Low birth weight and neonatal infections

1. Low birth weight
and neonatal
infections
Mrs.Jagadeeswari.J
M.Sc (N)

2. DEFINITION
LOW BIRTH WEIGHT:
LBW infant is defined as one
whose birth weight is less than 2500gms
irrespective of the gestational age.
WHO/D.C.Dutta

3. LBW
Very low birth weight infants
weight 1500gms or less and
extremely low birth weight
infants weighs 1000gms or
less.

4. CLASSIFICATION OF LBW
INFANTS
Low birth weight babies are again
classified after correlating both the
birth weight and gestational age into
two groups.
1. Preterm
2. Small for gestation age(SGA)

5. Cont..
Preterm-The growth potential is normal
and is appropriate for the gestational
period (10 to 90 th percentile)
Small for gestational age(SGA)-The term is
to designate the newborn with birth
weight less than 10th percentile or less
than gestational age.

6. Preterm infant
DEFINITION:
A baby born before 37 completed
weeks of gestation calculating from the first
day of last menstrual period is arbitrarily
defined as preterm baby
Babies born before 37 completed
weeks usually weighing 2500gms or less.

7. INCIDENCE
• Preterm baby constitutes 2/3 rd of
low birth weight babies. The
incidence of low birth weight baby is
about 30-40% in the developing
countries as such the incidence of
preterm baby is about 20-25%.

8. ETIOLOGY
•Spontaneous
•Induced

9. SPONTANEOUS
• Health status of the mother
• Multiple pregnancy
• Advanced parental age
• Placental problems
• Preterm labour and premature rupture of membrane
• Low maternal weight
• Chronic and acute systemic maternal disease
• Ante partum haemorrhage
• Cervical incompetence
• Maternal genital colonization and infections
• Cigarette smoking during pregnancy
• Acute emotional stress
• Physical exertion
• Sexual activity
• Trauma
• Bicornuate uterus
• Congenital malformations

10. INDUCED
• Maternal diabetes mellitus
• Placental dysfunction as indicated by
• unsatisfactory fetal growth
• Eclampsia
• Fetal hypoxia
• Ante partum haemorrhage
• Severe rhesus iso immunization

11. CLINICAL FEATURES
• Measurements:
• Size is small with relatively large head
• Crown- heel length is less than 47cm
• Head circumference is less than 33 cm
• But exceeds the chest circumference by more
than 33 cm

12. • Activity and posture:
• General activity is poor
• Automatic reflex response such as Moro
response, sucking and swallowing are sluggish
or incomplete
• Baby assumes an extended posture due to
poor tone

13. • Face and head:
• Face appears small
• large head size
• Sutures are widely separated
• Fontanels are large
• Small chin
• Protruding eyes
• Optic nerve is usually unmyelinated
• Ear cartilage is deficient or absent with poor recoil
• Hair appears woolly, and fuzzy and individual hair fibres can
be seen separately

14. • Skin and subcutaneous tissues:
• Skin is thin, gelatinous, Shiny and excessively
pink
• Abundant lanugo
• Very little vernix caseosa
• Edema may be present
• Subcutaneous fat is deficient
• Breast nodule is small or absent

15. • Genitals:
• MALE:
• testes undescended
• scrotum poorly developed
• FEMALES :
• labia majora widely separated exposing
labia minora
• hypertrophied clitoris

16. CHARACTERISTICS OF
PRETERM INFANTS
• Skin
• Bright pink, often translucent, depending on
the degree of maturity
• Smooth and shiny ( may be oedematous)
• Small blood vessels clearly visible underneath
the thin epidermis
• Fine lanugo hair is abundant

17. • Ear cartilage
Soft and pliable
• Soles and palms
Minimal creases
Smooth appearance
• Scarf sign
Elbow may be easily brought across the
chest with little or no resistance

18. • Male genitalia
 Male infant’s scrotum is undeveloped and not
pendulous
 Minimal rugae are present
 Testes may be in the inguinal canal or in the
abdominal wall
• Female genitalia
 Clitoris is prominent
 Labia majora are poorly developed and gaping

19. COMPLICATIONS OF
PRETERM BIRTH
Central nervous system:
oImmaturity of central nervous system
oPoor cough reflex
oIn coordinated sucking and swallowing
oRetrolental fibroplasias
oIntra ventricular and periventricular
haemorrhage

20. Respiratory system
• Resuscitation difficulties at birth
• Hyaline membrane disease
• Breathing is periodic and associated with intercostal
recessions due to soft rib
• Pulmonary aspiration
• Atelectasis
• Broncho pulmonary dysplasia

21. Cardio vascular system
• The closure of ductus arteriosus is delayed
among preterm infants
G I system
• Regurgitations and aspirations
• Abdominal distension and functional
• intestinal obstruction
• Enter colitis
• Hyperbilirubinemia
• Hypoglycaemia

