SGA

Question 1

What is SGA classified as in pregnancy?

Answer 1

A foetus with an estimated fetal weight on a customised growth chart below the 10th percentile for gestational age

Question 2

What is SGA classified as in a neonate?

Answer 2

Weight below the 10th percentile on customised growth chart

Question 3

What is intrauterine growth restriction?

Answer 3

A baby that has failed to reach their growth potential e.g. SGA or growth dropping off/slowing down. Blood flow directs to vital organs like the brain = HC vs AC disportionate

Question 4

What are the possible pathophysiologies of SGA?

Answer 4

• Placental insufficiency
• Constitutional small
• Intrinsic fetal
• Substance abuse

Question 5

What is the pathophysiology of IUGR/FGR?

Answer 5

• Abnormal placental blood flow = reduced blood flow = reduced oxygen and nutrients delivered to foetus = blood directed to vital organs (brain, heart, placenta) = growth affected = characteristics seen on USS e.g. AC reduced vs HC

Question 6

Risk factors for SGA/IUGR?

Answer 6

• Advanced maternal age
• Smoking/Drug use
• Obesity
• Underweight
• Previous SGA/stillborn
• Chronic hypertension
• Primiparity

Question 7

Screening for SGA?

Answer 7

• Fundal height measurements plotted on customised growth chart
• Serial growth scans via USS

Question 8

What perinatal period outcomes are you worried about for SGA?

Answer 8

• Preterm
• Asphyxia at birth
• Stillbirth

Question 9

What neonatal period outcomes are you worried about for SGA?

Answer 9

• Hypoglycaemia
• Hypothermia
• Hypoxia
• Asphyxia
• Polycythemia = jaundice
• NICU asmissions
• SUDI
• Neonatal deaths

Question 10

What is your management/care plan for a known SGA baby in pregnancy?

Answer 10

• Referral to obstetrician
• Serial growth scans
• Low dose aspirin if appropriate - decided by consultation/referral

Question 11

What is your care plan for a SGA baby in labour?

Answer 11

• Decision re timing of birth in consultation depending on factors such as severity of SGA
• CTG monitoring
• Anticipate fetal distress, perinatal asphyxia, need for resus
• Paediatrician in attendance at birth

Question 12

What is your care plan for an SGA baby after birth?

Answer 12

• Customised growth chart percentile to confirm SGA or not
• Preventing cold stress cycle: hypoxia, hypoglycaemia, hypothermia
• Warmer room, skin to skin, warm towels and blankets, beanie (prevent hypothermia)
• Early feeding (prevent hypoglycaemia)
• 3hrly effective feeding, may require top ups
• Monitor output closely
• Obs documented on NEWS chart for score

Question 13

Why are SGA babies more at risk of hypothermia?

Answer 13

• The result of increases body surface to weight ratio augments heat loss. Requires more energy to try and keep themselves warm

Question 14

Why are SGA babies more at risk of hypoglycaemia?

Answer 14

SGA neonates have reduced glycogen stores = less reserves to use as food and energy = requiring effective feeding to prevent low blood glucose concentration

Question 15

What is low blood glucose levels associated with?

Answer 15

Brain damage

Question 16

What obs should be taken for SGA baby and when?

Answer 16

• RR, T, HR, WOB, colour, behaviour and feeding = 1, 4 and 24 hours post birth
• O2 sats = once between 12 and 24 hours
• Blood glucose monitoring = within 1 - 2 hours of birth, 3 consecutive pre-feed blood glucoses above 2.6 mmol/L

Question 17

What is your plan if blood glucose level below 2.6 mmol/L?

Answer 17

• Administer dextrose gel = amount calculated based off weight
• Followed by breastfeed/top up
• Blood sugar repeated 30 minutes later

Question 18

Symmetrical vs asymmetrical IUGR

Answer 18

…