LOW BIRTH WEIGHT.pptx

At a population level, the proportion of infants with a low birth weight is an indicator of a multifaceted public health problem that includes long-term maternal malnutrition, ill-health and poor health care in pregnancy.

Low birth weight is included as a primary outcome indicator in the core set of indicators for the Global Nutrition Monitoring Framework. It is also included in the WHO Global reference list of 100 core health indicators. Low birth weight has been defined by WHO as weight at birth of < 2500 grams (5.5 pounds). Low birth weight is caused by intrauterine growth restriction, prematurity or both. It contributes to a range of poor health outcomes; for example, it is closely associated with fetal and neonatal mortality and morbidity, inhibited growth and cognitive development, and NCDs later in life. Low birth weight infants are about 20 times more likely to die than heavier infants.

Low birth weight is more common in developing than developed countries. However, data on low birth weight in developing countries is often limited because a significant portion of deliveries occur in homes or small health facilities, where cases of infants with low birth weight often go unreported. These cases are not reflected in official figures and may lead to a significant underestimation of the prevalence of low birth weight.

1. LOW BIRTH WEIGHT PRESENTED BY: REVATHI MAROJU

2. Contents Introduction Low Birth Weight Causes of LBW 01 03 02 04 Problems of LBW

3. Contents KMC Prevention of LBW References 05 07 06 Care of LBW babies 08

4. Birth weight is the single most important determinant of chances of child survival , healthy growth and development . Introduction

5. Birth Weight: 1 st weight of fetus or new born obtained after birth . Importance of birth weight: Reflects health status of mother during adolescence and pregnancy. Also reflects quality of antenatal care .

6. L ow birth weight babies Pre-term SFA/D term Introduction:

7. LOW BIRTH WEIGHT

8. Low Birth Weight (LBW): In countries like India , where the proportion of LBW is high, majority of LBW is due to SFA ( Small for Age ). By international agreement Birth Weight is considered as: (1) Low Birth Weight (LBW): Any neonate weighing less than 2500 gm at birth irrespective of gestational age.

9. Low Birth Weight (LBW): (2) Very Low Birth Weight baby (VLBW): Any neonate weighing less than 1500 gm at birth irrespective of gestational age. (3) Extremely Low Birth Weight baby (ELBW): Any neonate weighing less than 1000 gm at birth irrespective of gestational age.

10. Low Birth Weight (LBW): Besides this babies are also classified according to the gestational age (1) Pre-term Baby : Babies born before 37 completed weeks (<259 days) of gestation irrespective of the birth weight.

11. (2) Term baby : Babies born between 37 to 42 weeks of pregnancies (259-294 days) irrespective of the birth weight. (3) Post-term baby: Babies born at 42 completed week or thereafter (>294 days of gestation).

12. PRE-TERM BABIES

13. Pre-Term Babies: Preterm is defined as babies born alive before 37 weeks of pregnancy are completed. There are sub-categories of preterm birth, based on gestational age : - extremely preterm ( <28 weeks) - very preterm (28 to <32 weeks) - moderate to late preterm (32 to 37 weeks).

14. Even though born early, PRE-TERM baby’s intrauterine growth may be normal according to the gestation . Given good care ---- catch up good growth ---- 2 to 3 years of age ---- normal size and performance .

15. CAUSES OF LBW

16. Pre-term births (< 37 weeks) Intrauterine Growth Restriction (IUGR) (a) Spontaneous pre term birth (b) Provider initiated pre term birth (a) Medical causes (b) Social causes LOW BIRTH WEIGHTS Low birth weights includes 2 groups:

17. Causes of Pre- Term Births (a) SPONTANEOUS PRE-TERM BIRTH : Spontaneous onset of labor or following pre-labor pre-mature rupture of membranes (pPROM) (b) PROVIDER INITIATED PRE-TERM BIRTH : Induction of labor or elective caesarean birth before 37 completed weeks of gestation for maternal or fetal indications (both " urgent “ or " discretionary "), or other non-medical reasons .

18. Causes of IUGR: Maternal causes Placental causes Fetal causes Poverty, Illiteracy, Poor standard of living, Lack of knowledge on family planning, Early marriages, Smoking etc Medical causes Social causes In nearly 50% of cases of LBW the cause is not known . In remaining 50% the causes are grouped into:

19. Leading causes of death in LBW babies:  Atelectesis  Malformation  Pulmonary hemorrhage  Intracranial hemorrhage Pneumonia and other infections

20. PROBLEMS OF LBW

21. What problems do a low birth weight babies have?? Breathing problems at birth and later. Low body temperature because there is little fat on the body and the newborn’s temperature regulating system is immature. Low blood sugar because there is very little stored energy.

