• Growth & development of fetus and neonate

depends on 2 factors:

1. Genetic

2. Environment
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 morbidity
and mortality
DM
Thalassemia
2. Fetal period from the 9th weeks  born
 Somatic change consist of :

Increase in cell number and size of

structural remodelling of several organs

system

 Changes in body proportion are depicted in

Figure 1.
Figure 1.

2 month 5 month neonatus

(fetus)
 Table1. Milestones of Prenatal Development
Week Developmental Events
1 Fertilization and implantation; beginning of embryonic period
2 Endoderm and ectoderm appear (bilaminar embryo)
3 First missed menstrual period; mesoderm appears (trilaminar embryo);
somites begin to form
4 Neural folds fuse; folding of embryo into human-like shape; arm and leg
buds appear; crown-rump length 4-5 mm
5 Lens placodes; primitive mouth, digital rays on hands
6 Primitive nose, philtrum, primary palate; crown-rump length 21-23 mm
7 Eyelids begin
8 Ovaries and testes distinguishable
9 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
30 Term
Figure 2.
Associated with certain condition:
A. Maternal characteristic
1. Age at delivery:
a. > 40 yr :
- chromosomal abnormalities
- Intrauterine growth restriction (IUGR)
- Blood loss (previa, abruption)
b. < 16 yr :
 IUGR
 Prematurity
 Child abuse/neglect
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
f. Trauma
B. Fetal conditions
1. Multiple gestation: prematurity, twin-twin transfusion syndrome,
IUGR, asphyixia, birth injury
2. IUGR, fetal demise, congeniotal anomaly, asphyxia,
hypoglicemia, polycythemia
3. Macrosomia: birth injury, congenital anomaly, hypoglicemia
4. Abnormal fetal position/presentation: congenital anomaly, birth
injury, hemorrhage.
5. Polyhidramnios: anencephaly, problem with swallowing (e.g
agnatia, esophageal atresia)
6. Olygohydramnion: renal agenesis, pulmonary hypoplasia, etc.
(Condition of labor and delivery)

Normal and spontaneous delivery, without

complications  enhanced normal growth Quality in the future
development

1. Prolonged labor
2. Rapid labor
3. Preterm or postterm delivery
4. Prolaps cord
5. Cesarian section: transient tachypnea of the newborn (TTN)
6. Obstetric analgesia and anesthesia
7. Placental anomalies, etc
(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
9. Pallor or shock
 •Socec factor
•Diet of the mother
•Environment

Nutritional status Nutritional status

Breastfeeding behavior
of the baby 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 newborn’s 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
0 24
5 26
10 28
15 30
20 32
25 34
30 36
35 38
40 40
45 42
50 44
26
 (Gram)
5000

4750 L G A
Intrauterine Growth curve
4500
PERSENTIL
Battaglia & Lubchenco 4250 90

4000
(1967)
3750

3500

3250

3000 A G A

2750

2500 PERSENTIL
10
2250

2000

1750

1500

LGA : large for gestational age 1250 S G A

AGA : Appropriate for gestational age 1000

SGA : Small for gestational age 750

500

24 26 28 30 32 34 36 37 38 40 42 44 46

Preterm Term Postterm 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 within 7 days for
full-term and 14 days for preterm.
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 head circumference is 33-
38 cm
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 infant’s 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 infant’s 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 baby failed to breath spontaneously,
regularly and adequately
Permanent impairment of CNS  must be
prevented and if its already happened 
have to be managed fast and precisely
2. Birth injuries
Risk factor :
 Primigravida
 Partus precipitatus
 Oligohydramnion
 Small maternal stature
 Use of midforceps or vacuum extraction, etc
3. Hypoglikemi :
 Blood glucose < 45 mg%
4. Hyperbilirubinemia
 Indirect bilirubin  Kern Icterus
 Hearing disturbance
 Mental retardation
Follow up  growth, mental development, eye
sight
5. Low birth weight baby
 Birth weight < 2500 g
 Risk factor  increased morbidity &
mortality
6. Infection