LOW BIRTH WEIGHT BABY: causes , Risks and complications.

This comprehensive PowerPoint presentation provides an overview of low birth weight babies, including definition and prevalence of LBW
Causes and risk factors associated with LBW.
Health risks and complications faced by low birth weight babies.
prevention strategies and interventions to reduce the risk of low birth weight.

1. LOW BIRTH WEIGHT BABY PRESENTED BY: MS.UJJWALA K. MUNDHE M.SC NURSING (CHILD HEALTH NURSING)

2. At the end of the class students will be able to: Introduce low birth weight Define the common terminologies State the incidence of LBW and preterm babies Enlist the etiological factors of LBW babies. Discuss the body measurement of LBW babies. Discuss the physical characteristics of preterm babies . Explain the physiological problems of preterm babies. List down the salient clinical manifestation of preterm babies

3. Classify the small for date babies. Recognize the etiological factors for small for date babies. Describe the principles of management of low birth weight babies Discuss the nursing intervention for management of low birth weight babies. Outline the strategies to reduce incidence of preterm babies. Illustrate the complications. 

4. INTRODUCTION: A new born baby whose birth weight is less than 2500gms,regardless of gestational age is known as low birth weight baby. Approximately 10 % of low birth weight babies are in a serious condition, who needs high quality care and careful observation . The babies who are born before gestational age and the babies born on full term but with low birth weight (due to delayed growth and development in the womb ) are categorized under low birth weight babies.

5. According to UNICEF more than 20 million infants born each year , weigh less than 2.5 kg accounting for 17 % of all births in developing world. Infants with low birth weight are at higher risk of dying during their early months and years. Those who survive are liable to have an impaired immune system and may suffer from higher incidence of chronic illnesses like diabetes and heart diseases in later life.

6. DEFINITIONS : Low birth weight (LBW) Infant : Baby whose birth weight is less than 2.5 kg (2500gms) regardless of gestational age. Very low birth weight : A baby whose birth weight is less than 1500 gm Extremely low birth weight : A baby whose birth weight is less than 1000gm

7. Appropriate for gestational age : An Infant whose birth weight falls between the 10 th and 90 th percentiles of intrauterine growth curves. Small for dates or small or gestational age infant : An infant whose rate of intrauterine growth was slowed and whose birth weight falls below the 10 th percentile on intrauterine growth curves.

8. Intrauterine growth retardation: Babies who do not grow adequately in utero . Premature (preterm) infant : A baby born before completion of 37 th week of gestation, regardless of birth weight.

9. 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.  

10. ETIOLOGY:

11. BODY MEASUREMENTS OF LBW BABIES : Check all the milestones of newborn's body such as length, weight of low-birth weight and compare with normal child: 1. Weight: Less than 2500 gms 2. Length: Less than 47 cms 3. Head circumference: Less than 33 cms 4. Chest circumference: 3 cms less than head circumference. 5. Circumference in between arms: Less than 9 cms .

12. Classification These are classified into two groups. 1. Preterm: The growth potential is normal and is appropriate for the gestational period (10 to 90percentile). 2. Small for Gestational Age (SGA) or IUGR: The term is to designate the new-borns with birth weight less than 10 percentile or less than 2 standard deviation for their gestational age. a fetus of SGA may be constitutionally small or due to pathologic process there may be fetal growth restriction.

13. PHYSICAL CHARACTERISTICS OF PRETERM BABIES : If new born is born before 37 weeks, note the following characteristics: 1. Head and Face: Face is small and head is large in circumference than the shape of face. Head sutures are clearly visible. Fontanelles large in size.

14. 2 . Activity and posture : The normal functions of baby is low or weak. Sucking and swallowing reflex is also less or very weak. The movements of muscles is also weak. Baby looks inactive and weak. 3 . Hair: The hairs are brown colored , scattered and woolen like. 4. Ear cartilage : The ear cartilages are less in number. Sometimes, in very low-birth weight babies, the car cartilages are totally absent. There is less recoiling in the external part of ear.