22. Thermo-regulation
• Excess heat loss
Infections
Renal immaturity
• The blood urea nitrogen is high
• Acidosis
• Edema
Toxicity of drug
Nutritional problems
• anemia
• Deficiencies of folic acid and Vit E
• osteopenia and rickets
Biochemical disturbance
• hypoglycaemia, hypocalcemia, hypoxia

23. MANAGEMENT
• Care of preterm infant
• Intensive care protocol

24. IMMEDIATE CARE OF
NEWBORN
• Cord is clamped immediately to prevent
hypovolemic.
• Cord length is kept 10-12 cms in case of
exchange transfusion
• Airway is cleared
• Adequate oxygen is given
• Baby is wrapped including head with sterile
towel
• Administer inj .vitamin k

25. Intensive care protocol
Special care is needed incase of
• Inability to suckle the breast and to
swallow
• Incapacity to regulate the temperature
within limited range from 96-99F
• Inability to control the cardio-
respiratory function without cyanotic
attacks

26. PRINCIPLES OF SPECIAL CARE
• To maintain body temperature
• Adequate humidification to counter balance
increased water loss
• Oxygen therapy and adequate ventilation
• To prevent infection
• To maintain nutrition and adequate nursing
care

27. NURSING CARE
• Cushioned bed
• Avoid excessive light ,sound ,rough
handling and painful procedures
• Use effective analgesia and sedation for
procedures
• Provide warmth
• Ensure strict asepsis
• Cover the baby approximately

28. CONT…
• Provide effective and safe oxygenation
• Nutrition
• Tactile and kinesthetic stimulation
• Prone position or side lying with head lifted
• Phototherapy if needed
• Prevention of nosocomial infection
• Weight record daily
• Immunizations
• Family support

29. NEONATAL INFECTIONS
• Infection is still one of the leading causes of
neonatal death in developing countries.
• The neonates are more susceptible to infection
as they are deficient in natural immunity and
acquired immunity.
• Preterm infants are at high risk for perinatal
infections.
• Neonates that survive from sepsis often suffer
from severe neurological as well as severe
parenchymal lung diseases.

30. RISK FACTORS FOR
NEONATAL INFECTION
• Rupture of membrane > 18 hours
• Maternal intrapartum fever > 100.4˚F
• Low birth weight infant (< 2500 g)
• Prematurity (< 37 weeks)
• Chorioamnionitis
• Male infant
• Mother with (GBS) infection
• Repeated vaginal examination in labour
• Invasive procedures of monitoring

31. MODE OF INFECTION
Antenatal
• Transplacental : maternal infection that can affect
the fetus through transplacental route are
predominantely the viruses, they are rubella,
cytomegalovirus, herpes virus, HIV, chicken pox
and hepatitis – B virus. Other infections are
syphilis, toxoplasmosis and tuberculosis.
• Aminonitis : Following premature rupture of the
membranes can affect the baby following
aspiration or ingestion of infected amniotic fluid.

32. INTRANATAL
• Aspiration of infected liquor or meconium
following early rupture of the membranes or
repeated internal examination. This may lead to
neonatal sepsis, pneumonia and meningitis.
• while the fetus is passing through the infected
vagina –
(a) eyes are infected – opthalmia neonatorum or
(b) oral thrush with candid albican
Improper asepsis while caring the umbilical cord.

33. POSTNATAL – NOSOCOMIAL
INFECTIONS
• Transmission due to human contact – infected
mother, relative or staff of the nursery.
• Cross infection from an infected baby in the
nursery.
• Infection through feeding, bathing, clothing or
air-borne.
• Infection in environment of neonatal intensive
care (NICU) or invasive monitoring.

34. THE COMMON PATHOGENS
• Group b streptococcus (GBS),
• Staphylococcus aureus,
• E. Coli,
• Klebsiella and pseudomonas,
• Fungus(candida) and anaerobes.

35. THE PRIMARY SITES OF
INFECTION
• Skin,
• Nasopharynx,
• Oropharynx,
• Conjunctiva and
• Umbilical cord.

36. COMMON SITES OF
INFECTION
• Eyes – opthalmia neonatorum
• Skin
• Umbilicus
• Oral thrush
Severe systematic :
• Respiratory tract
• Septicaemia
• Meningitis
• Intra – abdominal infections

37. TREATMENT
Antibiotic therapy – broad spectrum
are given to cover the germ positive and
negative organisms as well as the
anaerobes. Inj. Ampicillin 150
mg/kg/every 12 hours, gentamycin 3-4
mg/kg/every 24 hours, usually are
started. In a severely ill patient,
cefotaxime or ceftazidime is also added.

38. CONT…
• Supportive therapy and management of
complications as needed. E.g. mechanical
ventilation for RDS, dopamine for
hypotension, ant convulsion for seizure
sodium bicarbonate for metabolic acidosis and
Immunotherapy with hyper immune globulins.