Low birth weight

Approach to low birth weight,introduction ,causes,management and prevention.

1. How to approach very low birth weight infant Dr. Ashok Yadav Resident, Year - 1 Department of Neonatology

2. Definition, types and importance Introduction 01 Explaining causes of low birth weight. Causes of LBW 02 Explaining all the problems of low birth weight. Problems of LBW 03 History, examination, investigations and treatment. Approach and management 04 Headlines Direct and indirect intervention. Prevention 05

3. Introduction BIRTH WEIGHT F irst weight of fetus or new born obtained after birth . Importance of birth weight It is single most important determinant for survival, growth and development of infant . Reflects health status of mother during adolescence and pregnancy and also quality of antenatal care.

4. LOW BIRTH WEIGHT Any infant with a birth weight of less than 2500gm with in 1 hr. of birth regardless of gestational age. GRADING Birth weight Grade 2500 – 1500 gm Low birth weight 1500 – 1000 gm Very low birth weight < 1000 gm Extremely low birth weight <800gm Micro preemie

5. Types of LBW 2 types based on the origin preterm Small-for-date(SDF)/IUGR <37 completed weeks of gestation < 10 th centile for gestational age Account for 1/3 rd of LBW Account for 2/3 rd of LBW

6. CAUSES of LBW Low birth weight includes 2 groups Preterm babies (<37Wks) IUGR In nearly 50% of cases of LBW the cause is not known In remaining 50% the causes are grouped into . a) medical b ) social

7. a) Medical causes Maternal causes :PIH , anaemia , low maternal age,chronic HTN,preeclampsia,short stature Placental causes :Placenta previa , Abruptio placenta, Congenital defects of placenta etc , Fetal causes : Multiple gestation , Chromosomal disorder , intrauterine infections etc.

8. b) Social causes Poverty, Illiteracy Ignorance, Poor standard of living, Lack of knowledge on family planning E arly marriages, smoking etc

9. LBW (Preterm) : Problems Early Hypothermia Hypoglycaemia Respiratory distress syndrome Infections Haemorrhage-intraventricular , GI, Pulmonary Problems of gut-NEC, GERD Exaggeration of physiological jaundice Patent ductus arteriosus (PDA) Anaemia of prematurity

10. Late Metabolic bone disease-rickets of prematurity, osteopenia of prematurity Retinopathy of prematurity(ROP) Delayed growth and development Cerebral palsy or other neurological deficit

11. VLBW (Approach and Management) Relevant History Age of mother-young Multiple pregnancies Previous LBW infants Poor nutrition Infection during pregnancy Antepartum hemorrhage Heart disease/Hypertension Economic status Drug addiction Alcohol abuse Insufficient prenatal care

12. Antenatal: Fundal height, abdominal girth After Birth :Birth weight and vital signs (heart rate,Spo2,respiratory rate,capillary refill time,temperature,pulse and blood pressure) should measure Complete physical examination from head to toe. All systemic examination should be done. Examination

13. Physical maturity Skin texture: Preterm-smooth, shiny, oedematus . IUGR-Dry, loose,thick . Hair: Preterm-soft, downy hair called lanugo. IUGR-Thick dark hair. Planter crease:Preterm-reduced or absent. IUGR-Covering entire foot. Breast bud: less developed in premature babies.

14. Cont …. Ear: soft in case of premature babies. Genitals, male: check for testis and how the scortum looks –smooth or wrinkled. Genitals, female: labia majora widely saperated in case of premature babies

15. Laboratory investigations Complete blood count with differential Random blood sugar Serum electrolyte Pulse oximetry Arterial blood gas Chest radiography Echocardiography USG of brain Others according to requirements

16. Management Interventions during pregnancy and labour Antenatal corticosteroid injection. If rapture of membrane before onset of labour -Antibiotics should be given.

