NCLEX Review Guide: Small for Gestational Age (SGA) Newborns

SGA Classification

• Small for Gestational Age (SGA) refers to newborns whose birth weight falls below the 10th percentile for their gestational age.
• SGA newborns may be preterm, term, or post-term but are smaller than expected for their gestational age due to intrauterine growth restriction (IUGR).

Maternal Risk Factors

• Hypertensive disorders (preeclampsia, chronic hypertension) reduce placental blood flow leading to poor fetal nutrition.
• Substance abuse (smoking, alcohol, drugs) causes vasoconstriction and decreased oxygen delivery to the fetus.
• Maternal malnutrition, chronic diseases (diabetes, renal disease), and multiple gestations increase SGA risk.

Appearance and Physical Features

• SGA newborns appear thin and wasted with loose, dry skin that may be peeling or meconium-stained.
• Disproportionate head size - head appears large compared to body due to brain-sparing growth pattern.
• Decreased subcutaneous fat, prominent ribs, and sunken abdomen give an "old man" appearance.

Major Complications

• Hypoglycemia is the most critical complication due to decreased glycogen stores and increased metabolic demands.
• Hypothermia occurs rapidly due to large surface area-to-body weight ratio and decreased subcutaneous fat.
• Polycythemia may develop as compensation for chronic intrauterine hypoxia, increasing risk of hyperviscosity syndrome.

1. Monitor blood glucose every 2-3 hours for first 24 hours
2. Initiate early and frequent feedings (every 2-3 hours)
3. Maintain neutral thermal environment
4. Monitor for signs of respiratory distress
5. Assess for polycythemia (hematocrit >65%)

Priority Nursing Care

• Thermoregulation support through skin-to-skin contact, radiant warmers, and appropriate clothing to prevent cold stress.
• Nutritional support with early initiation of breastfeeding or formula feeding every 2-3 hours to prevent hypoglycemia.
• Careful monitoring of vital signs, especially temperature and blood glucose levels during the critical first 24-48 hours.

Frequently Missed Concepts

• Don't confuse SGA with preterm - SGA babies can be full-term but small due to growth restriction.
• Remember that SGA newborns have mature organ systems if born at term, unlike preterm infants.
• SGA babies are at risk for both hypoglycemia AND polycythemia - monitor both glucose and hematocrit.