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High-Risk Newborn o placental abruption (placenta

detaches from the uterus)

Small for Gestational Age o placenta previa (placenta attaches
low in the uterus)
o infection in the tissues around the
What is small for gestational age (SGA)?

Small for gestational age (SGA) is a term used to

describe a baby who is smaller than the usual amount • Factors related to the developing baby
for the number of weeks of pregnancy. SGA babies (fetus):
usually have birthweights below the 10th percentile
for babies of the same gestational age. This means that o multiple gestation (twins, triplets,
they are smaller than 90 percent of all other babies of etc.)
the same gestational age. o infection
o birth defects
SGA babies may appear physically and neurologically o chromosomal abnormality
mature but are smaller than other babies of the same
gestational age. SGA babies may be proportionately Why is small for gestational age (SGA) a concern?
small (equally small all over) or they may be of
normal length and size but have lower weight and
When the fetus does not receive enough oxygen or
body mass. SGA babies may be premature (born
nutrients during pregnancy, overall body and organs
before 37 weeks of pregnancy), full term (37 to 41
growth is limited, and tissue and organ cells may not
weeks), or post term (after 42 weeks of pregnancy).
grow as large or as numerous. Some of the conditions
that cause SGA and IUGR restrict blood flow through
What causes small for gestational age (SGA)? the placenta. This can cause the fetus to receive less
oxygen than normal, increasing the risks for the baby
Although some babies are small because of genetics during pregnancy, delivery, and afterwards.
(their parents are small), most SGA babies are small
because of fetal growth problems that occur during Babies with SGA and/or IUGR may have problems at
pregnancy. Many babies with SGA have a condition birth including the following:
called intrauterine growth restriction (IUGR). IUGR
occurs when the fetus does not receive the necessary
nutrients and oxygen needed for proper growth and • decreased oxygen levels
development of organs and tissues. IUGR can begin at
any time in pregnancy. Early-onset IUGR is often due • low Apgar scores (an assessment that helps
to chromosomal abnormalities, maternal disease, or identify babies with difficulty adapting after
severe problems with the placenta. Late-onset growth delivery)
restriction (after 32 weeks) is usually related to other
problems. • meconium aspiration (inhalation of the first
stools passed in utero) which can lead to
Some factors that may contribute to SGA and/or difficulty breathing
IUGR include the following:
• hypoglycemia (low blood sugar)
• Maternal factors:
• difficulty maintaining normal body
o high blood pressure temperature
o chronic kidney disease
o advanced diabetes • polycythemia (too many red blood cells)
o heart or respiratory disease
o malnutrition, anemia How is small for gestational age (SGA) diagnosed?
o infection
o substance use (alcohol, drugs)
The baby with SGA is often identified before birth.
o cigarette smoking During pregnancy, a baby's size can be estimated in
different ways. The height of the fundus (the top of a
• Factors involving the uterus and mother's uterus) can be measured from the pubic bone.
placenta: This measurement in centimeters usually corresponds
with the number of weeks of pregnancy after the 20th
o decreased blood flow in the uterus week. If the measurement is low for the number of
and placenta weeks, the baby may be smaller than expected.
Although many SGA babies have low birthweight, • expectations for the course of the condition
they are not all premature and may not experience the • your opinion or preference
problems of premature babies. Other SGA babies,
especially those with IUGR, appear thin, pale, and
with loose, dry skin. The umbilical cord is often thin, Babies with SGA may be physically more mature than
and dull-looking rather than shiny and fat. They their small size indicates. But they may be weak and
sometimes have a wide-eyed look. less able to tolerate large feedings or to stay warm.
Treatment of the SGA baby may include:
Other diagnostic procedures may include the
following: • temperature controlled beds or incubators
• tube feedings (if the baby does not have a
strong suck)
• ultrasound
Ultrasound (a test using sound waves to • checking for hypoglycemia (low blood
create a picture of internal structures) is a sugar) through blood tests
more accurate method of estimating fetal • monitoring of oxygen levels
size. Measurements can be taken of the
fetus' head and abdomen and compared with Babies who are SGA and are also premature may have
a growth chart to estimate fetal weight. The additional needs including oxygen and mechanical
fetal abdominal circumference is a helpful help to breathe.
indicator of fetal nutrition.
Prevention of small for gestational age (SGA):
• Doppler flow
Another way to interpret and diagnose
IUGR during pregnancy is Doppler flow, Prenatal care is important in all pregnancies, and
which use sound waves to measure blood especially to identify problems with fetal growth.
flow. The sound of moving blood produces Stopping smoking and use of substances such as drugs
wave-forms that reflect the speed and and alcohol are essential to a healthy pregnancy.
amount of the blood as it moves through a Eating a healthy diet in pregnancy may also help.
blood vessel. Blood vessels in the fetal brain
and the umbilical cord blood flow can be [wikipEdiA]
checked with Doppler flow studies.

