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Consultation with the specialist: prenatal growth: the sum of maternal, placental, and fetal contributions.

D. Oelberg

Published 2006 in Pediatrics in review

ABSTRACT

1. David G. Oelberg, MD* 1. *Professor of Pediatrics, Division Head, Neonatal Medicine, Department of Pediatrics, Center for Pediatric Research, Children’s Hospital of The King’s Daughters, Eastern Virginia Medical School, Norfolk, Va After completing this article, readers should be able to: 1. Differentiate the features of intrauterine growth restriction from those of small-for-gestational age and low-birthweight newborns. 2. Discuss patterns of abnormal fetal growth according to maternal, placental, and fetal causes. 3. Detect and diagnose abnormal prenatal growth. 4. Anticipate the short- and long-term consequences of abnormal prenatal growth. You are examining a term newborn of Filipino descent whose weight, length, and head circumference measurements are at the 3rd percentile for gestational age. Findings on his physical examination are normal. The pregnancy was monitored closely because of prior spontaneous miscarriages. Crown-rump length was restricted from the first trimester, and fetal head circumference, femur length, and abdominal circumference (as monitored sonographically every 2 to 4 weeks) remained less than the 10th percentile for gestational age throughout pregnancy. Normal amniotic fluid volume was noted, as well as normal Doppler studies of the umbilical and middle cerebral arteries. What is the most likely cause of the infant’s fetal growth restriction? What neonatal diagnostic tests are indicated? What are the infant’s long-term prognoses for growth and development? In the course of intrauterine development, the human embryo grows by increasing its length 5,000-fold, increasing its surface area 60 million-fold, and increasing its weight 6 billion-fold. Following birth, measurements of weight, length, and head circumference provide the best “screens” for appropriateness of prenatal growth. By definition, 95% (mean±2SD) of newborns have normal rates of prenatal growth that are based on normative data exhibiting bell-shaped distributions for the three markers. Restricted prenatal growth is defined by the 2.5% of small but normal newborns at the left ends of the distributions. Excessive prenatal growth is defined by the 2.5% of large, normal newborns at the right ends of the distributions. Although only 2.5% of American newborns would be expected to be born underweight based …

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