Growth & development of fetus and

neonate depends on 2 factors:

1.Genetic
2.Environment

CHILD

1. Before married
2. Pranatal
3. Intranatal
4. Postnatal (neonatal)

1. Genetic factor :
DM
Thalassemia
2. Chromosom abnormality
Down syndrome / mongolisme
Klinefeiter syndrome / turner
3. Mothers disease

1. Embryonic period (0-8 weeks)

Organogenesis
Factors that influence intrauterine
chromosom, gen

Vulnerable period : increased morbidit

and mortality
DM
Thalassemia
2. Fetal period from the 9th weeks born

Figure 1.

2 month
(fetus)

5 month

neonatus

Week

Table1. Milestones of Prenatal

Development
Developmental
Events

Fertilization and implantation; beginning of embryonic period

Endoderm and ectoderm appear (bilaminar embryo)

First missed menstrual period; mesoderm appears (trilaminar

embryo); somites begin to form

Neural folds fuse; folding of embryo into human-like shape; arm

and leg buds appear; crown-rump length 4-5 mm

Lens placodes; primitive mouth, digital rays on hands

Primitive nose, philtrum, primary palate; crown-rump length 2123 mm

Eyelids begin

Ovaries and testes distinguishable

Fetal period begins; crown-rump length 5 cm; weight 9 g

10

External genitals distiuishable

20

Usual lower limit of viability; weight 460 g; length 19 cm

25

Third trimester begins; weight 900 g; length 25 cm

28

Eyes open; fetus turns head down; weight 1,300 g

Figure 2.

Associated with certain condition:

A.Maternal characteristic
1. Age at delivery:
a. > 40 yr :
- chromosomal abnormality
- Intrauterine growth restriction (IUGR)
- Blood loss (previa, abrupttion)
b. < 20 yr :
IUGR
Prematurity

2. Personal Factor
a. Sosioeconomic : prematurity, infection, IUGR
b. Smoking: IUGR, increased perinatal mortality
c. Poor diet: mild IUGR
d. Trauma (acute or chronic): abruptio placentae,
fetal demise, prematurity

3. Medical condition:
a. Diabetes Mellitus : congenital anomaly,
stillbirth, RDS, hypoglycemia, macrosomia,
birth injury
b. Thyroid disease
c. Renal disease
d. Hypertension, etc

4. Obstetric history:
a. Past history of infant with : prematurity,
jaundice, RDS, anomaly
b. Medications
c. Bleeding in early or late pregnancy
d. Prematur
rupture
of
membarane
(PROM): infection, sepsis.
e. TORSCH

B. Fetal conditions
1.

Multiple
gestation:
prematurity,
twin-twin
transfusion syndrome, IUGR, asphyixia, birth injury

2.

IUGR, fetal demise, congeniotal

asphyxia, hypoglicemia, polycythemia

anomaly,

3. Macrosomia: birth injury, congenital anomaly,

hypoglicemia
4. Abnormal fetal position/presentation: congenital
anomaly, birth injury, hemorrhage.
5.

Polyhidramnios: anencephaly, problem

swallowing (e.g agnatia, esophageal atresia)

with

(Condition of labor and delivery)

Normal and spontaneous delivery,
without complications enhanced
normal growth development

Quality in the
future

1.

Premature labor

2.

Rapid labor

3.

Prolaps cord

4.

Cesarian section: transient tachypnea of the

newborn (TTN)

5.

Obstetric analgesia and anesthesia

6.

Placental anomalys

(Immediately evident neonatal condition)

1. Prematurity
2. Asphyxiated baby
3. Foul smell of amniotic fluid
infection
4. Small for gestational age(SGA)
5. Postmaturity
6. Birth injuries
7. Hypoglicemia
8. Hyperbilirubinemia

Socec factor
Diet of the
mother
Environment

Breastfeeding
behavior

Nutritional
status of the
baby

Nutritional
status of the
mother

The quality and

quantity of breast
milk

Humoral secretion

Amenore post
delivery

Classification of the Newborn

By gestational age :
Preterm < 37 completed weeks
Term 37 42 weeks
Post-term > 42 weeks

