lowbirthweight-170107103158.pdf

Pediatrics

1. Low Birth
Weight
Dr. RewantSingh
Intern Doctor
BBMH, USTC

3. Low Birth weight
•Lowbirthweight(LBW)isatermusedtodescribe
babieswhoarebornweighinglessthan2,500grams.
“Or”
Babieswithabirthweightoflessthan2500gm
irrespectiveoftheperiodoftheirgestationare
classifiedaslowbirthweightbabies.
•Averagenewbornweighsabout2.5-<4kg.

4. Incidence
50% of pre term are Low birth weight baby.
80% of neonatal death and 50% of infant mortality
are due to LBW.
Higher incidence of LBW babies in Bangladesh is due
to higher no. of babies with IUGR rather than
preterm.
About 10% of all LBW babies require admission to
the NICU

5. Incidence Of Neonatal Death

6. Classification
According to Severity :
1.Very Low Birth Wt Baby- <1.5 kg
2.Extreme Low Birth Wt Baby- <1.0 kg
3.Low Birth Wt Baby - < 2.5 kg

7. According to birth weight and gestational age
•Preterm LBWSAG(small for gestational
age)

8. Causes of LBW
A.FoetalCauses :
•Foetaldistress
•Multiple gestation
•Erythroblastosisfoetalis
•Placenta praevia
•Abruptioplacenta
•Foetalabnormalities

9. B.Maternal Causes :
•Maternal Malnutrition
•Poverty
•Multiple pregnancy
•Elderly gravida
•Illiteracy
•Chronic medical illness –CHD, CKD
•Infection during pregnancy –UTI,
Chorioamnionitis

10. Problems of Prematurity
A.Early
Hypothermia (Temp < 95
o
F)
Hypoglycaemia(RBS < 2.2 mmol/L)
Respiratory Distress Syndrome / HIE
Apnoeicspells
Infection
Feeding difficulties –Inability to suck & tolerate feed
Problems of gut –NEC, GERD
Haematologicalproblems –Anaemia, DIC, Vit. K
deficiency, Hyperbilirubinaemia
Electrolyte imbalance

11. B.Late
Cerebral Palsy
Mental Retardation & poor school performance
Seizures
Microcephaly
Retinopathy of Prematurity (ROP)
BronchopulmonaryDysplasia (BPD)
Hearing & Visual impairment
Growth failure
Child Abuse

12. Management
Management depends on the birth weight of the
baby
1.>1.8 kg otherwise normal-requires special care
at home
2.> 1 .5 kg but < 1.8 kg-requires Hospital care
3.< 1.5 kg -Management in NICU

13. Home Management
1.Feeding: EBF
2.Thermal Regulation :
a) Proper wrapping of the baby
b) Maintenance of the room temperature
c) Kangaroo Mother Care (KMC)
d) Kangaroo Father Care (KFC)
3.Prevention of infection
4.Immunisation
5.Follow up after 2 wks or if any problem arises

14. Danger signals for early detection
and referral to hospital
Lethergy, refuse to feed
Hypothermia
Tachypnoea, grunting apnoea
Seizures
Abdominal distension
Bleeding, ictericover palms/soles

15. Indication for Hospitalization
Birth weight : <1800 gm
Gestation : <34 weeks
Unable to feed
Sick neonate

16. Principle of Management of
LBW in hospital
Correction of hypothermia
Correction of hypoglycaemia
Detection of other complications
Treatment of other complications
Follow up with all vital signs being monitored
continuously

17. Hospital Management
1.Maintenance of Airway, Breathing & Circulation
2.Feeding :
Appropriate feeding method to maintain nutrition of LBW
babies is determined by gestational age, birth wt & oral
feeding skills.
Daily fluid requirement for Preterm baby starts with 60ml/kg.
Daily requirement in preterm is increased by 20ml/kg/day and
can be raised up to 150 ml/kg/day.
Baby receiving phototherapy need 10-15 ml/kg extra fluid
daily.
<1.5 kg Ryle’s tube feeding
> 1.5 kg EBFor by feeder

18. 3.Thermal Regulation:
4.Prevention of infection: indication for antibiotics
5.Start antibiotic therapy without any symptoms too
6.Inj. VitK
7.Other supportive management
8.Follow up
<1.5 kg by overhead radiant warmer
> 1.5 kg Like Home management

19. Parameters to be monitored in
hospital
•Temperature
•Respiration
•Feeding
•Weight of baby
•Bladder & bowel condition
•Abdominal distention
•Appearance & extent of jaundice
•Along with the clinical assessment, investigation may
be needed.

20. Discharge Criteria
•Able to maintain temperature
•Weight > 1.8 kg and shows steady weight gain for 3
consecutive days
•Able to take & tolerate full feeding
•Parents confident enough to take care of baby at
home.
•After attainment of 34wks of gestation and weight
>1400 gm

21. Prognosis
Mortality
–inversely related to the gestation and birth weight
–Directly related to severity complications
–More than 90% of LBW babies have no
neurodevelopmentalhandicaps.
Morbidity
–LBW babies are more prone to infections due to
various reasons

22. Kangaroo Mother Care (KMC)
•KMCis a special way of caring of low birth weight
babies. It fosters their health and well being by
promoting effective thermal control, breastfeeding,
infection prevention and bonding.
•Kangaroo mother care was invented in 1978 by
Colombian pediatrician Edgar Rey. Faced with a
shortage of incubators, Reyfound that mothers
could use their own bodies to warm premature
infants.

23. KMC Position

24. Benefits of KMC
Stabilizationofthebaby'sheartrate.
Improved(moreregular)breathingpattern.
Improvedoxygensaturationlevels(anindicatorof
howwelloxygenisbeingdeliveredtoalltheinfants
organsandtissues)
Gaininsleeptime.
Morerapidweightgain.
Decreasedcrying.

25. At last
•Infactseveralrenownedandfamouspeoplewho
wereprematureandofLBWgrewuptobecome
greatpersonalitylikeSirIsaacNetwon,SirWinston
ChurchillandgreatpainterPabloPicasso.
•TheparentsofprematureLBWbabiestherefore
shouldnotfeeldespondent.