Small for

Gestational Age
Presentors:
Akemi Hoshitani
Kathleen Dimacali
Ma. Patricia Dy
Cyra Mae Cuevo
Jerwina San Pedro
Bryan Joseph Tiongson
INTRODUCTION
4th year BS Nursing students
Clinical rotation: Pediatric Ward at Dr. Paulino J.
Garcia Memorial Research and Medical Center
March 5, 2021
2nd semester year 2020-2021.
Clinical instructor: Mrs. Advincula Fe Agulan
OBJECTIVES

General objective
 This study aims to acquire knowledge on how to
improve health, development and quality of life of infant
with low birth weight.
Specific objectives
To gain understanding about the etiology of small
gestational age.
To develop appropriate nursing management for small
gestational age infant.
To distinguish physical appearance of infant with
small gestational age to a normal infant.
To determine ways on how to prevent development of
complications.
OVERVIEW
Small for Gestational Age- birth weight is below the 10th
percentile on an intrauterine growth curve for the age.
• Preterm: before week of 38 of gestation
• Term: between weeks 38 and 42
• Postterm: past 42 weeks

Infants is SGA because they experienced intrauterine

growth restriction or failed to grow at the expected rate in
the utero.
The most common cause of intrauterine growth restriction
is placental issue;
• did not obtain sufficient nutrients from the uterine
arteries or:
• inefficient at transporting nutrients to the fetus

Women with systemic diseases that decrease blood flow

to the placenta.
Cause of small for gestational age:
 Problems with the mother
 High blood pressure
 Chronic kidney disease
 Diabetes
 Heart disease or respiratory disease
 Malnutrition or anemia
 Infection
 Alcohol or drug use
 Cigarette smoking
 Weighing less than 100 pounds
 Problems with the uterus and placenta

Decreased blood flow in the uterus and placenta

Placenta detaches from the uterus
Placenta attaches low in the uterus
Infection in the tissues around the baby
 Problems with the developing baby

Multiple pregnancy, such as twins or triplets

Infection
Birth defects
Chromosome problems
Problems at birth:

Lower oxygen levels than normal

Low Apgar scores
Breathing in the first stools (meconium) passed in the
womb
Low blood sugar
Trouble keeping a normal body temperature
PATIENT’S PROFILE
Name: Baby Boy M
Age: New born Gender: Male
Religion: Catholic Nationality: Filipino
Address: Cabanatuan City
Admission Date: March 5,2021
Admitting Diagnosis: Pre-mature 35weeks, Small for
Gestational Age
Attending Physician: Dr. Dela Cruz
MEDICAL HISTORY
Present medical history

A male infant was born on march 5,2021 at 35 weeks of

gestation he is small for gestational age with a birth weight
of 1.8kg. The issue encountered during his stay at neonatal
intensive care unit were respiratory distress syndrome, low
birth weight, inability to maintain a constant body
temperature, difficulty in feeding and slightly jaundice in
appearance.
• His respiratory distress problem was given oxygen via
nasal cannula at 1-2L/min. Prophylactic aminophylline
was given to decrease the risk of apnea.
• According to the hospital guidelines, premature babies
are given 5 days of prophylactic ampicillin and
cefotaxime.
• The infant had an umbilical catheter inserted using
aseptic technique which provided good intravenous
access for the first 10 days of life.
• He was kept NPO for the first 48 hours and was
maintained on intravenous fluids.
• On the third day of life the infant, orogastric tube was
inserted to start on 1mL expressed breast milk every 2 
hours.The feeds were increased by 1mL every other feed
provided that aspirates were minimal.
• The neonate’s observations were monitored, with stool
and urine output recorded on a chart.
• On his third day infant manifested jaundice in
appearance and physician order to have photo-therapy.
Socio-economic

His mother, a 20 year old woman, lives in a semi

concrete house with her parents and other family
members. His mother is a out of school youth, and usually
goes to meet her friend. She and her friends have vices and
often drink alcohol without permission of her parents.
The mother admitted that she has poor nutrition, often
smokes and does not have prenatal checkup.
Family History

Parent DM HPN Kidney SGA

Disease

Father - - + -
Mother + + - +
ANATOMY AND PHYSIOLOGY

Placenta
PATHOPHYSIOLOGY
PRECIPITATING FACTORS:
Age of the mother
PREDISPOSING FACTORS
Lack of prenatal check-up
Family history (SGA)
Poor nutritional intake
Socio-economic
Smoking
Limit blood supply through the placenta and Lack of nutrients and oxygen supply

Decrease necessary oxygen and nutrients receive by the fetus

Failure to grow at expected rate

Low birth weight

 PHYSICAL ASSESSMENT
Asessment Examination Normal Actual Interpretation
findings findings
Scalp Inspection Presence of Both Not fully
anterior and anterior and develop
posterior posterior fontanelles due
fontanelles fontanelles to prematurity
No lesion are small

