2. Definition:
Low birth weight has been defined by the
WHO as weight at birth of less than 2,500
grams (5.5 pounds).
This is based on epidemiological
observations that infants weighing less
than 2,500 g are approximately 20 times
more likely to die than heavier babies.
4. Types of LBW:
Preterm Small-for-date (SFD)
/ intra uterine
growth retardation
(IUGR)
< 37 completed
weeks of gestation
< 10th Percentile
for gestational age
Account for 1/3rd of
LBW
Account for 2/3rd of
LBW neonates
5.
6. Overview:
More common in developing than developed
countries.
The goal of reducing LBW incidence by at least
one third between 2000 and 2010 is one of the
major goals in ‘A World Fit for Children’,.
Forms an important contribution to the Millennium
Development Goal (MDG) for reducing child
mortality.
7. Overview:
More than 20 million infants worldwide,
representing 15.5% of all births, are born
LBW, 95.6 % in developing countries.
LBW is closely associated with: foetal and
neonatal mortality and morbidity, inhibited
growth and cognitive development, and
chronic diseases later in life.
8.
9. Risk factors for LBW:
Mother's Malnutrition
Heavy work load
High blood pressure
Infection and diseases
Unregulated fertility.
10. Causes and consequences of
LBW
) Preterm babies:
There are babies born too early before 37
weeks of gestation, their intrauterine growth
may be normal, that is their, weigh, length and
development may be within normal tomtits for
the duration of gestation.
Given good neonatal care, these babies can
catch up growth and by 2 to 3 years of age will
be of normal size and performance.
11. Approximately 2 thirds of all babies of
LBW in developed countries are estimated
to be preterm the causation of preterm
babies is multifactoral. There include
multiple births, hard physical works
hypertensive disorders of pregnancy. But it
is often preventable by such measures as
good prenatal screening and care.
12. Small for dates (SFD):
These babies are result of intrauterine
fetal growth.
The factors associated with intra uterine
growth retardation are multiple and
interrelated to mother, placenta or to
foetus.
13. Factors affecting birth weight:
The maternal factors:
Include malnutrition.
Anaemia.
Heavy physical work-during pregnancy.
Hypertension.
Malaria.
Toxaemia.
Smoking.
14. The maternal factors:
:
Low economic status.
Short maternal stature.
Young age.
High parity.
Dose birth spacing.
Low education status.
15. Factors related to placenta:
Placental insufficiency.
Placental abnormalities.
16. The foetal causes:
Foetal abnormality.
Intra uterine infections.
Chromosomal abnormalities.
Multiple gestation.
17. SFD babies has a high risk of dying not
only during the neonatal period but during
their infancy, thus significantly raising the
rate of infant and prenatal mortality.
Most of them become victims of protein
energy mal nutrition and infection.
18. Importance:
LBW is one of the most serious challenges
in maternal and child health indevelped
and developing countries.
19. Its public health significance may be
ascribed, to numerous factors:
Its high incidence.
Its association with mental retardation.
A high risk of prenatal and infant mortality
and morbidity.
20. Its public health significance may be
ascribed, to numerous factors:
LBW is the single most important factor
determining the survival chances of the
child (the infant mortality rate is about 20
times greater for all breast fed babies.
.
21. Its public health significance may be
ascribed, to numerous factors:
Many of them become victims of protein –
energy – malnutrition and infection.
There is a strong and significant positive
status and the length of pregnancy and
birth weight
22. Prevention:
The rates of LBW could not be reduced to
more than 10 percent in all parts of the
world. There is no universal solution,
interventions have to be case specific.
23. In recent years good attention has
been given to ways and means of
preventing LBW through good prenatal
care and interventions programmes rather
than treatment of low birth weigh babies
born later.
24. Direct intervention measures: (mothers
)
1. Increasing food intake
2. Controlling infection
3. Early detection and treatment of medical
disorders
25. Prevention:
Indirect intervention:
1. Family planning
2. Improved sanitation
3. Improving health and nutrition of young
girls
4. Improvement of socio-economic
conditions
5. Government support (maternity leave)
31. LBW: Identification of types
SFD / IUGR
Intrauterine growth chart
Physical characteristics
Emaciated look
Loose folds of skin
Lack of subcutaneous tissue
Head bigger than chest by >3cm
32.
