(Dysmaturität, intrauterine growth retardation)
Infants whose weight is in relation to gestational age <10th percentile are classified as SGA (small for gestational age). Complications are perinatal asphyxia, meconium aspiration, and hypoglycemia.
The Fenton growth curves allow a more accurate assessment of growth vs. Gestational age (Fenton growth curves for premature boys and Fenton growth curves for premature girls).
Infants whose weight is in relation to gestational age <10th percentile are classified as SGA (small for gestational age). Complications are perinatal asphyxia, meconium aspiration, and hypoglycemia. The Fenton growth curves allow a more accurate assessment of growth vs. Gestational age (Fenton growth curves for premature boys and Fenton growth curves for premature girls). Etiology The causes can be divided into those where the growth retardation is Balanced: height, weight and head circumference are affected about the same. is asymmetric: First of all, the weight is concerned, during the growth of the brain and head, and the long bones is less affected. A symmetrical growth retardation typically results from a fetal problem that begins early in pregnancy, often during the first trimester. If the cause begins relatively early in pregnancy, the entire body is affected, resulting in fewer cells of all types. Common causes include many genetic disorders Congenital infection in the first trimester (z. B. with cytomegalovirus, rubella virus or Toxoplasma gondii) An asymmetric growth retardation typically results from a problem of the placenta or the mother, which is typically the second or 3rd trimester manifested. If the cause begins relatively late in pregnancy, organs and tissues are not affected equally, resulting in asymmetric growth retardation. Common causes include placental insufficiency due to maternal disease that affects the small blood vessels (eg. As preeclampsia [pre-eclampsia and eclampsia], hypertension [Hypertension in pregnancy], kidney disease [renal insufficiency during pregnancy], antiphospholipid antibody syndrome [antiphospholipid antibody syndrome ( APS)], long-standing diabetes) Relative placental insufficiency, which is caused by multiple pregnancy Plazentainvolution that a transfer accompanied Chronic maternal hypoxemia caused by lung or heart disease malnutrition of the mother conception using assisted reproduction an infant may also have an asymmetric growth retardation and small for his gestational age be (SGA, SGA -children) if the mother during pregnancy is a serious groove is Zerin of opioids, cocaine, alcohol and / or tobacco. Symptoms and complaints Despite their small size show SGA children's physical characteristics (eg., Skin texture, ear cartilage, sole) and behavior (eg. As vigilance, spontaneous activity, drinking pleasure) are similar to those of normal-sized children of the same gestational age. However, they may appear thin with reduced muscle mass and decreased subcutaneous fat. The features may be similar to those of an elderly person sunken look ( "wizened facies"). The umbilical cord may look thin and small. Complications maturity SGA children do not have the same complications that are found in the same weight preterm infants due to the Organunreife. However, they are at risk of perinatal asphyxia meconium aspiration hypoglycemia hypothermia Perinatal asphyxia during labor is the most serious potential complication. If growth retardation is due to placental insufficiency (with such a barely adequate perfusion), it means a particular risk because each uterine contraction slows the maternal placental blood flow by compressing the spiral arteries or completely brings to a halt. Therefore, the fetus should be judged in suspected placental insufficiency before the onset of labor pains and heart rate are monitored during labor. When it comes to a significant impairment of the child, is a fast delivery, often then indexed as a caesarean section. For meconium aspiration may occur during perinatal asphyxia. SGA infants, v. a. transmitted, meconium can deliver into the amniotic sac and begin with deep breathing movements. By aspirated meconium it is then very likely to a meconium aspiration syndrome (often more severe with IUGR or transmitted children because the meconium in these cases is dispersed in a small amount of amniotic fluid and thus a higher concentration of HAT meconium aspiration syndrome). Hypoglycaemia often occurs in the first few days or hours because sufficient glycogen synthesis and therefore reduced Glykosespeicher exist, and must be treated quickly with intravenous glucose (neonatal hypoglycemia). Polycythemia (polycythemia Perinatal and hyperviscosity syndrome) is created by SGA fetuses as a result of mild chronic hypoxia due to placental insufficiency. The Erythropoetinfreisetzung is amplified and leads to increased red blood cell formation. The newborn with polycythemia at birth looks dark and can be tachypneic and lethargic. Hypothermia (hypothermia in neonates) may occur due to the impaired thermoregulation, which relates to several factors, including increased heat loss due to the loss of subcutaneous fat, reduced heat generation due to the intrauterine stress and the reduction of nutrient storage, and increased surface to volume ratio due to the low Height. SGA infants should be kept in a thermo-neutral environment to minimize the O2 consumption. Prognosis If asphyxia can prevent the neurological prognosis for a mature born SGA infant is good. But is later in life probably an increased risk of ischemic heart disease, hypertension and strokes, which is believed that it is caused by the abnormal vascular development. Children who are too small for their gestational age due to genetic factors, congenital infections, maternal medications or drugs, have a worse prognosis, depending on the exact diagnosis. If the intrauterine growth retardation caused by a chronic placental insufficiency, adequate nutrition can lead to the SGA child shows a remarkable Catch-up growth after birth. Therapy Supportive care The problems and complications which they relate. There is no specific treatment of the SGA condition; prevention is supported in that in the pre-natal counseling avoidance of alcohol, cigarette and drug abuse is emphasized. Important points Infants whose weight is in relation to gestational age <10th percentile are SGA (small for gestational age). Diseases that occur early during pregnancy, causing a symmetrical growth retardation, are about equally affected in body weight, body length and head circumference. Diseases that occur late in pregnancy, causing asymmetric growth retardation, in which the weight is the most affected and the brain, skull and long bones grow relatively normal. Although they are small, SGA infants do not have the same complications that are found in the same weight preterm infants due to the Organunreife. The complications are mainly those of the underlying cause, but also generally include perinatal asphyxia, meconium aspiration, hypoglycemia, polycythemia, and hypothermia.