Hair Inspection Soft, downy Dull and Due to lack of

hair lusterless nutrients
Face Inspection Normal Normal
configuration

>Eyes Inspection Bright and Appears Due to early

clear small delivery
Symmetrical
eyelids

>Nose Inspection Presence of Presenc Normal;

milia e of usually
milia disappears
without
treatment
>Ears Inspection Well curved pinna Pinna less Due to
with firm cartilage; curve; Properly early
Properly aligned; aligned; No delivery
No presence of presence of skin
skin tag, redness tag, redness and
and lesion lesion

>mouth Inspection Pinkish smooth lips -Dry pale lips -Due to

and symmetrical and poor
Smooth gums pink symmetrical nutrition
color, smooth to Smooth gums -Due to
roughed texture, -White coating accumula-
non-coated tongue on tongue tion of
milk
Neck Inspection Symmetrical; no Symmetrical; Normal
Palpation presence of mass no presence of
mass
Skin Inspection Pink cover with -Thin, red, -Infant has not fully
Palpation vernix caseosa shiny skin; develop;
-presence of -Infant was born before
lanugo; the time lanugo will
decrease (36-40weeks);
-poor skin -due poor nutritional
turgor balance
Chest Inspection Presence of No breast Due to early delivery
AuscultationP breast edema; edema;
alpation unlabored chest
movement; clear
lung sounds
Abdomen Inspection Scaphoid, normal Sunken Due to small
Palpation distended; Cylindrical, abdomen liver
round, soft, bowel sound
presence 30-60 minutes
after birth, liver palpable
1-2cm below postal
marking

Upper Inspection Symmetrical, equal in Thin Due to lack

extremities length, no lesion, no extremities, of nutrients
deformities. Symmetrical received
, equal in from the
length, no mother
lesion, no during
deformities pregnancy
genital Inspection Descended testes Undescended Due to early
testes delivery

Lower Inspection sole creases over the absent of sole Due to early
extremities Palpation entire plantar surface creases to delivery
plantar faint red
surface of markings
foot
DIAGNOSTIC PROCEDURE
Laboratory Norma values Results Clinical Significance
Test
CBC
RBC 5.00-7.00 x 10^12/L 4.70 x 10^12/L --Low RCBC due to poor
nutritional status of the mother.
--Iron deposit at 36 weeks --

Lymphocyte 0.48 High; Indication that there is

0.30-0.35 already an infection and
inflammation.
RBS 30-125 78 --Within normal limits

Chest x-ray No demonstrate lung No demonstrate --Normal

parenchymal lung parenchymal
infiltrates infiltrates
 DRUG STUDY
Name of Drug Dosage/ Action Side Nursing
Route/ Effects Consideration
Frequency
Generic Dosage : Is a complex of >Increased >Monitor & record
Name: 4 mg theophylline and ethyl or rapid vital signs and I&O
Aminophylline enediamine and is given heart rate
Route: IV for its theophylline >Irregular
Brand Name: activity to relax smooth heartbeat
Corophyllin Frequency: muscle and to relieve >Seizures >Monitor serum
Every 6 bronchial spasm. theophylline levels.
Classification: hours Theophylline is a >Skin rash >Monitor for S&S of
Bronchodilator smooth muscle relaxant toxicity
and it relaxes the smooth >Notify physician or
muscle of the bronchial nursing staff
airways. immediately if these
reactions occur.
Name of Drug Dosage/ Action Side Effects Nursing Consideration
Route/
Frequency
Generic Name Dosage: Acts as an irreversible >acute >Assess the client
: 90 mg inhibitor of the inflammatory allergic reaction
Ampicillin enzyme trans skin eruption
Route: IV peptidase, which is >redness and
Brand Name: needed by bacteria to peeling of the >Assess for signs and
Omnipen Frequency: make the cell wall. It skin symptoms of super
Every 12 inhibits the third and >rash infection
Classification: hours final stage of bacterial >hives
Antibiotic cell wall synthesis in >fever
binary fission, which >seizure >Monitor blood studies
ultimately leads to >diarrhea >Assess the bowel
cell lysis, ampicillin pattern daily
is usually
bacteriolytic.
Name of Drug Dosage/ Action Side Effects Nursing Consideration
Route/
Frequency
Generic Dosage : It inhibits the >Injection site >Monitor injection site for
Name: 90 mg bacterial cell wall reaction(pain) pain, swelling, and irritation
Cefotaxime synthesis by binding irritation, a >perform skin test before
Route: IV to one or more of hard lump, or initial
Brand Name : the penicillin inflammation) administration
Claforan Frequency: binding’s protein. >rash >Monitor signs of allergic
Every 12 This inhibits the >itching reactions and anaphylaxis,
Classification: hours final >hives including pulmonary
Antibiotics – transpeptidation step symptoms.
Cephalosporin of peptidoglycan >fever >provide tepid sponge bath
third generation synthesis in >Notify physician or nursing
bacterial cell walls staff immediately if these
,thus inhibiting cell reactions occur.
wall biosynthesis
Name of Drug Dosage/ Action Side Effects Nursing Consideration
Route/
Frequency

