DEVIATIONS IN GROWTH PATTERNS

DEVIATIONS IN GROWTH PATTERNS - DEVIATIONSINGROWTHPATTERNS...

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DEVIATIONS IN GROWTH PATTERNS Deviations in intrauterine growth patterns not only increase the risk of morbidity and mortality in the early  newborn period, but may also have long-term implications for altered growth and development and for altered CNS  function and learning disabilities in childhood.  This general plan of care is designed to facilitate optimal nursing management of the infant with deviations in  intrauterine growth and is to be used in conjunction with the CPs: The Neonate at Two Hours to Two Days of Age, and  The Preterm Infant, as appropriate. Growth deviations are classified as SGA, intrauterine growth retardation/restriction  (IUGR), and LGA. SGA/IUGR: Any newborn whose birth weight falls at or below the 10th percentile on classification charts, considering  local factors (e.g., ethnicity, altitude). LGA/Macrosomic: Any newborn whose birth weight is at or above the 90th percentile on classification charts,  considering local population at any week in gestation (with special attention to determining appropriate  gestational age), or who at birth weighs more than 4000 g (8 lb 13 oz). NEONATAL ASSESSMENT DATA BASE SGA Infant Activity/Rest Activity level may be excessive, with vigorous cry/hungry suck attributable to chronic intrauterine hypoxia. MATERNAL FACTORS Excessive/strenuous exercise program Circulation MATERNAL FACTORS Resides at high altitude Heart/lung disease; bleeding, severe anemia or sickle cell anemia; chronic hypertension or PIH Elimination Abdomen may appear scaphoid or concave. MATERNAL FACTORS Pyelonephritis, chronic renal disease Food/Fluid All body parts may be below expected size for gestational age but in proportion/symmetrical to each other (suggests a  chronic or prolonged problem throughout gestation). Disproportionate weight as compared to length and head circumference (appears long and thin with normal head  circumference) suggests episodic vascular insufficiency in third trimester. Sunken abdomen; absence of subcutaneous tissue. Decreased muscle mass, especially in the cheeks, buttocks, and thighs. May demonstrate metabolic instability associated with hypoglycemia/hypocalcemia. MATERNAL FACTORS Small stature Malnutrition/poor nutritional intake (chronic or during third trimester); history of eating disorders Advanced diabetes mellitus (class D or above); PKU Neurosensory Skull suture and fontanels appear widened; bulging of fontanels caused by inadequate bone growth may be evident.
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DEVIATIONS IN GROWTH PATTERNS - DEVIATIONSINGROWTHPATTERNS...

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