20

By birthweight :
Normal birth weight (NBW) 2500 4000 g
Low Birth weight (LBW) 1500 g - 2499 g
While most LBW infants are preterm, some are
term but small for gestational age (SGA).
LBW infants can be further subclassified as
follows :
Very Low Birth Weight (VLBW) 1000- 1499 g
Extremely Low Birth Weight (ELBW) < 1000 g
21

Physical characteristics
The physical signs that are most valuable in
the assessment of gestational age are ear
firmness, breast and genital development.
Tone and posture are also valuable

22

Assessment of newborns nutritional

status
Determined gestational age by Ballard Score
Measure the birth weight
Plot in the Lubchenco curve

Ballard score

24

25

Score

Weeks

-10

20

-5

22

24

26

10

28

15

30

20

32

25

34

30

36

35

38

40

40

45

42

50

44
26

Intrauterine Growth curve

Battaglia & Lubchenco
(1967)

LGA : large for gestational age

AGA : Appropriate for gestational age
SGA : Small for gestational age
27

AGA Appropriate for gestational age

LGA Large for gestational age above the 10 th percentile.
LGA can be seen in infants of diabetic mothers,
constitutionally large infants with large parents or infants with
hydrops fetalis
SGA / IUGR Small for gestational age below the 10 th
percentile
Commonly seen in infants of mother who have hypertension or
preeclampsia or smoke. This condition has also been
associated with TORCH infections, chromosomal abnormality
and other congenital malformations
Note : SGA baby is not always IUGR
28

Anthropometry
Serial measurement for growth evaluation is
needed :
a. Body weight :
Full-term baby 2,500-4,000 gram
Postnatal growth varies from intrauterine growth in
that it begins with a period of weight loss,
primarily through the loss of extracellular fluid.
The typical loss of 5-10% of BW for a full-term infant.
It may increased to as much as 15% of BW in infants
born preterm.
Our goals are to limit the degree and duration of
initial weight loss and to facilitate regain of BW

The time for gain the birth weight of

preterm baby is longer than full term baby
Increased of body weight begin in the 2nd
week
The range of body weight gain depends on
intrauterine growth (normal or not)
10-20 g/day or
20-30 g/day
Mean 1-3% body weight/day
Body weight measured everyday

b. Body length
Crown-foot length is 48-53 cm
Measured every week
Mean gain of body length :
Preterm

: 0,18-1,0 cm/week

Full term

: 0,69 0,75 cm/week

c. Head Circumference
Intrauterine growth 0,5 0,8 cm/week
as indicator of brain development
The

average

full

term

circumference is 33-38 cm

head

Resting posture loosely clenched fists & flexed

arms, hips, and knees.
Primitive Reflex normal found in the newborn :
Palmar grasp/ grasp reflex place a finger in
the palm of the infants hand and the infant will
grasp the finger
Rooting Reflex stroke the lip and the corner of
the cheek with a finger and the infant will turn
in that direction and open the mouth
33

Moro Reflex support the infant behind the upper

back with one hand, and then drop the infant back
1 cm or more to but not on the mattress. This
should cause the abduction of both arms and
extension of the fingers. Normally symmetry.
Asymmetry a fracture clavicle hemiparesis and
brachial plexus injury.
Reflex (-) intacranial bleeding, cerebral edema.

34

Neck righting reflex turn the infants head to

the right or left and movement of the contralateral
shoulder should be obtained in the same direction
Sucking Reflex placing a nipple in the mouth
Stepping and placing holding the infant upright
with the feet on the mattress and then making the
baby lean forward. This forward motion often sets
off a slow alternate stepping action.

35

1. Neonatal Asphyxia :
The condition where the baby fail to
spontaneous breathing, regular and
adequate
Permanent impaired of CNS must
be prevented and if its already
happens have to be managed
fast and precisely

2. Birth injuries
Risk factor :
Primigravida
Partus precipitatus
Oligohydramnion
3. Hypoglicemia :
Blood glucose < 45 mg%

4. Hyperbilirubinemia
Indirect bile Kern Icterus

Hearing disturbance

Mental retardation

Period follow up growth, mental

development, eye sight

5. Low birth weight baby

Birth weight < 2500 g
Risk factor increased morbidity &
mortality
6.

Infection