33. Central nervous system :
Respiratory system
Cardiovascular system
Gastrointestinal system
Thermo regulation
Infections
Renal immaturity
Toxicity of drugs
Nutritional handicaps
Biochemical disturbances
34. Central nervous system :
The immaturity of central nervous system
is expressed as inactivity and lethargy,
poor cough reflex.
Resuscitation difficulties at birth and
recurrent apneic attacks are common.
Retrolental fibroplasia due to oxygen
toxicity is limited to babies with a gestation
of less than 35 weeks.
35. On the other hand, they are more resistant
to toxic effects of hypoxia as compared to
the term babies. They are extremely
vulnerable to develop intraventricular,
periventricular haemorrhage due to
relative deficiency of vitamin-K dependent
coagulation factors and increased capillary
fragility. The blood brain barrier, which is
possibly a function of available serum
proteins, is inefficient in preterm babies,
thus brain damage may occur at lower
serum bilirubin levels.
36. Respiratory system
They pose resuscitation difficulties at birth,
often followed by hyaline membrane
disease, if associated with deficiency of
pulmonary surfactant. Pulmonary
aspiration and atelectasis are common.
They are vulnerable to develop chronic
pulmonary insufficiency due to
bronchopulmonary dysplasia.
37. Cardiovascular system
The closure of ductus arteriosus is
delayed among preterm infants. About
one, third infants with gestational age of
34 weeks or less manifest clinical
evidences of patent ductus arteriosus with
or without congestive heart failure.
38. Gastrointestinal system
Regurgitation and aspiration are common
because of in coordinated sucking and
swallowing reflex, small capacity of
stomach, incompetence of
cardioesophageal junction and poor cough
reflex. Gastro,esophagal reflux and is
consequences are common. Abdominal
distension and functional intestinal
obstruction are due to hypotonia.
39. Enterocolitis occurs when other
predisposing factors are present.
Immaturity of glucuronyl transferase
system in the liver leads to
hyperbilirubinemia, which may be
aggravated by dehydration, delayed
feeding and hypoglycemia.
40. Relatively low serum albumin, acidosis
and hypoxia in these babies predispose to
bilirubin levels.
The poor hepatic glycogen stores, delayed
feeding, birth asphyxia and respiratory
distress syndrome contribute to the
development of hypoglycemia.
41. Thermo regulation
Hypothermia is invariable and life
threatening unless environmental
temperature is monitored. Excessive heat
loss is due to relatively large surface area
and poor generation of heat due to paucity
of brown fat in a baby who is equipped
with an inefficient thermostat.
42. Infections
Infections are an important cause of
neonatal mortality in low birth weight
babies. The low levels of IgG antibodies
and inefficient cellular immunity
predispose them to infections.
Excess handling, humid and warm
atmosphere, contaminated incubators and
resuscitators expose them to infecting
organisms, thus contributing to high
incidence of infections.
43. Renal immaturity
The blood urea nitrogen is high due to low
glomerular filtration rate.
The renal tubular amonia mechanism is
poorly developed thus acidosis occurs
early. They are vulnerable to develop late
metabolic acidosis especially when fed
with a high protein milk formula.
44. Toxicity of drugs
Poor hepatic detoxification and reduced
renal clearance make a preterm baby
vulnerable to toxic effects of drugs unless
caution is exercised during their
administration.
45. Nutritional handicaps
Low birth weight babies are prone to develop
anaemia around 6 to 8 weeks of age. This is due
to diminished total stores of iron due to short
gestation and also deficiency of folic acid.
Vitamin E deficiency occurs among infants
weighing less than 1,500g, particularly those fed
on iron fortified milk formula. These infants are
prone to develop haemolytic anaemia,
thrombocytopenia, and oedema at 6 to 10
weeks of age.
46. Biochemical disturbances
These babies are prone to develop
hypoglycemia, hypocalcemia,
hypoproteinemia, acidosis and hypoxia.
47.
48.
