# A nurse is assessing a newborn who was born at 38 weeks gestation and weighs 2,100 grams. Which assessment finding would be most characteristic of a small for gestational age (SGA) infant? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=543230 > language: ko > subject: Maternal Newborn Health ## 문제 A nurse is assessing a newborn who was born at 38 weeks gestation and weighs 2,100 grams. Which assessment finding would be most characteristic of a small for gestational age (SGA) infant? ## 보기 1. Decreased subcutaneous fat with loose, dry skin **✔ 정답** 2. Large fontanelles with wide suture lines 3. Excessive vernix caseosa covering the body 4. Prominent lanugo on the back and shoulders **정답: 1** ## 해설 SGA infants have decreased subcutaneous fat with loose, dry skin due to intrauterine growth restriction from inadequate nutrition. Other options are more characteristic of preterm infants (large fontanelles, excessive vernix, prominent lanugo). ## 심화 해설 Understanding SGA and IUGR The terms Small for Gestational Age (SGA) and Intrauterine Growth Restriction (IUGR) are often used interchangeably in clinical practice, though subtle differences exist. SGA is statistically defined as a birth weight less than the 10th percentile for gestational age, or more than two standard deviations below the mean [1]. IUGR, on the other hand, refers to a pathological process where the fetus does not reach its intrinsic growth potential [1]. An infant born at 38 weeks weighing 2,100 grams falls well below the expected weight for that gestational age, meeting the criteria for SGA. Pathophysiology of Asymmetric Growth Restriction In many cases of SGA resulting from uteroplacental insufficiency, the fetus adapts to a chronic shortage of oxygen and nutrients by redistributing blood flow to vital organs, particularly the brain. This "brain-sparing" effect leads to asymmetric growth restriction. The consequence is a significant depletion of glycogen stores and subcutaneous fat, which are the last to develop in the third trimester. At birth, this manifests as a wasted appearance with decreased subcutaneous fat and loose, dry, peeling skin, as the protective vernix caseosa is often diminished and the skin is directly exposed to amniotic fluid for a prolonged period without the cushion of fat [1]. This physical presentation is a hallmark clinical sign used in the assessment of nutritional status at birth [4]. Why Other Options Are Less Characteristic - Large fontanelles with wide suture lines are more indicative of a preterm infant, where cranial bone ossification is incomplete, rather than a term SGA infant. - Excessive vernix caseosa is a classic finding in preterm newborns; in term SGA infants, vernix is typically sparse or absent due to the advanced gestational age and placental insufficiency. - Prominent lanugo is another characteristic associated with prematurity. A term infant, even if growth-restricted, will have largely shed this fine hair, making it a less specific finding for SGA at 38 weeks. Clinical Assessment and Implications The physical assessment of decreased subcutaneous tissue aligns with the Clinical Assessment of Nutritional Status (CAN) score, a tool used to detect fetal malnutrition in term newborns [4]. This finding is critical because an SGA infant with depleted fat stores is at high risk for postnatal complications, including hypoglycemia due to low glycogen reserves and hypothermia due to an impaired ability to conserve heat [1]. Recognizing the thin, loose, and dry skin as a primary marker of depleted nutritional reserves allows the nurse to prioritize interventions such as early feeding and thermoregulation.References (research sources) - [1]Intrauterine Growth Restriction: Antenatal and Postnatal Aspects.Research articleSharma D, Shastri S, Sharma P. (2016) · DOI: 10.4137/cmped.s40070 - [4]Detection of fetal malnutrition at birth using clinical assessment of nutritional status (CAN) score and anthropometric indices and its associated risk factors among term newborns in southern Ethiopia: facility-based cross-sectional study.Research articleDebere MK, Eromo NC, Hussen H. (2026) · DOI: 10.1136/bmjopen-2025-100200 ## 임상 시나리오 Clinical Guide: SGA Infant Assessment Key Physical Exam Findings - **Wasted appearance:** Decreased subcutaneous fat, loose skin folds, and dry, peeling skin due to depleted glycogen and fat stores. - **Head circumference:** Often relatively large compared to the chest and abdomen (asymmetric growth pattern due to brain sparing). - **Vernix and lanugo:** Sparse or absent vernix caseosa; lanugo usually minimal or absent in term SGA infants. - **Skin:** May appear pale, meconium-stained, or have decreased turgor from chronic intrauterine stress. Immediate Nursing Priorities - **Thermoregulation:** Place under a preheated radiant warmer immediately; SGA infants have minimal insulating fat and large surface-area-to-body-weight ratio. - **Blood glucose monitoring:** Check bedside glucose within 30 minutes of birth and then per protocol (e.g., before feeds x 3-4); SGA infants are at high risk for hypoglycemia due to depleted glycogen stores. - **Early feeding:** Initiate breastfeeding or formula feeding as soon as stable to prevent hypoglycemia; consider supplementation if glucose remains low. - **Vital signs:** Monitor for respiratory distress, temperature instability, and signs of polycythemia (ruddy appearance, lethargy). Differential Considerations - **Preterm vs. SGA:** Preterm infants have abundant vernix, prominent lanugo, and soft ear cartilage; term SGA infants lack these features. - **Symmetrical vs. Asymmetrical IUGR:** Symmetrical IUGR (early insult) affects head, length, and weight proportionally; asymmetrical IUGR (late insult) spares head circumference. - **Congenital infections:** TORCH infections can cause SGA; assess for hepatosplenomegaly, petechiae, or chorioretinitis. ## 핵심 개념 - **Small for Gestational Age (SGA)** — Birth weight below the 10th percentile for gestational age, often due to intrauterine growth restriction. - **Intrauterine Growth Restriction (IUGR)** — Pathological failure of a fetus to achieve its intrinsic growth potential, commonly from uteroplacental insufficiency. - **Asymmetric Growth Restriction** — A pattern of IUGR where the brain is spared but the abdomen and limbs are wasted, with depleted subcutaneous fat and glycogen stores. - **Vernix Caseosa** — A protective, waxy coating on fetal skin that diminishes as the pregnancy advances past term or in SGA infants. - **Subcutaneous Fat** — Adipose tissue beneath the skin that develops primarily in the third trimester and is reduced in SGA infants, causing loose, dry skin. ## 같은 주제 문제 - [A nurse is assessing a newborn who was born at 38 weeks gestation and weighs 2,100 grams. …](https://mymerci.kr/pages/nclex_q.php?qn_id=543231) - [A nurse is caring for a newborn who is small for gestational age (SGA). 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