15. 5. Nails: The nails are short and even the borders of fingers are not formed. 6. Breast nipple : The diameter of breast nipple is less than 5 mm or the nipples are very small or not even formed. 7. Genitalia : In preterm male infant, the scrotum is undeveloped and not pendulous, the scrotum do not descend from abdomen (In normal male child, scrotum develops from the scrotal sac after 37 weeks).

16. 8. Sole creases : There is presence of only one crease on the anterior part of soles. Sometimes, no lines are found. 9. Skin: The preterm infant’s skin is sticky, friable and transparent. Vernix caseosa is less or totally absent. Edema is present on the skin. 10. Lanugo : The lanugo is present in abundance on the whole body, especially on the back and face.

17. PHYSIOLOGICAL PROBLEMS OF PRETERM BABIES : Alteration of respiratory function : The pulse and respiration of preterm infant is rapid and fast. Sometimes, the respiration also slows down and preterm baby has apnea . The cough and gag reflex is minimal. The problems such as pulmonary aspiration and atelectasis, hyaline membrane disease is also present in such kind of infants. The muscles of respiratory tract are also weak in preterms . The lungs do not expand well. The respiratory system is very weak

18. Immaturity of central nervous system : The preterm babies are always inactive and exhausted. The sucking and swallowing reflexes are not inter connected with each other, so the problems arise in the process of sucking and respiratory function. The ill-effect (excess concentration) of oxygen produces retinopathy of prematurity in pre-term babies

19. Disturbance of circulatory functions : The closure of ductus arteriosus in pre-term infant is late. The peripheral blood supply does not work well. The blood vessels are weak due to which complication like internal bleeding can occur.

20. Impaired thermoregulation: In preterm infants, hypothalamus is immature. The fat under the skin is also less which provides insulation. Due to this reason, pre-term newborns are at high risk of developing hypothermia.

21. Inefficient gastrointestinal and hepatic functions : Due to poor sucking and swallowing reflex, baby feels difficulty in sucking breasts or bottle. Due to less capacity of stomach, it gets full with little content. Due to undeveloped gastro- esophageal sphincter, it leads to regurgitation of gastric contents .

22. Increased susceptibility: The chances of infection is ten times higher in preterm than in normal infant. Due to low cell mediated immune system and less IgG antibodies, the chances of infection is increased in preterm infant.

23. Impaired renal function: The glomerular filtration rate is slowed in pre-term newborns . They form more concentrated urine, so they are easily prone to acidosis .they are also at high risk of dehydration.

24. drug toxicity : The liver is not properly functioning in preterm babies , so they are unable to remove the effects of drug toxicity .  

25. SALIENT FEATURES / CLINICAL MANIFESTATIONS OF PRETERMS : Weight is usually 2500 g or less. Length is usually less than 44 cm. Head and abdomen relatively large. Skull bones are soft with wide sutures and wide posterior fontanelle. Head circumference exceeds than that of chest

26. Pinna of ears are soft and flat. Eyes are kept closed. Skin is red, thin and shiny due to lack of sub. cutaneous fat. Deep plantar creases are not visible before 34 weeks. The testicles are undescended. The labia minora are exposed because the labia majora are not in contact. There is a tendency of herniation. Nails are not grown right up to the finger tips.

27. SMALL FOR DATE / SMALL FOR GESTATIONAL AGE BABIES: A baby whose birth weight falls below the 10 th percentile on intrauterine growth curves is also known as small for date or small for gestational age .

28. Classification of small for date SFD OR SGA babies are of 3 types : Malnourished small for date infants : Growth arrest in later part of pregnancy leads to reduction in cell size but not cellular number , resulting in small and malnourished baby. Such baby looks marasmic and has less subcutaneous fat and poor muscle mass.

29. Hypoplastic small for date babies : Growth retardation in early part of pregnancy leads to reduction in number of body cells resulting in hypoplastic small for date babies . these babies are proportionately smaller in all parameters including head size.

