Low Birth Weight (of infants)

Notes
  • Low birth weight (LBW) infant is defined as a birth weight of a live born infant of ≤ 2,500gm, regardless of gestational age.
  • Very Low birth weight (VLBW) infant is defined as a birth weight of a live born infant of ≤ 1,500gm, regardless of gestational age.
  • Extremely Low birth weight (VLBW) infant is defined as a birth weight of a live born infant of ≤ 1,00gm, regardless of gestational age.
  • A preterm baby refers to a baby born before 37 weeks of gestation have been completed (normal gestation lasts for about 40 weeks)
  • Preterm births happen spontaneously (majority), by early induction of labour or by caesarean birth.
  • Low birth weight babies can be due to premature birth (constitute 70% of cases) and/or due to restricted fetal (intrauterine) growth.
  • Most healthy newborns weigh between 2.5 - 4.5 kg
  • For the same gestational age, girls weigh < boys, firstborn infants weigh < subsequent infants, and twins weigh < singletons
  • Statistics: 10% (15 million) babies are born preterm globally of which 60% are in developing countries; one million preterm babies die annually. In developed countries 90% of preterm babies survive but in developing countries 90% of them die; 14th cause of mortality in Kenya
  • Babies should be kept at a temperature of 25 deg C (in a room or incubator)

##Risk factors for preterm births and low birth weights

  • Pregnancy in adolescence (majority of cases)
  • Women of short stature
  • Women living at high altitudes
  • Previous preterm birth
  • Poor nutrition of the mother
  • Multiple pregnancies
  • High blood pressure
  • Diabetes
  • Other underlying medical conditions
  • Smoking cigarettes
  • Alcoholism
  • Stress of the mother
  • Fetal or birth defects
  • Maternal and fetal infections e.g. cytomegalovirus, chicken pox and rubella
  • Uterine and cervical abnormalities

##Challenges associated with preterm births

  • Infant respiratory distress syndrome
  • Sudden Infant Death Syndrome (SIDS)
  • Infant apnea
  • Infant aspiration
  • Poor thermal regulation that leads to hypothermia
  • Poor feeding that leads to hypoglycemia
  • Neurologic problems e.g. intraventricular hemorrhage
  • Susceptibility to infections
  • Hyperbilirubinemia
  • Gastrointestinal problems e.g. necrotizing enterocolitis
  • Anemia of prematurity
  • Lifetime of health challenges such as:

_Hypertension

_Type 2 diabetes

_Coronary heart disease

_Cerebral palsy

Vision and hearing loss

_Slower cognitive and motor development

Symptoms
  • Low birth weight
Diagnosis
  • Clinical review
Differential
  • Not applicable
Prevention
  • It may not be prevented in some cases
  • Effective antenatal care and treatment of any underlying illness in expectant mothers
  • Proper nutrition of the expectant mothers
Management

## For babies weighing 2,000 – 2499gm

  • Cared for as the normal weight babies
  • Pay special attention to their feeding habit as some of them may have challenges in feeding
  • Observe the baby for 1-2 days before discharge.

## For babies weighing 1,750 – 1,999gm

  • Kangaroo Mother Care (KMC) to provide warmth may be adequate. In KMC, the baby (who has been dressed in a diaper/nappy, cap,2,499 and socks) is placed naked in frog like posture very closely on mother’s chest between her breasts. The mother is in a recliner position during rest and sleep.
  • Breastfeed the baby (which may be adequate)
  • If a baby gets tired too soon before adequate breastfeeding provide alternative feeding with cup feeding and eventually tube feeding

## For babies weighing ≤1,750 gm

  • These are babies who require very close attentions as they are likely to feed poorly, are susceptible to infection, hypothermia and apnea
  • They are transferred to specialized care area
  • Once they are stable, they are offered Kangaroo Mother Care

##Feeding of the preterm babies

  • Feeding of a newborn baby should be done within the first one hour after birth to avoid hypoglycemia
  • In a preterm baby, monitor the feeding and evaluate every 6hrs to check its effectiveness
  • For babies <1,500gm the starting oral feeding should be 3mL. For babies >1,500gm the starting oral feeding should be 6mL
  • The quantity of feeding is calculated as follows:

_Start with 60mL/kg/day on day

_Increase the feeding by 20-30mL/day (maximum 180-200mL/kg/day) even in breastfeeding

_Give multivitamin supplement containing at least 400IU of Vitamin D as soon as the baby starts feeding orally

_Give iron supplements 6mg/kg/day after the age of 4 weeks) 

_Monitor weight at least 3 times a week (the expected weight gain after the first week is 15g/kg/day)

##Management of anemia of prematurity

  • Give iron supplements 6mg/kg/day
  • This anemia can be caused by blood loss that may be associated with hemorrhage (like cranial) and repeated drawing of blood during investigation
  • Transfuse if HB ≤ 8g/dL, if the baby is showing poor gaining of weight, recurrent apnea, and signs of congestive heart failure.
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