22. Feeding problems because of their small size, lack of energy, small stomach and inability to suck. Infections because the infection fighting system is not mature. Jaundice (high bilirubin) because the liver is not mature. Bleeding problems due to immature clotting ability at birth.

23. Other clinical Problems of LBW: Retinopathy of prematurity Apneic spells Intraventricular hemorrhage Metabolic acidosis

24. ROP (Retinopathy of Prematurity): Retinopathy of prematurity (ROP) is  an eye disorder caused by abnormal blood vessel growth in the light sensitive part of the eyes  (retina) of premature infants. ROP generally affects infants born before week 31 of pregnancy and weighing 1,250 grams or less at birth.

25. Causes of ROP: Retinal detachment is the main cause of visual impairment and blindness in ROP. During the last 12 weeks of a pregnancy, the eye develops rapidly . If a baby is born prematurely , before the blood vessels have reached the edges of the retina, normal vessel growth may stop .

26. Stages of ROP is classified in five stages, ranging from mild (stage I) to severe (stage V)

27. Signs & symptoms of ROP: White pupils, called leukocoria . Abnormal eye movements, called nystagmus . Crossed eyes, called strabismus . Severe nearsightedness, called myopia .

28. CARE OF LBW BABIES

29. How to take care of LBW babies?? 2500 – 2000 gm Requires special care at home <2000 gm Requires special care at hospital <2000 gm & >1800 gm & stable Hemodynamically Requires kangaroo mother care   Depends upon birth weight

30. SPECIAL CARE AT HOME PRINCIPLES: Prevention of infections Prevention of hypothermia Correction of malnutrition

31. 1. Prevention of Infections: Gentle and minimal handling. Handling with clean hands. Room must be warm , clean and dust-free. Immunization at right time.

32. 2. 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.

33. 3. Correction of Malnutrition: As LBW babies cannot suck milk actively , they gets tired faster. So frequent breast feeding must be given almost every alternate hour .

34. SPECIAL CARE AT HOSPITAL PRINCIPLES: Prevention of infections Prevention of hypothermia Correction of malnutrition

35. 1. Prevention of Infections: Prophylactic antibiotics to prevent septicemia. Separate nurses for feeding and toilet attending. Barrier nursing to prevent cross infections.

36. 2. Prevention of Hypothermia Child is kept under incubator – it maintains the temperature , humidity and O2 supply , till weight increases to 2000g . Careful monitoring of O2 supply : low O2 - hypoxia and cerebral palsy high O2 - retinopathy of prematurity

37. 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.

38. KMC

39. KANGAROO MOTHER CARE Introduced first in Colombia in 1979 by Dr. Hector Martinez and Dr Edzar Rey. Intervention to combat high infection and mortality rate owing to overcrowding in hospitals. Now adopted across the developing world and considered as essential element in neonatal care.

40. Components of KMC: The four components of kangaroo mother care are all essential for ensuring the best care. They include: skin-to-skin positioning of a baby on the mother's chest; adequate nutrition through breast-feeding;

41. ambulatory care as a result of earlier discharge from hospital; support for the mother and her family in caring for the baby

42. Benefits of KMC: Baby is kept warm all the 24 hours by the mother (natural incubator). Baby has minimum risk of apnea . Baby gains physiological stability . Baby gets safety and love . Early growth is promoted. Reduced risk of nosocomial infections .

43. PREVENTION

44. Prevention of LBW: Experts opinion is that the rates of LBW babies could be reduced to not more than 10% in all parts of the World. It is clear from the multiplicity of causes that there is no universal solution .

45. Prevention of LBW: Interventions have to be cause-specific . Main attention has been given in recent years to ways and means of preventing LBW through good prenatal care and intervention programmes , rather than " treatment " of LBW babies born later.

46. “ A new baby is like the beginning of all things - wonder, hope, a dream of possibilities. - Eda J LeShan

47. References: https://www.slideshare.net/drsrinivasraod/low-birth-weight-50014477 https://www.slideshare.net/jamesmacroony/low-birth-weight Park K . Textbook of Preventive and Social Medicine. 26 th ed. Banarasidas Bhanot publishers;2021. Image source: Google.

48. Thanks!