30. ETIOLOGY OF SMALL DATE BABY/IUGR IUGR may be fetal response to following factors : Fetal factor : Placental factor : Maternal factors:

31. Fetal factor : Chromosomal anomalies Infections Infarctions Multiple gestation Pancreatic hypoplasia Insulin deficiency

32. Placental factor : Placental weight Infarction Abruptio placenta Infection of placenta

33. Maternal factors: Toxemia of pregnancy Renal diseases Malnutrition Short stature of mother Primi or grand multipara Young mother Smoking , alcohol or drug abuse .

34. PRINCIPLES OF MANAGEMENT OF LOW BIRTH WEIGHT INFANTS : Care at birth : Select a suitable place for delivery which has optimum facilities for handling LBW baby. In case, premature labour is indicated administer betamethasone (12 mg IM, 2 doses at interval of 18 hours ) or hydrocortisone 100 mg to the mother as they help in improving the lung capacity and reduces the incidence of hyaline membrane disease in newborn . Avoid administration of sedatives to the mother , as they can depress baby’s respiration.

35. A good episiotomy should be given to prevent intracranial birth injury. Delayed cord clamping to help improve iron stores of baby and prevent anemia . Efficient resuscitation Administration of vitamin k 0.5 mg IM to reduce incidence of hemorrhage in baby. Prevent hypothermia

36. Appropriate place to care : If birth weight >1800gm – home care , if baby is well. If birth weight 1500-1800gm – secondary level newborn unit (level 2) If birth weight <1500gm – tertiary level new born care (level 3 )

37. Thermal protection : Delay bathing up to 48-72 hours of birth or even more till the baby is stable. Maternal skin to skin contact or kangaroo care Warm delivery room External heat source .

38. Nutrition: Intravenous fluids for very small babies and those who are sick Expressed breast milk with NG tube or katori & spoon Direct breast feeding , if possible for the baby to suck and Swallow.

39. monitoring and early detection of complications: weight and other clinical signs. Electronic monitoring like heart rate , temperature, oxygen saturation etc. Biochemical monitoring like hemoglobin , serum bilirubin , blood sugar

40. Appropriate management of specific complications especially infection.  

41. NURSING INTERVENTIONS FOLLOWING THESE PRINCIPLE ARE AS FOLLOWS : Nursery care : At birth measures are needed to clear the airway , initiate breathing , care of umbilical cord and eyes and administration of vitamin K. special care is required to maintain a patent airway and oxygen saturation in blood

42. Thermal control: Survival rate of LBW infants is higher when they are cared for in thermoneutral environment. Incubators or radiant warmers should be used to maintain normal body temperature. Also kangaroo mother care can be given to stable low birth weight babies.

43. Fluid requirement : Fluids needs of infants vary according to their gestational age, environmental conditions and disease states. Assuming minimal water loss in stool of infants not receiving oral fluids , their water needs are equal to insensible water loss and excretion of renal solutes . fluid intake in term infants is usually started at 60-70 ml /kg on day 1 and increased to 100-120 ml/kg by day 2-3 . preterm infants may need to start with 70-80 ml/kg on day1 and advance gradually to 150 ml/kg/day . daily weight , urine output and serum urea , nitrogen and sodium levels should be monitored carefully to determine water balance and fluid needs.

44. Feeding and nutrition: Preterm LBW babies have some limitations that would make breast feeding difficult. The limitation includes a) inability to suck effectively b) inability to co-ordinate sucking and swallowing c) inability to co-ordinate swallowing and breathing . because of these limitations , some LBW babies cannot be given any oral feeds while some might require gavage feeding . birth weight can be used as a guide to decide appropriate method of feeding

45. Management of complications :

46. Problem/ causes Immature defenses Invasive interventions like mechanical ventilation, umbilical cord catheterization. Management : Strictly follow aseptic technique Hand washing Minimal handling of babies Nobody with communicable diseases like respiratory or skin infections should attend the baby

47. b) metabolic derangements problem / causes due to low hepatic glycogen stores there is increased risk of hypoglycaemia immature glucose homeostatic mechanism in preterm babies can lead to hyperglycemia . Hypocalcemia leading to neonatal seizures , jitteriness and tetany in preterm infants , feeds with higher phosphate content such as cow’s milk or formula feed result in hyperphosphatemia with subsequent hypocalcaemia.

