Dr Giridhar Sethuraman

Associate Professor, Department of Neonatology

Chettinad Hospital and Research instituteChennai, Tamilnadu

D.M. (Neonatology)

Non – nutritional causes of Failure to thrive

Dr. S. Giridhar M.D;D.M Associate Professor of Neonatology

Chettinad Hospital and Research Institute, Chennai, India

giridharsethu@gmail.com

+919841027228

Identifying FTT

Different presentations of FTT

Underlying etiologies and their identification

Approach

Overview

Baby girl S

• Delivered to a primigravida mother at term.

• Normal delivery

• Birth Weight 3.2 kg

• Length 49 cm

• Head circumference 34.5 cm

4

• Back on Day 15 for complaint of loose stools

• Weight 3 kgIS THIS FAILURE TO THRIVE ?

“Definition”

Defining FTT Use growth charts

Weight decrease of ≥ 2 major centiles

Daily increase is less than expected

Weight for length < 10th centile

Organic 30%

Types of FTT

Non – Organic 70%

Failure to Thrive

What we must do?

Approach

Failure to thrive

Rapid Weight Loss

Progressive Weight loss or not gaining weight

Rapid Weight Loss

Life – threatening conditions

• Acute decompensation in the neonatal period with lethargy, vomiting, seizures,

consanguinity and unexplained sib deaths

Inborn error of metabolism

• Recurrent non-bilious/ bilious vomiting

Pyloric stenosis / Malrotation

• History of ambiguous genitalia in a female infant or a positive screen for congenital

adrenal hyperplasia

CAH

• Fever, vomiting, loose stools, feed refusal with fever

Dehydration

• Tachypnea, diaphoresis, or cyanosis with feeding

• Congenital Heart Disease

When do we think Metabolic ?

If the child:

• Looks bad

• Smells bad

• Feels bad

• Tastes bad

• Sounds bad

Neonatal screen help us a lot…

Clues are always there

Salt – Losing CAH

Persistent, moderate

weight loss

Antenatal Clues

Some causes are obvious…

Post NEC – Short Gut Syndrome

Diligent clinical examination…

Vomiting – Never Ignore

Hypertrophic pyloric stenosis

What does this 4 week old with FTT have ?

Congenital Hyperthyroidism

3 ½ wk old with not gaining weight and “cold”

Stridor

Usually associated with GERD

2 neonates with FTT & Hypoplastic mandible with Microstomia

Treacher CollinsPierre Robin

10 weeks old with FTT

Neonatal Cholestasis

Investigations

Rule 1

• If Hx and Exam is negative – Mostly inadequate nutrition

• Do not investigate if well

Rule 2

• No Fishing

• Hx and Exam should guide investigations

Rule 3

• Start with simple & non invasive

• Proceed to complex & invasive

Copyrights apply

Baby S

Mother was reassured

regarding loose stools

Feeding assessed, reinforced

She was seen at vaccination visits

• 6 weeks 4 kg

• 10 weeks 4.9 kg

• 14 weeks 5.4 kg

• 6 m 1 w 6.2 kg

• 8 m 3 w 7.0 kg

97th

50th

3rd

1st

Baby S

Take Home Messages

Growth charts help us to suspect and monitor FTT

History and physical exam are the most valuable tool

Use labs to supplement history and physical examination

Routine Neonatal Screening could help in avoiding catastrophies

Thank you