LBW BABY

LBW BABY

1. L O W B I RTH WEIGHT BABIES

2. D E F I N I T I O N : - Low birth weight (LBW ) :- “ Defined as one whose birth weight is less than 2500 grams , i rrespective of gestational age .” INCIDENCE :- Preterm baby constitutes 2/3 rd of low Birth weight babies.

3. ETIOLOGY :- Preeclampsia Chronic medical illness Infection (group B streptococcus , UTI ) Drug abuse (such as cocaine ) Previous preterm birth Placenta previa Placental abruption Abnormal or decreased function of placenta Multiple gestation (twins , triplets or more )

4. MANIFESTATION S : 1. Anatomical :- The weight is 2500 gms or less & length is usually less than 44 cm . Head & abdomen are relatively large, skull bones are soft with wide sutures & post fontanels Head circumference is disproportionately exceeds that of chest . Pinnae of ear are soft & flat . Eyes are kept closed .

5. Plantar creases are not visible. Testicles are undescended , labia minora are exposed because labia majora in contact. Nails are not grown right upto the finger tips.

6. FUNCTO NALLY :- CNS:- Lethargic & inactivity, poor cough reflex. CVS:- About 1/3 rd of babies have PDA. RS:- RDS, pulmonary aspiration & atelactesis are common. GI:- Difficulties in feeding D/T poor sucking, small capacity of stomach. Hepatic immaturity leads to hyperbilirubinaemia which may be aggravated by delayed feeding, dehydration & hypoxia.

7. e) Thermoregulation :- Temperature regulating centre is immature, heat loss is excessive. Hence preterm infant develop hypothermia. f) US:- D/T renal immaturity preterm infant develop acidosis & dehydration. g ) Infection:- low levels of IgG antibodies preterm babies are prone t o infection.

8. PRINCIPLES OF MANAGEMENT :- To maintain body temperature Respiratory support Prevention of infection To maintain nutrition Adequate nursing care

9. COMPLICATION S :- Asphyxia Cerebral hemorrhage Fetal shock Heart failure Edema Infection Jaundice Anemia Retrolental fibroplasia

10. “The term is to designate the newborns with birth weight less than 10 th percentile or less then two standard deviation for their gestational age.” SMALL FOR GESTATIONAL AGE (SGA)

11. Maternal :- ETIOLOGY : short stature mother primi or grand multipara teenage pregnancy low Pre-Pregnant weight maternal illness- anemia, heart disease, malaria complications of pregnancy – PIH smoking, alcoholism or drug abuse by mother poor weight gain during pregnancy previous similar baby 16

12. Placental factors disorders of placental implantation Abruptio placenta single umbilical artery structural & functional abnormalities of placenta umbilical cord. Fetal Factors:-  first born babies are generally smaller  twin or multiple pregnancy  intrauterine infections  genetic or chromosomal aberrations

13. Environment al factors :-    poor socioeconomic status nutritional habits cultural practices

14. T YPES :- the babies with small for dates ( SFD ) are found as three different types : 1. Malnourished small for dates infants: 1. These babies appear long, thin and alert 2. They look marasmic poor subcutaneous fat & poor muscle mass . 3. They have excess skin folds on the buttocks & thigh. 4. The difference in head circumference and chest circumference is more then 3 cms. 5. The internal organs such as liver thymus & lungs are shrunken but pulmonary alveoli are mature as per the gestation.

15. 2. Hypo plastic SFD :- In case of intrauterine infection, genetic defects & chromosomal aberration growth retardation occurs in the early part of the pregnancy, the no of body cell is reduced these babies are small including the head size, prognosis is poor permanent mental& physical growth retardation.

16. 3. Mixed group:- There is reduction in the cell no. & the cell size because of the adverse factors operate during both the early & mid pregnancy

17. Common problems of SFD Babies  Birth asphyxia SFD infant suffer from prenatal asphyxia due to maternal factors & placental insufficiency. Some of them pass me conium in utero due to distress & are liable to develop me conium aspirant syndrome.  Fetal hypoxia & introspection death due to place dysfunction  Inappropriate thermoregulation

18.  Pulmonary hemorrhage polycythemia due to unknown cause  Increased risk of infections  Poor growth potential  Metabolic changes these infants develop hypoglycemia due to poor reserves of glycogen & fat. Hypokalemia is frequent because of transient hypoparathyroidism.

19. Management :- Whenever a SFD fetus is suspected careful observation of mother is made to determine LBW with the help of USG. Majority of fetal deaths occur after 36th wk gestation so correct diagnosis is Essential.  Mother is advised for adequate bed rest in left lateral position.  To correct malnutrition by balanced diet: 300 extra calories per day to be taken  Avoid smoking & alcohol  Fetal growth & assessment of well being of for his to be done, by NST.