48. C ) neonatal jaundice : Problem/ causes Hyperbilirubinemia due to large RBC volume and short life span of RBCs Immaturity of liver to conjugate bilirubin. Management:

49. Hematological abnormality : problem /causes polycythemia : placental insufficiency with intrauterine hypoxia leads to stimulation of erythropoiesis and resultant polycythemia . this increases blood viscosity leading to decreased organ perfusion . manifestations include jitteriness . respiratory distress , cardiac failure and hyperbilirubinemia .  

50. anemia : anemia results from rapid destruction of fetal RBCs and low iron stores

51. Management : Polycythemia : Symptomatic infants or those with hematocrit >75% require partial exchange transfusion . for others, management includes increasing the fluid intake . Anemia : Iron supplement should be started in dose of 2-3 mg/kg from 2 months of age till 2 years of age. Blood transfusion may be done if required.

52. Retinopathy or prematurity : the underdeveloped retinal vessels of premature infants when subjected to premature transition of postnatal life especially high oxygen saturation undergo pathological proliferation resulting in retinal damage . this leads to vision loss if left untreated management : maintaining SPO2 between 85-95 % regular screening for early detection.

53. DISCHARGE AND FOLLOW UP : Before discharge , the baby is evaluated for any complication of prematurity nutrition supplements including multivitamins , iron , calcium and vitamin D are started. Baby should be immunized with BCG, Hep B, and OPV at birth. Parents are instructed regarding regular feeding of baby. Mothers are instructed regarding routine care of baby like prevention of hypothermia and infections, proper feeding , maintenance of personal hygiene , growth monitoring etc. All the danger signs are explained to the parents in detain with information regarding whom to contact.

54. Danger signs include : Feeding difficulty Lethargy Hypothermia or hyperthermia Tachypnea Chest indrawing Convulsions. Follow up should be planned within 3-7 days of discharge to ensure that baby has adjusted in home environment .

55. STRATEGIES TO REDUCE INCIDENCE OF LBW BABIES :

56. Women should be considered as the creator of progeny and accorded due health care, education , status and empowerment in society. Provide optimal nutrition and health care to girl children throughout their life cycle. Impart family life and mother craft education to teenage boys and girls. Avoid early marriage and teenage pregnancy . Provide pre pregnancy health check-up , general and nutritional guidance and essential vaccines.

57. Ensure inter-pregnancy interval of at least 3 years . Provide optimal and good quality antenatal care to all pregnant women. Enhance caloric intake , ensure balanced protein intake and provide supplements of iron , folic acid and micronutrients during pregnancy. Avoid smoking , tobacco chewing and substance abuse especially during pregnancy. Early recognition and management of incompetent cervix , PIH, placental dysfunction, malaria , tuberculosis , UTI diarrhoea, dysentery , genital colonization and bacterial vaginosis etc. Avoid physical labor , emotional stress and sex during third trimester.

58. COMPLICATIONS: Asphyxia (due to anatomical and functional immaturity ) Respiratory distress syndrome( due to deficiency of lung surfactant) Cerebral haemorrhage (cause being soft skull bones) Fetal shock -IVH Heart failure -CHF

59. Edema Infection / sepsis Dehydration and acidemia Anemia ( due to lack of iron stores, hypofunction of bone marrow. Retrolental hypoplasia (ROP) ( due to administration of high level of oxygen above 40%for a period of 1-2 days) Oliguria ,anuria

60. Jaundice P olycythemia , A pnea of prematurity H ypoglycemia , H ypocalcemia , Hypomagnesemia O steopenia of prematurity , H ypothermia