Screening, investigation and follow-up of neonates with small for gestational age in a metropolitan hospital in Australia-observational retrospective study.

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Infants with small for gestational age (SGA) have an increased risk of short and long-term health outcomes, with potentially modifiable risk factors. This study aims to determine the prenatal risk factors associated SGA and evaluate the clinical management of affected infants. An observational retrospective study of medical records of infants born at Nepean Hospital and discharged with a diagnosis of SGA over 5 years (1st January 2015 to 31st December 2019). Data included demographic details, antenatal care, maternal risk factors and clinical management of the infants. Six hundred and seven infants had a discharge diagnosis of SGA, from 20,392 infants born. Of the 607 infants identified, 487 (80%) had SGA, 97 (16%) had asymmetrical SGA, 175 (29%) had symmetrical SGA, and 50 (8%) were incorrectly diagnosed with SGA based on growth measurements taken at birth. The most prevalent maternal risk factors were the presence of chronic disease (n=402, 66.23%), current smoking (n=159, 26.19%), social work input (n=108, 17.79%), gestational diabetes mellitus (n=96, 15.82%) and Aboriginal background (n=73, 12.03%). Prenatal genetic testing was conducted in 89.62% (n=544); 58.81% (n=357) had placental abnormalities; 36.57% (n=222) were recommended follow-up with a general practitioner (GP) and paediatrician, and 21.09% (n=128) were recommended a combination of midwifery in the home (MITH), GP, and paediatric follow-up. Two infants were recorded with no follow-up. Diagnostic inaccuracies were found in infants with SGA. More intensive antenatal care for women with risk factors for SGA might improve the health of those with chronic disease; support for smoking cessation could also be offered.