Small-for-Gestational-Age

&
Large-for-Gestational-Age
Infant
GROUP 2

Small-forGestational-Age
Infant

Small-for-Gestational-Age Infant
GENERAL INFORMATION
Birth weight <10th percentile on an
intrauterine growth curve
May be born:
Preterm (before 38 week of gestation)
Term (between weeks 38 and 42)
Postterm (past 42 weeks)

Common Cause: INTRAUTERINE

GROWTH
RETARDATION (IUGR)

PICTURE

Small-for-Gestational-Age Infant
ETIOLOGY
Lack of adequate nutrition
Pregnant adolescents
Placental Anomaly (most common):
Placenta did not obtain sufficient nutrients from the arteries
Placenta is inefficient in transporting nutrients to the
fetus

Placental Damage:
Partial Placental Accreta with bleeding

Small-for-Gestational-Age Infant
ETIOLOGY (cont.)
Systemic Diseases
Severe Diabetes Mellitus
Pregnancy Induced Hypertension

Women who smoke heavily

Women who used:
Narcotics
Cocaine
Amphetamines

Small-for-Gestational-Age Infant
ETIOLOGY (cont.)

In other instances, the placental supply of

nutrients is adequate but an infant cannot use
them
because the has contracted an
intrauterine infection such as rubella,
toxoplasmosis, or has a chromosomal
abnormality.

Small-for-Gestational-Age Infant
ASSESSMENT
Fundal height during pregnancy becomes progressively less than
expected
SONOGRAM demonstrate decreased in size
Caesarean Labor

Biophysical Profile (provides additional information on placental

function)
No stress test

Small-for-Gestational-Age Infant

APPEARANCE:

< average weight

< average length
< average head circumference
Overall wasted appearance
Small liver
Poor skin turgor
Generally to appear large head
Skull sutures may be widely separated
Acrocyanotic

Small-for-Gestational-Age Infant
LABORATORY FINDINGS:

High hematocrit levels

Polycythemia (increase in the total number of red
blood
cells)
Increased blood viscosity
Hypoglycemia (decreased blood glucose
or a level below 45 mg/dL)

Small-for-Gestational-Age Infant
CHARACTERISTIC

SMALL-FOR-GESTATIONAL-AGE INFANT

Gestational Age

24-44 week

Birth Weight

<10th percentile

Congenital Malformations

Strong Possibility

Pulmonary Problems

Meconium aspiration, pulmonary

hemorrhage, pneumothorax

Hyperbilirubinemia

Possibility

Hypoglycemia

Very strong possibility

Intracranial Hemorrhage

Strong Possibility

Apnea Episodes

Possibility

FEEDING problems

Most likely because of accompanying

problem such as hypoglycemia

Weight gain in nursery

Rapid

Future restricted growth

Possibly always be <10th percentile because

of poor organ development

Large-forGestational-Age
Infant

LARGE-for-Gestational-Age Infant
GENERAL INFORMATION
also termed macrosomia
birth weight is >90th percentile
on an intrauterine growth
chart
appears
deceptively
healthy
immature development

PICTURE

LARGE-for-Gestational-Age Infant
ETIOLOGY
Overproduction of growth hormone in utero
Women with:
Diabetes Mellitus
Obese

Multiparous women
Transposition of great vessels
Beckwith syndrome
Congenital Anomalies (e.g. Omphalocele)

LARGE-for-Gestational-Age Infant
ASSESSMENT
Womans uterus is unusually large for the date of
pregnancy
SONOGRAM shows abnormal rapid growth of the
fetus
Nonstress test
Amniocentesis
Baby cannot descent through pelvic grim
Caesarean Delivery to avoid shoulder dystocia

LARGE-for-Gestational-Age Infant
IMPORTANT ASSESSMENT CRITERIA FOR LGA
INFANT
ASSESSMENT

RATIONALE

Skin color for ecchymosis, jaundice, and

erythema.

Bruising occurs with vaginal birth; jaundice may

occur from breakdown of ecchymotic collection of
bloods; Polycythemia causes ruddiness of skin.

Motion of extremities on spontaneous movement

and in response to a Moros reflex to detect
clavicle fracture or Erbs Palsy.

Clavicle or cervical nerve injuries may occur

because of problem at birth of wider-then-normal
shoulders.

Asymmetry of the anterior chest or unilateral lack This cervical nerve may be stretched by birth of
of movement to detect diaphragmatic paralysis
wide shoulders.
from edema of the phrenic nerve.
Eyes for evidence of unresponsive or dilated
pupils; vomiting, bulging fontanels, and a highpitched cry; which can be a suggestive of
intracranial pressure.

Compression of third, fourth, and sixth cranial

nerves by increased intracranial pressure limits
eye response; other signs of increased IP may
occur.

Activities such as jitteriness, lethargy, and

uncoordinated eye movements that suggest
seizure activity.

Seizures may be caused by increased IP;

hypoglycemia seizures to newborns often
produce only vague symptoms.

LARGE-for-Gestational-Age Infant
APPEARANCE
Immature reflexes
Extensive bruising/Birth injury (e.g. Broken Clavicle or ErbDuchenne Paralysis)
Head is large
Prominent Capput succedaneum
Cephalhematoma
Molding
Hypoglycemia
Cardiovascular Dysfunction

Kamsahamnid
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