This presentation is aimed at giving the basic information of a neonate classification on basis of gestational age and the birth weight. Prematurity has been discussed in details. I have also included the growth charts that can be used for growth monitoring in term as well as preterm babies. ** This presentation is available in a video lecture format at my youtube channel - NeonatoHub. Do watch it for further understanding of the topic & subscribe to the channel.

1. Birth weight
&
Gestation……
Presented by :
Dr. Sonali Paradhi Mhatre

2. Basics :
• Gestation is measured in
weeks starting from the
first day of the last
menses.
• Pregnancy gestation
considered Full Term is
between 39 to 41 wks
6days.
• Infants born before 37
weeks are considered
premature. Infants born
after 42 weeks are
considered postmature.
Dr. Sonali Paradhi Mhatre

3. Classification by Gestational (Postmenstrual) age
Dr. Sonali Paradhi Mhatre

4. As per the latest guidelines by the ACOG &
SMFM,
Dr. Sonali Paradhi Mhatre

6. Dr. Sonali Paradhi Mhatre
New Ballard Scoring – Physical Maturity Criteria

7. Dr. Sonali Paradhi Mhatre
New Ballard Scoring – Neuromuscular Maturity Criteria

8. Signs of Prematurity
 Body hair (lanugo)
 Small scrotum, smooth without ridges, and undescended testicles
(male infant)
 Enlarged clitoris (female infant)
 Lower muscle tone and less activity than full-term infants.
 Less body fat
 Soft, flexible ear cartilage
 Thin, smooth, shiny skin, which is often transparent (can see veins
under skin)
 Problems breathing due to immature lungs (neonatal respiratory
distress syndrome) or pneumonia
 Problems feeding due to difficulty sucking or coordinating swallowing
and breathing
 Abnormal breathing patterns (shallow, irregular pauses in breathing
called apnea)
Dr. Sonali Paradhi Mhatre

9. Possible complications of Prematurity
Hypothermia
Hypoglycemia
Anemia / Polycythemia
Hyperbilirubinemia
Hypocalcemia
Respiratory Distress Syndrome
Intraventricular hemorrhage / Periventricular leukomalacia.
Sepsis
Patent ducturs arteriosus
Necrotizing enterocolitis
Apnea of Prematurity.
Possible long-time complications include:
Bronchopulmonary dysplasia (BPD)
Delayed growth and development
Mental or physical disability or delay
Retinopathy of prematurity, vision loss, or blindness
Dr. Sonali Paradhi Mhatre

10. Birth
weight
Dr. Sonali Paradhi Mhatre

11. Classification by Birth weight
Dr. Sonali Paradhi Mhatre

12. Intrauterine
growth
assessment
charts
1. Female – Birth
weight &
gestational age.
Dr. Sonali Paradhi Mhatre

13. Intrauterine
growth
assessment
charts
2. Female – length ,
head circumference &
gestational age.
Dr. Sonali Paradhi Mhatre

14. Intrauterine
growth
assessment
charts
3. Male – Birth weight
& gestational age.
Dr. Sonali Paradhi Mhatre

15. Intrauterine
growth
assessment
charts
4. Male – length ,
head circumference &
gestational age.
Dr. Sonali Paradhi Mhatre

16. Important terminologies
• AGA (Appropriate for gestational age) : 50th
Percentile of weight for particular gestation.
• SGA (Small for gestational age) : weight below the
10th percentile for the gestational age.
• LGA (Large for gestational age) : Birth weight
greater than the 90th percentile (2 standard
deviations above the mean)
Dr. Sonali Paradhi Mhatre

17. Dr. Sonali Paradhi Mhatre

18. Dr. Sonali Paradhi Mhatre

19. Types of IUGR
 Symmetric IUGR:
weight, length and head circumference are all below the
10th percentile. (33 % of IUGR Infants)
 Asymmetric IUGR:
weight is below the 10 th percentile and head
circumference and length are preserved. (55 % IUGR)
 Combined type IUGR:
Infant may have skeletal shortening, some reduction of
soft tissue mass. (12 % of IUGR)
Dr. Sonali Paradhi Mhatre

20. Dr. Sonali Paradhi Mhatre
WHO Growth charts

21. WHO Growth charts
Dr. Sonali Paradhi Mhatre

22. Growth charts for premature infants
• Normative growth data are available for healthy term infants. However,
data are limited for preterm infants during both hospitalization and after
discharge.
• The charts used for growth monitoring of preterm infants are :
• 1. National Institute of Child Health and Development (NICHD)
Growth Charts (Ehrenkranz)
• 2. Fenton charts
(The Fenton growth chart for preterm infants has been revised to
accommodate the World Health Organization Growth Standard and
reflect actual age instead of completed weeks, in order to improve
preterm infant growth monitoring.)
Dr. Sonali Paradhi Mhatre

23. Fenton
growth
chart
-Boys
Dr. Sonali Paradhi Mhatre

24. Fenton
Growth
charts
-girls
Dr. Sonali Paradhi Mhatre

25. Take Home Message ……
• Prematurity as well as Low birth weight in newborns is associated with
large amount of morbidity and mortality.
• Gestational agewise :
Preterm (<37wks gestation),
Term (37- 42 wks)
Postterm (>42wks gestation)
• Birth weight dependant classification :
Macrosomia (>4000gm)
Low birth wt (1500 – 2500 gm),
Very low birth weight (1000 – 1500 gm),
Extremely low birth weight (<1000gm)
Dr. Sonali Paradhi Mhatre
Term Gestation classification:
Early Term : Between 37wk0d to 38wk6d
Full Term : Between 39 wk0d to 40wk6d
Late Term : Between 41wk0d to 41wk6d

26. Cont….
• Neonates with weight below the 10th percentile for the gestational age
are termed as Small for gestational age.
• These SGA babies may be constitutionally small or IUGR (Intrauterine
growth Restriction)
• Growth charts are very helpful in the further growth monitoring of these
babies and are separately available for fullterm and preterm neonates.
• Symmetrical and Asymmetrical IUGR can be differentiated on the basis
of Ponderal index.
• The commonly used charts for preterm babies are : Ehrenkranz charts,
Fenton charts.
Dr. Sonali Paradhi Mhatre