a. Small for Gestational Age Infant (SGA).

The birth weight of a small for gestational age infant (SGA) infants fall below the tenth percentile for this given gestational age. These neonates may be preterm, full-term, or post term.

However, the defining characteristic specifies that they are small for their designated gestational age (see figure 11-1).

(1) Characteristics of the SGA infant are as follows:

(a) The infant appears thin and wasted; their skin is loose and dry.

(b) There is little subcutaneous fat; their face appears shrunken and wrinkled.

(c) The length and head size may be normal but the head looks really big in comparison to the rest of the body.

(2) The underlying cause of SGA infants is an interruption in the normal pattern of in utero growth of the fetal, placental, or of maternal origin. Factors considered are:

(a) Chromosomal abnormalities.

(b) Smoking.

(c) Alcohol consumption/narcotic abusers.

(d) Preeclamptic/eclamptic.

(e) Inadequate prenatal care.

(3) The following conditions occur more frequently in the SGA:

(a) Asphyxia. This tolerates labor poorly which is due to the decreased of metabolic stores of carbohydrates. The SGA is often resuscitated at birth.

(b) Meconium aspiration. The fetus grasps amniotic fluid containing meconium, or it occurs when the neonate takes his first breath. It may cause atelectasis, pneumothorax, or pneumonitis.

(c) Hypoglycemia. This is most likely to occur from 12 to 48 hours after birth but may also be noted within 6 hours if the infant is severely hypoxic. It may lead to neurological damage.

(d) Hypothermia. This is due to lack of subcutaneous fat.

(e) Polycythemia. This is frequently seen when SGA is due to placental insufficiency.

(f) Congenital anomalies. The genitourinary and cardiovascular systems are most common problem area.

NOTE: Congenital anomalies are defects or disorders present in the infant when born.

(4) Nursing care considerations.

(a) Monitor blood sugars according to local policy.

(b) Observe for signs of respiratory distress (grunting, flaring, retractions, apnea, and cyanosis).

(c) Monitor input and output (I&O), daily weights, and head circumference.

(d) Prevent hypothermia by maintaining thermal stability.

(e) Assess hematocrit according to local policy.

(f) Support the parents by listening to their concerns and answering questions.

b. Large for Gestational Age.

Large for gestational age (LGA) infants are those whose birth weight places them above the 90th percentile of normal for their gestational age.

(1) Conditions that occur frequently in the LGA infant are:

(a) Hypoglycemia. This is related to hyperinsulinism following birth.

(b) Hypocalcemia. This is associated with prematurity or asphyxia.

(c) Polycythemia. This is a complicated factor of decreased extracellular fluid.

(d) Hyperbilirubinemia. This may be influenced by decreased extracellular fluid and birth trauma hemorrhage.

(e) Respiratory distress syndrome. This is associated with premature delivery.

(f) Congenital anomalies.

(2) Nursing care considerations.

(a) Monitor the infant’s respiratory and temperature status.

(b) Monitor the infant’s levels of glucose, calcium, bilirubin, and hematocrit and hemoglobin per physician’s orders.

(c) Employ measures to prevent infection.