Small for Gestational Age is a term used to describe a baby who is smaller than the usual growth for the number of weeks of pregnancy. Small for gestational age (SGA) babies usually have birth weight below the 10^th percentile for babies of the gestational age. Formally known as intra uterine growth retardation, the term SGA associated with IUGR is used. Intra uterine growth restriction refers to a condition in which a fetus is unable to achieve its genetically determined potential size.¹

Asymmetric, symmetric growth retardation most growth retarded infants have asymmetric growth restriction. First there is restriction of weight and then length, with a relative “head sparing” effect. This asymmetric growth is more commonly due to extrinsic influences that affect the fetus later in gestation, such as preeclampsia, chronic hypertension, and uterine anomalies. Postnatal growth after IUGR depends on cause of growth retardation, postnatal nutritional intake, and social environment. Symmetric growth retardation affects all growth parameters. In the human brain, most neurons develop prior to the 18th week of gestation. Early gestational growth retardation would be expected to affect the fetus in a symmetric manner, and thus have permanent neurologic consequences for the infant.²

Mothers of infants who require special care which may result in delayed maternal attachment. Parents of small for gestational age babies are believed to experience high level of distress including increasing anxiety, depression, and trauma symptoms, as compared to parents of healthy infants.⁴ According to Shin, mothers experience feelings of ambivalence, shame, guilt, and failure that are related to social prejudice.³

The most commonly reported parents’ responses to alteration of the parenting are the inability loss of control, fear, uncertainty, and worries about small for gestational age babies. In such situations the factors that contribute parent’s satisfaction which include assurance caring communication the provision consistent education environmental follow up care as well as emotional, physical, and spiritual support, from the health care personnel become essential. It is important for health-care professionals to understand the parental experience when infants are small for gestational age, in order to meet parents’ needs and concerns and enhance their satisfaction, which will promote more appropriate attachment and bonding.⁴

Need for THE study

According to WHO, every year about 15 million babies are born prematurely around the world and that is more than one in 10 of all babies born globally. Almost 1 million children die each year due to complications of preterm birth (2016)⁵. Across 184 countries, the rate of preterm birth ranges from 5% to 18% of babies born. In India, out of 27 million babies born every year, 3.5 million babies born are premature According to UNICEF; the incidence of LBW neonates is 30% in India.⁶

In 2015, 32.4 million babies were born SGA in low- and middle-income countries, constituting 27% of all live births. The estimated prevalence of SGA is highest in South Asia and in Sahelian countries of Africa. India has the world's largest number of SGA births, 12.8 million in 2010, due to the large number of births and the high proportion, 46.9%, of births that are SGA. The prevalence of SGA births is approximately double the prevalence of low-birth weight births globally and in the world's regions.⁷

Globally, around 2.6 million infants are stillborn each year. It is estimated that almost 15 million infants are born preterm, and at least 32 million infants are born SGA. Those who survive are at increased risk of long‐term developmental and health complications.⁸

According to international journal of obstetrics and gynaecology the incidence of SGA babies in Andhra Pradesh Chittoor district is 37%.⁹

A double -blind randomized control study was conducted on effect of educational program on stress among parents of premature infants at Iran. Parents were randomly allocated into the experimental and control group with pre and post test and follow up design. The valid and reliable "Parental Stressor Scale was used to measure the parental stress. The data were collected and intervention was given. After admission of intervention, post test was done on the second day, fifth day and after one week. The data were analyzed in SPSS (Spouse Support and Problem Solving Strategies), using t-test and repeated measures analysis of variance. In the second day after admission, the mean score of stress in premature infants' mothers and fathers in the intervention group were 94.79±14.28 and 76.77±16.39, respectively. In the control group, it was 94.48±20.03 and 92.30±21.95 for mothers and fathers.¹⁰

STATEMENT OF THE PROBLEM

A study to assess the experience of parents caring their infants with small for gestational age in the neonatal period in NMCH, Nellore.

OBJECTIVES

• To assess the experience of parents caring infants with small for gestational age.
• To find the association between parents experience with selected socio demographic variables.

