispanic black, and Mexican–American children show that children born SGA remain significantly shorter and lighter throughout early childhood and do not seem to catch up from 36 to 83 months of age. LGA infants remain longer and heavier through 83 months of age, but unlike children born SGA, children born LGA may be prone to an increasing accu- mulation of fat in early childhood. Thus, early childhood may be a particularly sensitive period in which there is increase in variation in levels of fatness associated with size at birth. These findings have implications for the evaluation of the growth of young children. The results indicate that intrauterine growth is associated with size in early childhood. Particularly, children born LGA may be at risk for accumulating excess fat at these ages. Birth weight status and gestational age may be useful in as- sembling a prognostic risk profile for children. Pediatrics 1999;104(3). URL: http://www.pediatrics.org/cgi/content/ full/104/3/e33; blacks, birth weight, growth, large-for-ges- tational-age, multiple imputation, Mexican–Americans, National Health and Nutrition Examination Survey, small-for-gestational age, whites.

Small for gestational age infants (SGA) represent a signif- icant percentage of infants admitted to the Neonatal Intensive care units (NICU). There are a number of studies comparing premature small for gestational age (SGA) infants with appropriate for gestational age (AGA) infants, for differences in their mortality and morbidity [1-8] Although there is a consensus that premature SGA infants have higher mortality than AGA infants, the differences in outcomes regarding respiratory and non-respiratory mor- bidity are controversial. The discrepancies between differ- ent studies may partly be explained by variations in gestational age (GA) of the study populations and by the studies' failure to stratify the study population by GA. Moreover, several of these studies used birth weight per- centile curves from older norms, to determine whether the infant is SGA or AGA [9-11] and/or did not take into account the racial differences in birth weight.

T he term “small for gestational age” (SGA) de- scribes a neonate whose birth weight or birth crown-heel length is at least 2 standard devia- tions (SD) below the mean (ⱕ⫺2 SD) for the infant’s gestational age, based on data derived from a refer- ence population. SGA has also been defined in some publications as birth weight or length below the 10th, 5th, or 3rd percentile for gestational age. Although segregation of SGA from normal is somewhat arbi- trary, ⬍⫺ 2 SD was selected because it likely encom- passes the majority of patients with disordered fetal growth and because most studies that have defined postnatal growth patterns and response to growth- promoting therapies have selected patients whose birth size is approximately ⫺2 SD or less. Gestational age is most accurately gauged with the use of ultra- sonography during pregnancy 1 and the date of the

Introduction: The platelet indices offer valuable information about the morphology and maturity of platelets. These parameters are now available, but they are not reported because clinicians are not aware that they are available, and the reference ranges with which the patient results should be interpreted are not known. The main aim of present study is to compare blood platelet indices in small for gestational age neonates and appropriate for gestational age neonates admitted in the department of paediatrics. Methods: 140 number of platelet count and its indices were derived from automated haematology analyser SYSMEX Xs1000i for neonates born in PES institute of medical sciences and research and other neonatal cases referred for management of disease conditions. Results: In our prospective study out of 140 neonates, 84 (60%) male and 56 (40%) were female. Platelet count (0.007) and plateletcrit (0.010) was lower in 17 (12.1%) small for gestational age neonates (SGA) compared to 123 (87.9%) appropriated for gestational age neonates and it was statistically significant. Conclusion: The current study proved that platelet indices values play some significant role between small for gestational age neonates and appropriate for gestational age neonates. Further studies will be needed in clinical application of platelet indices in neonates.

pregnancy such as premature delivery, bacterial vaginosis, hypertension, and gestational diabetes. Caesarian section is four times more common among women with low levels of 25-OH-D than women with normal levels of vitamin D (4-9). Vitamin D deficiency during pregnancy may also have a relation with the risk of developing small for gestational age (SGA) newborns (10-13). In general, 4-7% of all born infants in developed countries are SGA. This prevalence depends on the population under study, geographical concentration and the standard curve used as reference for assessing infants (14, 15).

Current research does not adequately characterise the human milk of mothers with SGA infants, in this case report we describe altered milk composition and volume, indicating that placental insufficiency (with GDM) in humans could impact lactation. Further investigation is warranted in humans, with a more comprehensive study design for pregnancy complications such as being born small for gestational age or the mother having GDM (in- cluding maternal glucose tolerance testing, ultrasound, placenta histology, and collection of other clinical data). Future human milk research in this area is essential in order to determine whether pregnancy complications, such as growth restriction, placental insufficiency and GDM, are linked to poor lactation outcomes.

There are three major methods currently used for gestational age estimation: Ultrasound Scans (USS), Last Menstrual Period (LMP), and clinical assessment such as the Ballard Score [9]. USS are prenatal and accurate to within a day if performed early in pregnancy [6]. However, USS machines can be inaccurate if used outside the first trimester and are expensive and not deployable to many rural areas [9]. Additionally, they require trained personnel to use them, and report biased estimations for very large or small fetuses [9]. The LMP and Ballard methods, in comparison, are postna- tal, low-cost and easy to deploy [10], [11]. The LMP method calculates the gestational age of a baby from the mother’s last menstruation until the birth of the baby [9]. On the other had, the Ballard score (shown in Fig. 2) looks at two different sets of measurements regarding the newborn: Neuromuscular and Physical criteria. Neuromuscular criteria include posture, square window, arm recoil, popliteal angle, scarf sign, and heel to ear measurements, while Physical criteria include skin, ear/eye, lanugo hair, plantar surface, breast bud and genital measurements. Using the LMP entails estimation problems due to uncertainty, very often due to bleeding not related to periods or delayed ovulation, and using the Ballard Score is reported to be subjective, dependent on the clinicians’ experience and, overall, inaccurate [9].

Accurate determination of gestational age is essential for a diagnosis of SGA. The menstrual history of the mother and the use of ultrasound, usually in week 16 of gestation, increase the accuracy of the estimation. When this information is not available, physical examination of the newborn can be helpful (Ballard score [19]). Mea- surements of birth weight, length, and head circumfer- ence should be performed by trained personnel and follow appropriate, standardized procedures. The accu- racy of newborn body measurements is paramount. Electronic scales for measuring weight and paper tapes for measuring head circumference are considered reli- able methods [20-22]. Head circumference should be assessed at birth, as well as at first pediatric analysis during the first month of life in order to derive a more consistent measurement. Measurement of an infant ’ s length can be less reliable [20,23], but its accuracy may be improved if the infant is measured by 2 people using a headboard [20,24]. The values should be compared with population-specific reference tables, allowing for classification as AGA or SGA, according to the chosen definition [25]. Country-specific reference charts for size at birth are preferred [26], but in some Latin American countries, these specific reference charts for size at birth are still unavailable. There is a critical need to develop reference charts for size at birth in each country, other- wise the definition of SGA could still be misleading in certain areas.

Kapitulnik J, Kaufmann NA, Blondheim SH, et al: Effect of light on bilirubin binding by serum, in Brown AK, Showacre J (eds): Phototherapy for Neonatal Hyperbiliru- binemiw Long-Term Imp[r]

Selection of the most useful single biometric pa- rameter depends on the timing and purpose of mea- surement; crown-rump length is the best parameter for early dating of pregnancy, whereas biparietal diameter maintains the closest correlation with ges- tational age in the second trimester. When ultra- sound rather than LMP is used to determine gesta- tional age, birth weight percentiles are lower early in gestation and greater late in gestation. Accordingly, as the institutional use of ultrasonography rather than LMP for gestational dating has increased, there has been a decrease in the mean gestational age by approximately 1 week, accompanied by a recorded increase in the preterm delivery rate. 44 Ideally, intra-