Gestational age assessment of infant
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Transcript of Gestational age assessment of infant
Gestational Age
An appropriate for gestational age
AGA
a fetus or newborn infant whose size is within the normal range for height, weight, head size, and developmental level for a child of the same gestational age and gender.
full-term infant is heavier than 2,5kg (about 5.5 lbs.) and lighter than 4 kg (about 8.75 lbs.).
• . The gestational age can be determined by physical criteria & neurological criteria according to estimated NBS score…
• An AGA baby tends to have the lowest risk for any problems. AGA babies have lower rate of disease and death than babies that are small or large for their gestational age
• The mortality rate of full term babies is 0.69 per 1,000 live births.
The main cause of death: congenital anomalies (64.5%), specifically
cardiac anomalies. chromosomal anomalies or syndromes
(12.9%)labor complications (12.9%) infections (3.2%) congenital diseases (3.2%) and metabolic disorders (3.2%).
Small for gestational age
• Infant born at weight less than the 10th percentile for age .
• low birth weight (LBW), an infant with a weight less than 2500 g regardless of gestational age at time of birth.
• very low birth weight infants, weighting less than 1500g .
• 6-7% of all births and 70% of neonatal death
CausesGenetic (down syndrome – renal agenesis – congenital heart disease )Fetal rubella infectionreduce fetal production of insulin and insulin like growth factor IUGR is the most common cause Maternal factors associated with LBW caused by premature birth or
IUGR include : previous low birth weight low socioeconomic status low level of maternal education no antenatal care maternal age younger than 16years or older than 35years short interval between pregnancies cigarette smoking, alcohol and illicit drug use psychological stresses(poor social support) poor weight gain during pregnancy(less than10Ib) low prepregnancy weight(lessthan45kg) African-american women
complication
Birth asphyxia . Respiratory distress syndrome . hypoglycemia. Failure-to-Thrive. Infection (sepsis, pneumonia, gastroenteritis ) Jaundice Cardiac (PDA) Neurologic (hemorrhage , seizures )
Large for gestationel Age
Infant born at weight greater than the 90th percentile for age .
Macrosomia confused with LGA . 1 out of 10 women .
causes
Gestational age; beyond 40 weeks Fetal sex; male infant Excessive maternal weight gain Multiparity (3 times risk than primparus ) Congenital anomalies (transposition of great
vessels) Erythroblastosis fetalis - Hydrops fetalis Use antibiotics (amoxicillin, pivampicillin) during
pregnancy Genetic disorders of overgrowth (e.g. Beckwith–
Wiedemann syndrome, Sotos syndrome)
complication
Metrnal :reason for an induction (16%), and for C-S(9%)
Child:shoulder dystocia .hypoglycemia .Meconium aspiration syndrome .Congenital heart disease .3% risk for diabetes
Diagnosis
us Fundal height
DiagnosisUsUS not good informative about weight so cannot be diagnosed until after birth .
Fundal heightMore than 2 cm larger than expected ….LGALess than 2 cm smaller than expected ….SGA
1 of 3 is accurate
Assessments for newborn babies
1- Apgar score .
2- weight .
2- Ballard criteria .
Apgar score Asses the need for resuscitation at intervals 1-5 minutes
Apgar score 0 - 3 Cardiopulmonary arrest Sever bradycardia , hypoventilation , CNS depression
4 - 7Close monitoring
>8normal
Weight
Macrosomic . > 4000 g
LBW . < 2500 g
VLBW . < 1500 g
Must apply on chart .
Ear—The preterm infant’s ear cartilages are poorly developed,and the ear may fold easily; the hair is fine andfeathery, and lanugo may cover the back and face. Themature infant’s ear cartilages are well formed, and thehair is more likely to form firm, separate strands.
Sole—The sole of the foot of the preterm infant appearsmore turgid and may have only fine wrinkles. The matureinfant’s sole (foot) is well and deeply creased.
Female genitalia—The preterm female infant’s clitoris isprominent, and labia majora are poorly developed andgaping. The mature female infant’s labia majora are fullydeveloped, and the clitoris is not as prominent.
Male genitalia—The preterm male infant’s scrotum is undevelopedand not pendulous; minimal rugae are present,and the testes may be in the inguinal canals or in the abdominalcavity. The term male infant’s scrotum is welldeveloped, pendulous, and rugated, and the testes arewell down in the scrotal sac.
Grasp reflex—The preterm infant’s grasp is weak; theterm infant’s grasp is strong, allowing the infant to be lifted up from the mattress.