DELIMITATIONS:

     The study is limited to:

• Parents who are taking care of neonates with small for gestational age (SGA)
• Sample size is 100 only.

METHODOLOGY:

RESEARCH APPROACH:

A quantitative approach was adopted in the present study.

RESEARCH DESIGN:

The present study was conducted by using descriptive research design.

SETTING:

The study was conducted in NICU at Narayana Medical College Hospital, located at Chinthareddypalem, Nellore.

POPULATION

TARGET POPULATION

 Parent’s of babies with small for gestational age.

ACCESSIBLE POPULATION

Parent’s of babies with SGA admitted in NMCH, Nellore.

SAMPLE

The Sample of present study was parent’s, of babies with SGA, admitted in NICU at NMCH, Nellore and who fulfilled the inclusion criteria.

SAMPLE SIZE

The sample size was 100 parents, whose babies are admitted in NICU for small for gestational age at Narayana Medical College Hospital, Nellore.

SAMPLING TECHNIQUE

Non-probability purposive sampling technique was adopted to select the samples.

SAMPLING CRITERIA

INCLUSION CRITERIA

• Parent’s of babies with SGA and admitted in NICU, at NMCH, Nellore.
• The parent’s who know Telugu or English.
• Parent’s who were willing to participate in the study.

EXCLUSION CRITERIA

• Parent’s of healthy babies/normal newborns
• Parents who are not willing to participate in the study

RESEARCH VARIABLE:

Parents experience on caring of infants with SGA.

DEMOGRAPHIC VARIABLES:

This includes age of mother, age of father, education of mother, education of mother, occupation   of mother, occupation   of father, family income rupees, number of children, mode of delivery, gestational age at birth, birth weight of baby, APGAR score and any disorders in newborns.

DESCRIPTION OF THE TOOL

SECTION-I

It deals with demographic variables of parents.

SECTION-II

Self administered rating scale was used to assess the parent’s experience on caring their babies with SGA. It is a 6 point rating scale which consists of 25 statements. The minimum score is 0 and the maximum score- is 125.

SCORING INTERPRETATIONS

DATA COLLECTION PROCEDURE:

After obtaining the formal permission from concerned authorities, the study was conducted at Narayana Medical College Hospital, Nellore for a period of 4 weeks. 100 parents were selected by using non-probability purposive sampling technique. The parents were informed about the nature and purpose of the study and then written consent was obtained and confidentiality was assured. At first demographic data was collected, followed by rating scale was used to assess the parent’s experience about caring their babies with SGA. Approximately, 3-5 parents per day were selected majority of the participants were mothers. The data was collected between 2-4pm and it took 25-30 minutes to collect the data from each participants. The collected data was organized, tabulated and analyzed by using descriptive and inferential statistics.

Tab-1: Frequency and percentage distribution of experience of parent’s caring their infants with small for gestational age.                                                                                         (N=100)                                                          

Fig-1: Percentage distribution of experience of parent’s caring their infants with small for gestational age.

Tab-2: Mean and standard deviation of experience of parent’s caring their infants with small for gestational age.                                                                                              (N=100)  

Tab-3: Association between parent’s experience of caring their infants with small for gestational age and selected demographic variables.                             (N=100)                                                                                                                                      

MAJOR FINDINGS OF THE STUDY:

• Regarding the experience among parent’s, 39(39%) had emotional resources, 47 (47%) had long term uncertainty, 14(14%) had unresolved sorrow and anger and none of them had minimal concern or guilt and worry.
• The mean score of parent’s experience was 57.71 and standard deviation was 16.754.
• Among all the demographic variables, age of parents,education of parents, occupation of parents, family income in rupees, gestational age of baby at birth, and birth weight of the baby had significant association with parents experience at P<0.05 level.

The study findings revealed that, half of regarding the experience among parents, 39(39%) had emotional resources, 47 (47%) had long term uncertainty, 14(14%) had unresolved sorrow and anger and none of them had minimal concern or guilt and worry.

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2. C.Dutta text book of obstetrics sixth edition, 2008 published by new central book agency, page no.159-164.
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