49. Treatment:
From the point of view of treatment. LBW
babies can be divided into 2 groups.
Those under 2 kg.
Those between 2 – 2.5 kg.
The first group require first class modern
neonatal care which is hardly available
50. globally in an intensive care unit their
weight reaches the weight of the second
group.
The second group may need an intensive
care unit for a day or two.
51. The intensive care comprises of:
Incubatory care, that adjust temp, humility
oxegen supply (low levels of oxygen in the
blood steam can produce cerebral palsy. If
it is excessive leads to retrolenta fit
roplasia).
52. Feeding: Nasal catheter.
Prevention of infection: Infection can
cause death in the first few hours
(respiratory infection so prevention of
infection is there fore one of the most
important functions of an intensive care
unit.
53. The leading causes of death in low
birth weight babies:
Atelectasia.
Malformation.
Pulmonary haemorrhage.
Intracranial bleeding.
Pneumonia and other infections.
The development of perinatal intensive
care units has been associated with a
decline in neonatal mortality.
54. Feeding of infants:
Breast feeding:
1. Ideal
2. Protect from infection and malnutrition
3. Reduces infant mortality
55. Advantages:
Safe, clean ,cheap, and available in correct temp.
Meets nutritional requirement of infant in first
months of life
Antimicrobial factors
Easily digested ,has biochemical advantages.
Promotes bonding
Protects against obesity
Sucking is good for development of jaws & teeth
Prevents malnutrition
Child spacing
56. Artificial feeding:
Dried milk,cow`s milk
Indications:
1. Failure of breast milk
2. Prolonged illness
3. Death of mother
57. Comparison between breast milk
and cow's milk
Cow's milkBreast milkconstituent
↑↓proteins
==fats
↓↑carbohydrates
↑↓Minerals
↓↑vitamins
58. Weaning:
Gradual process starts around 4-5 months
Supplementary foods
If not done properly ,diarrhoea and growth
failure
Solid foods introduced at age of one year
Nutrition education
Promoting home-made weaning foods.
59. Nursing care of low birth
weight baby:
The objectives of management are to:
Support respiratory effort
Provide neural thermal environment
Provide fluid and nutrition
Prevent infection
Provide sensory stimulation
Keep mother infant attachments
60. Support respiratory
effort:
Position-neck slightly extended, use
shoulder roll.
Continuous monitoring of SPO2
If apnea occurs, give tactile stimulation by
flicking on soles
Administer O2 by hood method.
Prevent complication of retrolental
fibroplasia.
62. Maintaining Temperature
Temperature of nursery should be
maintained 30+/- 2 C
Temperature probe should be attached to
skin of baby.
Monitoring of temperature for
hyperthermia and hypothermia.
66. LBW: Fluids and feeding
Weight <1200 g; Gestation <30 wks*
Start initial intravenous fluids
Introduce gavage feeds once stable
Shift to katori-spoon feeds over next
few days. Later on breast feeds
67. LBW: Fluids and feeding
Weight 1200-1800 g; Gestation 30-34
wks*
Start initial gavage feeds
Katori-spoon feeding after 1-3 days
Shift to breast feeds as soon as baby
is able to suck
68. LBW: Fluids and feeding
Weight >1800 g; Gestation > 34 wks*
Breast feeding
Katori-spoon feeding, if sucking not
satisfactory on breast
Shift to breast feeds as soon as
possible
69. LBW: Feeding schedule
Begin at 60 to 80ml/kg/day
Increase by 15ml/kg/day
Maximum of 180-200ml/kg/day
First feed at 2 hrs of age then every 2
hourly
72. Guidelines for the modes of providing fluids
and feeding
Age Categories of neonates
Birth weight (gm)
Gestation (wks)
Condition
<1200
<30 weeks
1200-1800
30-34 weeks
>1800
>34 weeks
Initial
Intravenous fluids
Try gavage feeds, if
not sick
Gavage Breast feeding. If
unsatisfactory,
give katori-
spoon feeds
After 1-3 days Gavage Katori-spoon Breast
Later (1-3
wks)
Katori-spoon Breast Breast
After some
more time
(4-6 wks)
Breast Breast Breast
