SEMINAR ON SMALL FOR DATE BABY.

CONTENT OF THE SEMINAR1. INTRODUCTION2. DEFINITION.3. INCIDENCE OF

SMALL FOR DATE.4. CAUSES OF

SMALL FOR DATE.5. PATHOPHYSIOLOG

YOF SMALL FOR DATE.

6. CLINICAL FEATURES.

7.DIFFERENTIAL DIAGNOSTIC EVALUATION.

8.MANAGEMENT.9.COMPLICATION.10. NURSING Mx

USING NURSING PROCESS.

11.CONCLUSION.

INTRODUCTION Expert care of new born requires an

understanding of intra- uterine growth pattern as they relate to gestational age.

Small for date & Intra- uterine growth restriction (IUGR) is used as common.

But, IUGR is failure of normal growth & Small for date is babies lower than normal body weight.

In this two- some etiology & management are common , that why they are regarded as same condition.

DEFINITION OF SMALL FOR DATE Small for date baby can be defined as “ Babies whose birth weight is below the tenth percentile of the average for the gestational age”(New ballard Scale)

NEW BALLARD SCALE

INCIDENCES Small for date can occur in pre-term, term

baby & post term baby. Dysmaturity comprised about one- third of

low birth weight babies. Incidences among tem babies ->5%. Incidences among post-term babies ->15% Incidences in developed countries -> 2-

8%. Incidences in developing countries ->6 -

30%. Incidences in India is 26%(2010 census).

CAUSES OF SGA

PATHOPHYSIOLOGY OF SGA

CLINICAL FEATURES OF SDA

Weight-> deficit about 600gm below minimum percentile standard.

Length -> smaller than normal standard length.

Head circumferences -> 3cm larger than abdomen circumferences.

(Contd)4.Physical features- Dry & wrinkle skin. Schaphoid abdomen. Thin umbilical cord. Cartilaginous ridges on pinna

of the ear. Well defined plantar creases.5.Movement & reflex are

normal.6.Mostly have small liver with poor glycogen stored &

relatively large brain.

DIFFERENTIAL DIAGNOSISA. History: *Habitual small baby. *Mal-nourished & hard work mother. *Maternal substances abuse.B. Clinical diagnosis: *Maternal weight gain below 3kg during pregnancy. *Fundal height <2cm/week during 24-26 wks. *Fetal condition- small head & trunk sizes &steady

bradycardia in late pregnancy. *Poor uterine tone/ flank not full.C. Ultrasonography.D.Ultrasonography doppler.E. At delivery.

MANAGEMENT OF SGAA. Ante-natal care i. mild IUGR(90% asymmetric): Adequate diet- 1.5kg weight

gain/month. 8 hrs sleep at night & 2 hrs at noon. Avoidances of sex, substances abuse,

etc. ii.Severe IUGR( 10% asymmetric): Total bed rest. Diet therapy. Oxygen therapy. Monitoring clinical & biophysical profile.

B.INTRA-NATAL CARE:i.Mild IUGR: Delivery at 40wks. Induction of labour with ARM & oxytocin. For unripe cervix, foetal distress, slow

progress of labour & other high risk -> Caesarean section.

ii. Severe IUGR: Caesarean section. Paediatrician & other precaution.

C. Post-natal care: Intensive neonatal care as that of pre-term baby. Feeding start within 1-2hrs with 5-10 mlsof 10%

glucose &repeated Q2H if tolerated. Expressed breast milk/ humanized milk given

small amount Q2H for 48 hrs. Blood glucose- *Monitor blood glucose level Q2h /before each

feed for 48 hrs. *fall in blood -> IV 10% glucose.

(Contd)

•Baby to be discharge only at optimal weight, good vigour & brestmilk suck sufficiently.•Kangaroo mother care- thermal regukation.

•Mother & family advices-*Feeding method.*Well baby clinic.*Immunization.

COMPLICATIONA. Asphyxia.B. Hypoglycemia.C. Meconium aspiration.D. Pul.haemorrhage.E. Polycythemia.F. Necrotising

enterocolitis.G. Hyper viscosoty

syndrome.

NURSING MANAGEMENT OF SGA USING NURSING PROCESSNursing diagnosis:1. Ineffective airway clearance r/t immaturity of respiratory

tract as evidences by excessive drooling, decrease saturation of 02.

2. Ineffective breathing pattern r/t lung maturity as evidences by wheezing of respiration process.

3. Infective infant feeding pattern r/t diseases process as evidences by poor sucking behaviour .

4. Risk for infection r/t small sizes & dysmaturity of the baby.5. Risk for impaired skin integrity r/t poor skin tone.6. Fear(parent) survival / prognosis of baby as evidences by

worry.7. Compromised family coping r/t guilt & concerned for baby

as evidences by……………….8. Knowledges deficit r/t home care of the baby as evidences

by ………………………………….

CONCLUSION Mild SGA can be given as normal baby

care , but severs SGA required optimal care.

Sufficient neo-natal care plays vital role. All IUGR may not be SGA & all SGA may

not be IUGR Following norm of ante-natal care &

check up help avoid SGA baby. Midwives play vital role in preventing

IUGR & SGA.

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