3. SMALL FOR DATES.pptx

Prematurity

1. SMALL FOR DATES Definition A small for gestational age baby is one who is usually small for the number of weeks spent in the womb. This term refers to weight not length . Clinical features The baby usually looks small

2. Clinical features cont... has all the organs well formed but small ribs are easily seen and the abdomen is narrow the baby is wasted due to lack of subcutaneous tissue

3. Predisposing factors Maternal factors Poor nutritional status Infections like malaria and HIV. Uterine abnormalities e.g. bicarnuate uterus. Bad obstetric history e.g. history of abortions and pelvic inflammatory diseases . Fetal causes

4. Fetal causes Multiple pregnancies for example twins who are competing for nutrition . Intra uterine diseases e.g. syphilis, Human Immune Deficiency virus (HIV), rubella. Placental factors Chorioammonites which leads to uterine growth retardation

5. Placental factors cont.. ii.Abnormal cord insertion – this will affect blood circulation iii.Single umbilical artery. This may affect proper fetal circulation. long cord – This may affect transportation of nutrients to various fetal organs hence cause uterine fetal growth retardation.

6. Medical investigations Get blood for rapid plasma reaction to rue out congenital syphilis blood slide if child has fever to rue out malaria infection blood for full blood count to rue out anemia blood for polymerase chain reaction to the out HIV infection . Blood for assessment of random blood sugar to rue out hypoglycemia .

7. History taking from the mother Ask the mother if she attended antenatal clinic regularly. This helps to know if all the possible interventions like blood test for HIV, syphilis and other examinations were done promptly. Ask about history of maternal infections like malaria, hypertension, HIV and renal faire. Also find out if prompt treatment was done.

8. Medical therapy Since these children are susceptible to infection drugs to prevent infections can be given e.g. cefotaxin 100mg/kg body weight for fourteen days. If any infection is detected through lab investigations there are supposed to be treated accordingly. Can give dextrose 10% to prevent hypoglycemia .

9. Nursing care Aims of the nursing care To improve nutritional status prevent infections Psychological care Teach the mother about the condition of her child so as to allay anxiety

10. Psychological care cont.. Also tell the mother about the interventions which will be done on the child to improve the nutritional status and prevent infections like insertion of a nasal gastric tube to improve on the feeding that is if the child is unable to suck and also restrict visitors to promote rest. Tell the mother on how to take care of the child like good hygiene practices which may prevent infections.

11. Nutrition Encourage the mother to breast feed the child to promote good nutrition and health of the child. If the child can not breast feed encourage and teach the mother on how to express breast milk and useof a cup for feeding. A nasal gastric tube can also be inserted to improve child’s nutritional status if he/she has poor sucking reflexes.

12. Nutrition cont... Feeds should be given two hurly and calculated according to weight If child has hypoglycemia glucose 10% dextrose can be given to prevent hypoglycemia and brain damage Intravenously, 5mls per kg body weight start.

13. Environment ensure that the environment is clean to prevent infection Accessories being used should also be clean at all times Should be nursed in neonatal ICU because care for such babies is given promptly. Should be nursed in a quite, well ventilated room to promote rest and air circulation. Also the room should have enough light to prevent bacterial manifestation Also the baby must be kept warm at all times to prevent hypothermia.

14. Observations Vital signs should be done regularly to monitor recovery. Temperature to rue out hypothermia Apex pulse to be done to rue out tachycardia or tachypnoea Observe breathingpatterns of the child to rue out dyspnea and apnea . Observe skin color to rue out jaundice

15. Obs. Cont... Observe for input and out put to rue out overfeeding Observe for abdominal distension to rue out retention of feeds. (constipation) Also observe for the color , frequency and consistency of meconium to rue out abnormalities like diarrhea .

16. Elimination Monitor passage of meconium to rue out constipation. Monitors passage of urine, ask the mother if nappies are normally wet this is done to ascertain patency of the body parts (orifices)

17. Information Education and Communication Encourage the mother to exclusively breast feed the child also re-emphasize on the benefits of breast milk Also encourage on the importance of under five clinic because this helps to monitor the child’s growth and recovery and also acquiring of vaccines which help in boosting the childs immunity.

18. IEC cont... Advise the mother to practice good hygiene practices so as to prevent infections. If drugs are dispensed to the child advice the mother to give the child drugs correctly and also reemphasize on the side effects.

19. Complications Hypothermia – due to poor metabolic process in the production of heat . Also due to exposure to the cold and poor subcutaneous tissue which promotes rapid heat loss . Hypoglycemia – may be due to poor feeding. May be due to decreased hepatic stores and reduction of subcutaneous fat stores that are quickly utilized by the body.

20. Complications cont.. The baby may present with apneic disorders, lethargy and poor feeding. Untreated hypoglycemia may lead to brain damage and consequently death.