Generic Name Dosage : Is a competitive >Stomach pain >administer medication

: 1.8mg inhibitor of >Nausea and with food
Ranitidine histamine H2- vomiting
Route:IV receptors. The >Diarrhea or >Increase fluid intake if
Brand Name : reversible inhibition constipation not contraindicated
Zantac Frequency: of H2-receptors in >Skin Rash >Monitor signs of
Every 12 gastric parietal cells hypersensitivity reactions,
Classification: hours results in a reduction including pulmonary
Histamine H2 in both gastric acid symptoms (tightness in the
Antagonists volume and throat or chest, wheezing,
concentration. cough) or skin reactions
(rash, pruritus, urticaria).
Assessment Background Nursing Planning Nursing Rationale Evaluation
Knowledge Diagnosis Intervention
Subjective: SGA infant had Ineffective After 8hrs of INDEPENDENT: After 8hrs of
N/A lower body fat Thermore- nursing Monitor vitals -Serves as a nursing
due to gulation r/t intervention, signs. baseline intervention,
Objective: inadequate to decrease infant will information and infant
Cold skin nutrient supply stored body maintain any changes may maintained
Pale during fetal life. fats as body indicate worsening normal
Shivering Exposure to evidenced temperature of infant’s temperature
cold leads to by within condition. - appropriate
Vital signs: heat loss shivering normal for age.
HR-150bpm through and range. Maintain T= 36.5 °C.
T- 35°C convection, temperature Temp:36.5°C Place infant in a thermoneutral -Goals Met
RR-26cpm radiation, of 35°C. . warmer, incubator, environment and
conduction and or open bed with helps prevent cold
evaporization radiant warmer. stress.
makes the
infant unable to -Decreases heat
maintain normal Use heat lamps loss to the cooler
body during certain environment of the
temperature. procedures. room.
Assessment Background Nursing Planning Nursing Rationale Evaluation
Knowledge Diagnosis Intervention
Warm the objects -Decreases loss of After 8hrs of
coming in contact heat by conduction. nursing
with infant’s body, intervention,
such as stethoscopes infant
and thermometer. maintained
normal
Change clothing or temperature
bed linens when wet. -Decreases appropriate
Keep infant’s head evaporative heat for age.
covered. losses T= 36.5 °C.
COLLABORATIVE: -Goals Met
1. Provide or
administer meds as -Helps prevent
prescribed. seizures associated
with hypothermia.
Monitor
lab/diagnostic studies -Reveals & prevents
as appropriate. any further
complications.
Assessment Background Nursing Planning Nursing Rationale Evaluation
Knowledge Diagnosis Intervention
Subjective: Lack of Imbalance After 1 week INDEPENDENT: After 1 week
N/A prenatal care Nutrition: of nursing Monitor the weight -Identifying the of nursing
and poor Less than intervention by measuring body risk and the degree intervention
Objective: nutrition of the body the client will weight every day, of risk to growth the client was
*Poor skin mother during requirements experience then document in patterns. SGA able to
turgor pregnancy related to progressive infant growth charts infants with excess experience
*poor leads to infant lack of weight gain every day. extracellular fluid progressive
muscle tone received less nutrients as evidenced possibility of weight gain
*Weight - than required received by: Weight of losing 15% of birth as evidenced
1.8kg nutrients. from the 2.2 kg. weight. by: Weight of
*Low RBC mother Assess the level of -Provide 2.2 kg.-Goals
during hydration, note information about met
V/S pregnancy as fontanelle, skin the actual input in
PR:120bpm evidenced by turgor, urine conjunction with
RR:40cpm low birth specific gravity, the an approximate
T:36.5OC weight and condition of the adjustment needs
poor muscle mucous to be used in the
tone. membranes, weight diet.
fluctuations.
Assessment Background Nursing Planning Nursing Rationale Evaluation
Knowledge Diagnosis Intervention
-Monitor for signs -Glucose is the main
of hypoglycemia; source of fuel for the
tachypnea and brain, deficiency can
irregular breathing, cause permanent damage
apnea, lethargy, to the CNS.
temperature Hypoglycemia
fluctuations, and significantly improve the
diaphoresis. mobility of mortality and
severe effects of time
dependent on the duration
of each episode.
-Place in semi- -To prevent back flow of
fowler’s position formula.
during feeding and
burp after.
-Administer -To provide feedings into
feeding through stomach until baby can
orogastric tube. take food by mouth.
Assessment Background Nursing Planning Nursing Rationale Evaluation
Knowledge Diagnosis Intervention
COLLABORATIVE: After 1 week
Monitor laboratory -Hypoglycemia can of nursing
tests as indicated: occur in the early 3 intervention
serum glucose, blood hours of birth infants the client was
urea nitrogen, SGA when glycogen able to
creatinine, osmolality, stores quickly reduced experience
serum / urine, urine and gluconeogenesis progressive
electrolyte. inadequate because of a weight gain
decrease in deposits of as evidenced
protein drugs and fat. by: Weight of
2.2 kg.-Goals
met
QUESTION AND
ANSWER
THANK YOU AND
GOD BLESS!