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PEDIATRIC NURSING CARE OF the SMALL FOR GESTATIONAL
NURSING CARE of AT- RISK/HIGH –
RISK/SICK CLIENT
Newborn, Infant and young infant
.. a variety of other factors influences the
outcomes of at-risk infants, including the
following:
IDENTIFICATION OF AT RISK NEWBORN
An at-risk newborn is one who:
• is susceptible to illness(morbidity)
• Death(mortality) because of dysmaturity,
immaturity, physical disorders, or
complications during or after birth
• In most cases, the infant is the product of
pregnancy involving one or more predictable
risk factors
Includes the following:
o Low socioeconomic level of the mother.
o Limited access to health care or no prenatal
care.
o Exposure to environmental dangers, such as
toxic chemicals and illicit drugs.
o Preexisting maternal conditions, such as
heart disease, diabetes, hypertension,
hyperthyroidism, and renal disease.
o Maternal factors such as age or parity.
o Medical conditions related to pregnancy and
their associated complications.
o Pregnancy complications such as abruptio
placentae, placenta previa, oligohydramnios,
preterm labor, premature rupture of
membranes, preeclampsia, uterine rupture.
Newborn classification and neonatal
mortality risk chart
Infants are classified according to weight and
weeks
According to weight:
➢ SGA (Small for gestational age)
➢ LGA (Large for gestational age)
➢ AGA (Appropriate for gestational age
According to weeks:
➢ Preterm (Pr)
➢ Term (F)
➢ Post term (PO)
AGE / INTRAUTERINE GROWTH
RESTRICTED NEWBORN
• Considered small for gestational age (SGA)
when they are less than the 10th percentile
for birth weight
• may be preterm, term, or post term.
• An undergrown newborn may be also said
to have intrauterine growth restriction
(IUGR).
• SGA infants are commonly seen with
mothers who smoke or have high blood
pressure, causing these infants to have an
increased incidence of perinatal asphyxia
and perinatal mortality when compared with
AGA infants (Resnik & Creasy, 2009).
• The incidence of polycythemia and
hypoglycemia are also higher in this group of
infants.
FACTORS CONTRIBUTING TO
INTRAUTERINE GROWTH RESTRICTION
Mother who:
o who smoke
o have high blood pressure
➢ causing these infants to have an
increased incidence of perinatal
asphyxia and perinatal mortality when
compared with AGA infants
Perinatal asphyxia- failure to establish
breathing at birth
IUGR may be caused by:
maternal, placental, or fetal factors and may not
be apparent antenatally
Maternal Factors
o Primiparity
o grand multiparity
o multiple gestation pregnancy (twins and
higher order multiples)
o lack of prenatal care
o age extremes (under 16 or over 40)
o low socioeconomic status (which can result
in inadequate health care
Most common causes of case restricted
growth
MATERNAL DISEASE
• Maternal heart disease
• substance abuse (drugs, tobacco, alcohol)
• sickle cell anemia
• phenylketonuria (PKU)
• lupus erythematosus
• asymptomatic pyelonephritis is associated
with SGA
ENVIRONMENTAL FACTORS
• High altitude
• exposure to x-rays
• excessive exercise
• work-related exposure to toxins
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• hyperthermia
• maternal use of teratogenic drugs, such as
nicotine, alcohol, antimetabolics,
anticonvulsants, narcotics, and cocaine
affect fetal growth

PLACENTAL FACTORS
• small placenta
• infarcted areas
• abnormal cord insertion
• placenta previa
• reverse end-diastolic blood flow
• thrombosis may affect circulation to the fetus

FETAL FACTORS
• Congenital infections such as TORCH
infections (toxoplasmosis, other, rubella,
cytomegalovirus, herpes simplex virus)
• Syphilis
• congenital malformations

ASYMMETRIC (DISPROPORTIONAL) IUGR

• is associated with an acute compromise of
uteroplacental blood flow.
• The growth restriction may not be evident
before the third trimester because although
weight is decreased, length and head
circumference remain appropriate for that
gestational age
• Asymmetric SGA newborns are particularly
at risk for perinatal asphyxia, pulmonary
hemorrhage, hypocalcemia, and
hypoglycemia in the newborn period.

Patterns of IUGR
Intra uterine growth occurs by an increase in cell
number and cell size. If insult occurs early during
the critical period of organ development in the
fetus, fewer new cells are formed, organs are
small, and organ weight is subnormal.

SYMMETRIC (PROPORTIONAL) IUGR

• caused by long-term maternal conditions
• can be noted by ultrasound in the first half of
the second trimester.
• In symmetric IUGR there is chronic,
prolonged restriction of growth in size of
organs, body weight, body length, and,
especially, head circumference.

Common Complications of the SGA Newborn

o Fetal hypoxia.
o Aspiration syndrome
o Hypothermia
o Hypoglycemia
o Polycythemia
o Congenital malformations
o Intrauterine infection
o Continued growth difficulties
o Cognitive difficulties