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*Small for dates:.

The small-for-date babies are often full term or


borderline term in gestation. When their birth weight is plotted on the
intrauterine growth chart, it falls below the 10th centile. Any baby at
birth may be classified based on gestation into preterm, term or
postterm and on the birth weight into small-for- dates (SFD)
If you compare the head circumference with chest circumference, it is
easy to identify a small-for-dates baby. Normally, the head is bigger
than the chest by about 2 cm. In small- for-date babies, the head
circumference exceeds the chest circumference by more than 3 cm.
*Appropriate-for-dates (AFD): babies with a birth weight between
10th to 90th percentile for the period of their gestational age .also
termed as a appropriate for gestational age.(AGA)
*large-for-dates (LFD): babies with a birth weight more than 90th
percentile for the period of their gestational age. the neonate with a
birth weight than 97 percentile for their gestationa are at high risk
and should be monitored for hypoglycemia. Also termed as a heavyfor-dates or large for gestation age (LAG).
*Preterm baby: A baby born with a gestational age of less than 37
completed weeks is termed as preterm baby. also termed as a
immature, early born, or premature.
*Term baby: A baby born with a gestational age between 37 to41
weeks is called as term baby.
*Post term baby: A baby born with a gestational age of 42 weeks or
more is called post term baby.
The neonates divided in to 9 sub groups
Pre term

-Small for date


-Appropriate for
date
-Large for date

Term
-Small for date
-Appropriate for
date
Post term

-Large for date


-Small for date
-Appropriate for
date

-Large for date

Clinical manifestations

Length < 44cm


Weight 2,500g-2,500g
Head circumference disproportionally exceeds than that of chest
The skin is shiny, due to lack of subcutaneous tissues fats and
covered by launugo and vernix caseosa
Pinnae of the ear are soft
The are kept closed
Muscle tone is poor
The testis undescended
Labia minora is exposed, and there is tendency of herniation
The nails is not grown up to the finger tips
Poor reflexes
grunting, and
cyanosis. Because of the immature respiratory control
mechanisms these babies also have a tendency for apneic spells.
Fast breathing (RR>60/min)
Severe chest in-drawing
Apnea
Convulsions
Fever (>37.50 C) or low temperature
They may not establish respiration satisfactorily at birth and
develop asphyxia necessitating expert resuscitation.

Management
Adequate resuscitation, temperature regulation, oxygen
therapy
Fluid and electrolyte balance, adequate nutrition
Management of hyperbilirubinemia, infection treatment with
appropriate antibiotics
NURSING MANAGEMENT
1.Care at birth
Suitable place of delivery 'in-utero' transfer to a place optimum
facilities if a LBW delivery is anticipated.
Prevention of hypothermia
Effecient resuscitation.
2. Appropriate place of care
Birth weight > 1800 g: Home care, if the baby is otherwise well.
Birth weight 1500-1800 g; Secondary level newborn unit
Birth weight < 1500 g: Tertiary level newborn care (or intensive
care)
3. Thermal protection
Delay bathing.
Maternal contact.
Kangaroo mother care.
Warm room.
External heat source (incubator, radiant warmer)
4. Fluids and feeds
Intravenous fluids for very small babies and those who are sick.
Expressed breast milk with gavage or katori spoon.
Direct breastfeeding.
5. Monitoring and early detection of complications
Weight and other clinical signs.
Electronic monitoring
Biochemical monitoring
6. Appropriate management of specific complications
Newborn babies keep themselves warm by active metabolism in
the brown fat stores.,
IMMUNIZATION :Administer 0 day vaccines on the day of
discharge The dose is not reduced in preterm babies
FAMILY SUPPORT :Family should be constantly informed and
involved in care of baby The frightened seen of NICU should be
demystified
Complications
Meconium aspiration syndrome, neonatal asphyxia,
respiratory distress syndrome,
Hyperbilirubinemia,

patent ductus arteriosus,


ventricular brain hemorrhage
Hypothermia, hypoglycemia, hypocalcemia, Anemia, blood
clotting disorders
Infection, Retrolental fibroplasia