Large or small for gestational age - management of infants on the postnatal ward
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This guideline refers to term or near-term babies who are:
- <10th or >95th centile by customised centile charts, or
- <2.5kg or >4.5kg if customised centiles are not available
These babies are at risk of:
- jaundice secondary to polycythaemia
- Temperature should be monitored before feeds for 12 hours or until stable
- Baby should be closely observed for signs of hypoglycaemia or hypothermia (e.g jitteriness, pallor, lethargy).
- Routine blood glucose measurement should have been requested by the LMC or Paediatrician within the first hour following birth and 4-hourly or pre-feed thereafter (whichever comes first). All blood glucose measurements should be performed by the Laboratory. That is, bedside testing methods (BM-stix, Precision-G monitors) are not reliable at detecting hypoglycaemia.
- Feeding should be commenced early; first feed within one hour of delivery and thereafter at least 3 hourly. Either breast or formula feeds (maternal preference) can be given. Complement feeds are not necessary unless the baby's blood glucose falls to <2.6mmol/L.
- The baby should be watched for jaundice and bilirubin levels measured as indicated.
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- Date last published: 29 July 2004
- Document type: Clinical Guideline
- Services responsible: Neonatology
- Owner: Newborn Services Clinical Practice Committee
- Editor: Sarah Bellhouse
- Review frequency: 2 years
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