• mother's weight gain Small for gestational age

A mother's weight gain can also indicate a
baby's size. Small maternal weight gains in Small for gestational age (SGA) babies are those
pregnancy may correspond with a small whose birth weight lies below the 10th percentile for
baby that gestational age. They have usually been the
subject of intrauterine growth restriction (IUGR),
• gestational assessment formerly known as intrauterine growth retardation.[1]
Babies are weighed within the first few Low birth weight (LBW) is sometimes used
hours after birth. The weight is compared synonymously with SGA, or is otherwise defined as a
with the baby's gestational age and recorded fetus that weighs less than 2500 g (5 lb 8 oz)
in the medical record. The birthweight must regardless of gestational age. Other definitions include
be compared to the gestational age. Some Very Low Birth Weight (VLBW) which is less than
physicians use a formula for calculating a 1500 g, and Extremely Low Birth Weight (ELBW)
baby's body mass to diagnose SGA. which is less than 1000 g.[2]

Treatment of babies who are small for gestational There is a 8.1% incidence of low birth weight in
age (SGA): developed countries, and 6–30% in developing
countries. Much of this can be attributed to the health
of the mother during pregnancy. One third of babies
Specific treatment for SGA will be determined by
born with a low birth weight are also small for
your baby's physician based on:
gestational age.

• your baby's gestational age, overall health, Diagnosis

and medical history
• extent of the condition
The condition is generally diagnosed by measuring the
• your baby's tolerance for specific mother's uterus, with the fundal height being less than
medications, procedures, or therapies it should be for that stage of the pregnancy. If it is
suspected, the mother will usually be sent for an • Chronic high blood pressure
ultrasound to confirm. • Severe malnutrition
• Anemia
[edit] Predetermining factors • Maternal substance abuse (prenatal alcohol
use can result in Fetal alcohol syndrome)
The risk factor/etiology can be broadly divided into 3
categories- Asymmetrical

• Fetal Asymmetrical growth restriction occurs when the

• Maternal embryo/fetus has grown normally for the first two
• Placental trimesters but encounters difficulties in the third,
usually pre-eclampsia. Such babies have a disparity in
their length and head circumference when compared
The primary risk factor is that development of the
to the birth weight. A lack of subcutaneous fat leads to
placenta is insufficient to meet the demands of the
a thin and small body out of proportion with the head.
fetus, resulting in malnutrition of the developing fetus.
Other symptoms include dry, peeling skin and an
There are numerous contributing factors, of both
overly-thin umbilical cord, and the baby is at
environmental and genetic origin:
increased risk of hypoxia and hypoglycaemia.

• Environmental factors such as poor Treatment

nutrition, tobacco smoking, drug addiction
or alcoholism
Possible treatments include the early induction of
• Severe anaemia (although hydrops may also
labour, though this is only done if the condition has
been diagnosed and seen as a risk to the health of the
• Thrombophilia (tendency for thrombosis) fetus.
• Prolonged pregnancy
• Pre-eclampsia
• Chromosomal abnormalities
• Damaged or reduced placental tissue due to:
o Chronic renal failure
o Sickle cell anemia
o Phenylketonuria
• Infections such as rubella, cytomegalovirus,
toxoplasmosis or syphilis
• Twins and multiple births.

[edit] Categories of growth restriction

There are two distinct categories of growth restriction,

indicating the stage at which the development was
slowed. Small for gestational age babies can be
classified as having symmetrical or asymmetrical
[asymmetrical] growth restriction.[3][4]

[edit] Symmetrical

Symmetrical growth restriction, less commonly

known as global growth restriction, indicates that the
fetus has developed slowly throughout the duration of
the pregnancy and was thus affected from a very early
stage. The head circumference of such a newborn is in
proportion to the rest of the body. Common causes

• Early intrauterine infections, such as

cytomegalovirus, rubella or toxoplasmosis
• Chromosomal abnormalities