Underweight For Gestational Age (UGA)
Description Diagnostic criteria General and supportive measure Referral DESCRIPTION UGA is failure of an infant to achieve their genetic growth potential. This may be due to maternal, placental or foetal factors in utero. DIAGNOSTIC CRITERIA The birth weight of the underweight for gestational age infant plots below the 10th centile on the Fenton chart. Symmetrically wasted: weight, length and hea
General and supportive measure
DESCRIPTION
UGA is failure of an infant to achieve their genetic growth potential. This may be due to maternal, placental or foetal factors in utero.
DIAGNOSTIC CRITERIA
- The birth weight of the underweight for gestational age infant plots below the 10th centile on the Fenton chart.
- Symmetrically wasted: weight, length and head circumference is below the 10th centile. Causes include chromosomal disorders, genetic abnormalities, chronic intra-uterine infection, maternal under-nutrition, and teratogenic agents such as alcohol.
- Asymmetrically wasted: only the weight is below the 10th centile. Causes include placental insufficiency, hypertension and diabetes mellitus during pregnancy and smoking during pregnancy.
The neonate is at risk of:
- Preterm delivery.
- Birth asphyxia.
- Hypoglycaemia
- Polycythaemia
- Hypothermia
- Increased mortality.
GENERAL AND SUPPORTIVE MEASURES:
- Admit unwell/unstable infants to a neonatal high/intensive care facility.
- Temperature control:
- Kangaroo mother care: Initiate if baby is well and vital signs are stable.
- Keep infant’s temperature, axilla or skin of anterior abdominal wall, at 36.5– 37.5°C.
- Whole blood glucose (heel prick) < 2.6 mmol/L.
- Monitor the blood glucose, at least 2 hourly, to prevent the development of hypoglycaemia.
- See management of hypoglycaemia (see: Hypoglycaemia, neonatal) if the glucose < 2.6 mmol/L.
- If renal function is compromised, use a potassium-free solution.
- Hospital discharge if:
- clinically well,
- able to breastfeed or formula feed,
- able to maintain body temperature, and
- weight > 1.8 kg, and on an upward trend.
- Follow-up visits to assess growth parameters and neurodevelopment.
REFERRAL
Presence of one or more of the following complications that cannot be managed at the facility:
- Respiratory distress requiring ventilatory support.
- Feeding difficulties where the underlying cause is unclear.
- Congenital abnormalities requiring surgical intervention.
- Hypoglycaemia not responding to treatment.
Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter 19: Prematurity And Neonatal Conditions, 19.9 Underweight For Gestational Age (UGA)