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What happens in discordant twins?

There is a disruption to the placenta to 1 twin, which causes significant decrease in size of that twin.


When is a baby defined as small for gestational age?

If the length and weight are below the 3rd centile.


What causes the increase in size of a macrosomic baby?

  • The high blood sugar of the mother causes the β-cells of the foetus' pancreas to overproduce insulin
  • Insulin is a potent growth factor so leads to an accelerated growth pattern


What can cause isolated adrenache?

Increased levels of dihydroepiandrosterone (secreted from the adrenal glands).


What are the risks of foetal/infantile growth for later life?

Increased risk of:

  • Ischaemic heart disease
  • Type II diabetes
  • Developmental and behavioural problems


What are the symptoms of Turner's syndrome?

  • Dysmorphia - Short stature, low set ears and hairline and webbed neck
  • Cognitive impairment
  • Gonadal dysfunction
  • Diffuse systemic symptoms.


What is the upper limit to which growth hormones may be given to a baby who is small for gestational age?

Usually around 4 years old, as if they haven't responded by this time, they are usually resistant to growth hormone.


What are the symptoms of Down's syndrome?

  • Dysmorphia - Small chin, up-slanting eyes and oversized tongue
  • Short stature
  • Cognitive impairment


What are the features of Noonan Syndrome?

  • Affects 1 in 1500; both males and females
  • Dysmorphia - short stature, low set ears, webbed neck
  • Cognitive impairment
  • Indented chest
  • Bleeding tendancy


What are the symptoms of Foetal alcohol syndrome?

  • Low birth weight
  • Faltering growth
  • Developmental delay
  • Behavioural problems
  • Facial features; epicanthal folds, flat nasal bridge, upturned nose, smooth philtrum and thin upper lip.


What medical conditions may lead to faltering growth?

  • Coeliac - Malabsorption of nutrients
  • CF & Crohn's - hinderance of nutrition
  • Down's syndrome
  • Isolated growth hormone deficiency
  • Hypothyroidism