SMALL FOR GESTATIONAL AGE

This term refers to a baby whose birth weight is below 10^th percentile of his gestational age commonly referred to as low birth weight but this includes preterm babies.

They are susceptible to various problems including:

ü Congenital abnormalities

ü Foetal hypoxia that may lead to intrapartal death

ü Birth asphyxia due to inadequate perfusion, meconium aspiration leading to airway obstruction.

ü Hypothermia due to little subcutaneous tissues

ü Apnoeic attacks hypoglycemia

 SIGNS AND SYMPTOMS

ü Mostly they are born after 37 weeks.

ü Pale, dry loose skin with wrinkles and have little or no lanugo

ü Subcutaneous fat is minimal

ü Shows features of retarded growth

ü  The abdomen appears sunken

ü  Sutures and fontanel appear normal

ü Eyes are alert and has mature facial expression

ü Skull bones are hard and allow little mobility

ü Have strong cry

ü Umbilical cord is thin

ü Swallowing and sucking reflexes are present so they feed well

ü Normal muscle tone are active

NURSING MANAGEMENT

 

· The baby is predisposed to the risks similar to those of preterm baby thus the management principles are the same.

· Management should start in labour by closely monitoring foetal condition for signs of foetal distress.

· In case of foetal distress in the first stage, administer oxygen to the mother and start IV drip of 10% dextrose as you prepare the mother for emergency caesarian section. If in second stage, the delivery is hastened by giving generous episiotomy.

· Since the baby is prone to hypoglycaemia, it should be stared on breastfeeding as soon as possible.

· Gastric lavage should be done with warm dextrose before breastfeeding.

· Substitutes are given if there is no breast milk. The feed is calculated at 90 mls/kg of body weight in 24 hrs in 8 divided doses i.e. 3 hourly feeding.

· Closely observe vital signs TPR and signs of infection.

· The baby should be nursed in a warm environment to prevent hypothermia although it has temperature regulating mechanism.

· Closely monitor blood sugar to rule out hypoglycaemia.

· Weigh the baby on alternate days to monitor the progress. Usually weight loss is minimal and it gains weight more rapidly and steadily than preterm.

· Teach the mother how to take care of the delicate skin that may be dry, cracked or peeling.

COMPLICATIONS

· Hypoglycaemia

· Respiratory distress syndrome

· Aspiration pneumonia

· Brain damage