17. Contd. Delivery management LBW is prone to be asphyxiated. Management at birth according to guidelines of resuscitation. Consider -Early intubation -Early CPAP -Prevent hypothermia -Prevent hyperoxia

18. Special care at Hospital 1.Prevention of hypothermia Child is kept under incubator /radiant warmer– it maintains the temperature , humidity and o2 supply , till weight increases to 2000g . Kangaroo mother care(KMC) Warm transport Postpone bathing till 72 hrs of age. Careful monitoring of O2 supply : low O2 – hypoxia and cerebral palsy high O2 – retinopathy of prematurity

19. Contd … 2 .Prevention of infections Prophylactic antibiotics to prevent septicemia. Separate nurses for feeding and toilet attending . Barrier nursing to prevent cross infections.

20. Contd … 3.Correction of malnutrition The baby is already malnourished . Further malnutrition should be prevented. Tube feeding is done because baby is in incubator and it is too young to suck mothers milk.

21. Contd … 4.Correction of electrolyte imbalance. 5.Management of others complication accordingly.

22. Guidelines for starting fluid and electrolytes and glucose(Day-1) Birth weight Starting volume(ml/kg/day) Types of fluid <1000gm 90 5%Dextrose in Aqua 1000-1500gm 80 7.5-10 % Dextrose in Aqua >1500gm 60 10% Dextrose in Aqua [ Increase fluid volume at a rate of 15-20 ml/kg/day to reach 150-180ml/kg/day at 7 days of age.Use dextrose in aqua up to 24 hrs of age then replace by Dextrose in 0.225% saline]

23. Special care at Home 1 Prevention of hypothermia Avoid bath till baby attains 2500g weight. Cover baby with clean dry & warm cloth. Bottles filled with warm water & covered with thin cloth are kept on both sides (or) baby without blanket is kept near 60 candle bulb burning. Kangaroo mother care(KMC).

24. 2.Prevention of infections Gentle and minimal handling Handling with clean hands Room must be warm, clean and dust-free Immunization at right time

25. 3.Correction of malnutrition As LBW babies cannot suck milk actively , it gets tired faster. So frequent breast feeding must be given almost every alternate hour.

26. Supplements in preterm infants<35 weeks and /or<1500 gm Add multivitamins pediatric drop 0.3ml OD from 2 wks and /or when full feeds have been achieved ;continue after discharge till 6 months. Folic acid :dose 50mcg/day every alternate day for 6 months. Add iron (1ml=50mg) at the following doses. 1 drop OD (2mg/kg/day) at 4 wks of age for 2 weeks. 1 drop BD(4mg/kg/day) at 6 weeks of age. 2 drop BD (5-6mg/kg/day) at 1.8kg and continue till 6 months of age.

27. EARLY DISCHARGE Criteria for discharge : Hemodynamically stable Has cross birth wt. and shows stable weight gain for at least 3 consecutive days.wt . atleast >1500gm. Baby should feed well on breast milk . Temperature should be maintained in open crib. There should not be any evidence of illness . Successful ‘in-hospital adaptation’ of the mother and other members of the family . ROP,Hearing,Thyroid screening has completed.

28. FOLLOW-UP After discharge , KMC is continued at home . Follow-up is done daily by the health worker for one week and ensured that baby is feeding well and gaining about 40g weight daily . Afterwards once a week till the baby reaches 40 weeks of post conceptional age.

29. PREVENTION OF LBW BABY A . DIRECT INTERVENTION MEASURES Prevention of malnutrition - By nutritional education and supplementation of vitamins and minerals. Prevention of anemia - By distribution of IFA tablets Control of infections - By early diagnosis and prompt treatment. Avoid strenuous exercise , smoking & alcohol among pregnant mothers.

30. B . INDIRECT INTERVENTION These are mainly family welfare services such as Deciding age at marriage. Deciding age at first child . Birth spacing . Deciding no of children. Improvement of availability of health services to women .

31. THANK YOU Dr. Ashok Yadav