Fetal growth restriction and small-for-gestational-age infant — viva

Stem

The examiner hands you the antenatal summary of a 36-week infant: birthweight 2100 g (below the 3rd centile), maternal pre-eclampsia, absent end-diastolic flow on the umbilical artery Doppler, and a wasted neonate now in the nursery. ^[1]

Examiner: What is your opening approach to this infant? ^[1]

Strong answer: I would first classify this as fetal growth restriction rather than constitutional smallness, because the antenatal Doppler is abnormal and the infant is wasted. I would plot the weight, length and head circumference on a gestation- and sex-specific INTERGROWTH-21st chart, calculate the Ponderal Index, and judge symmetry. Then I would pre-empt the four neonatal complications — hypothermia, hypoglycaemia, polycythaemia and feeding difficulty — from the first feed, with warmth, early feeding, scheduled glucose monitoring and a selective haematocrit. ^{[3] [7]}