Neonatal clinical Assessment for IUGR newborn
1. Reduced birthwight for gestational age.
2. Physical appearance:
When infants with congenital malformation syndromes and infections are excluded, the remaining groups of FGR infants have a characteristic physical appearance:
- These infants, in general, are thin with loose, peeling skin because of loss of subcutaneous tissue, a scaphoid abdomen (must be distinguished from infants with diaphragmatic hernias), and disproportionately large head.
- Senile face.
- Cranial sutures may be widened or overriding, and the anterior fontanelle may be larger than expected, representing diminished membranous bone formation.
- Vernix caseosa frequently is reduced or absent as a result of diminished skin perfusion during periods of fetal distress or because of depressed synthesis of estriol, which normally enhances vernix production. In the absence of this protective covering, the skin is continuously exposed to amniotic fluid and will begin to desquamate.
- Sole creases appear more mature due to increased wrinkling from increased exposure to amniotic fluid.
- Breast tissue formation also depends on peripheral blood flow and estriol levels and will be reduced.
- female external genitalia will appear less mature because of the absence of the perineal adipose tissue covering the labia.
- Ear cartilage also may be diminished.
- The umbilical cord often is thinner than usual. When meconium has been passed in utero, the cord is yellow-green stained, as are the nails and skin.
- Cerebral cortical convolutions, renal glomeruli and alveolar maturation all relate to gestational age and are not delayed with IUGR.
3. Neurologic examination for gestational age assessment may be little affected by IUGR. These infants often appear to have advanced neurologic maturity, although this observation is derived mostly from comparisons with infants of similar birth weight, not similar gestational age.
4. Peripheral nerve conduction velocity and visual or auditory evoked responses correlate well with gestational age and are not impaired as a result of IUGR.
5. Appropriate growth charts should be used.
7. Ballard score.
8. Bone ossification may be retarded.
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