Pathophysiology

3) Placental Factors:
Placental insufficiency ( most imp in 3
rd
trimester)
Anatomic problems:
Multiple infarcts
Aberrant cord insertions
Umbilical vascular thrombosis & hemangiomas
Premature placental separation
Small Placenta
Postnatal Assessment
Growth parameters: weight, height, HC
Assess GA with Ballard score.
Plotted growth parameters in growth chart

Physical Appearance

Physical appearance:

Heads are disproportionately large for their
trunks and extremities
Facial appearance has been likened to that
of a wizened old man.
Long nails.
Scaphoid abdomen

Signs of recent wasting
- soft tissue wasting
- diminished skin fold thickness
- decrease breast tissue
- reduced thigh circumference
Signs of long term growth failure
- Widened skull sutures, large fontanelles
- shortened crown heel length
- delayed development of epiphyses
Comparison to premature infants,IUGR has brain
and heart larger in proportion to the body weight,
in contrast the liver, spleen, adrenals and thymus
are smaller.

Complication
Hypoxia
- Perinatal asphyxia
- Persistent pulmonary hypertension
- meconium aspiration
Thermoregulation
- Hypothermia due to diminished
subcutaneous fat and elevated
surface/volume ratio
Complications
Metabolic
- Hypoglycemia
- result from inadequate glycogen stores.
- diminished gluconeogenesis.
- increased BMR
- Hypocalcemia
- due to high serum glucagon level, which
stimulate calcitonin excretion
Complications
Hematologic
- hyperviscosity and polycythemia due to
increase erythropoietin level sec. to hypoxia
Immunologic
- IUGR have increased protein catabolism
and decreased in protein, prealbumin and
immunoglobulins, which decreased humoral
and cellular immunity.

Management
Antenatal diagnosis and management is the
key to proper management of IUGR
Delivery and Resuscitation
- appropriate timing of delivery
- skilled resuscitation should be available
- prevention of heat loss
Hypoglycemia
- close monitoring of blood glucose
- early treatment ( IV dextrose, early feeding )
Management
Hematological Disorder
- central Hct to detect polycythemia
- CBC with diff to r/o leukopenia or thrombocytopenia
Congenital infection
- infant should be examined for signs of congenital
infection (eg.rash, microcephaly hepatosplenomegaly,
lymphadenopathy, cardiac anomalies etc.)
- TORCH titer screening
- Viral cx of urine, nasopharynx
- Head CT to r/o calcification

Management
Genetic anomalies
- screening as indicated by physical exam
- chromosomal analysis (infant with
dysmorphic features)
Others
- serum calcium to r/o hypocalcemia
- fractionated bilirubin sec to polycythmia,
congenital infection
- urine, meconium tox for substance abuse


Management
Early feeding and caloric intake should be
100-120 kcal/kg/d
Developmental and growth f/u in all IUGR
infants
Outcome
Symmetric vs. Asymmetric IUGR
- symmetric has poor outcome compare to asymmetric
Preterm IUGR has high incidence of abnormalities
IUGR with chromosomal disease has 100%
incidence of handicap
Congenital infection has poor outcome - handicap
rate > 50%
IUGR has higher rate of learning disability.

Thank You