Low Birth Weight (LBW)
World Health Organization has defined
low birth weight as the one whose weight is less than 2500 gm irrespective of
the gestational age. Very low birth weight infants weigh 1500 gm or less and
extremely low birth weight infant weighs 1000 gm or less.
Low birth weight is sub classified into 2 groups:
1. preterm
2. Small for gestational age.
Preterm Baby:
A Baby born before 37 weeks of
gestation calculating from the first day of the last menstrual period is
defined as preterm baby.
Causes:
1. Maternal factors:
- Medical disease
during pregnancy such as heart disease, anaemia,
malnutrition, hypertension, renal disease
etc.
- Complication of
pregnancy which compel for premature delivery eg
APH.
- Incompetence of
cervix.
- Physical exertion.
- Maternal infection
as hyperpyrexia, trauma.
- Heavy smoking and
drug addiction.
2. Fetal factor:
- Multiple pregnancy.
- IUGR
- Congenital
malformation.
- Rh incompatibility
3. Medical factor:
- Uncontrolled
diabetes mellitus in mother.
- Fever, cardiac
illness, toxemia.
- Fetal hypoxia and distress.
Manifestations:
- Weight 2500 gm or
less and length less than 44 cm.
- Head and abdomen are
large, skull bones are soft, sutures are wide.
- Head circumference
less than chest circumference.
- Pinna of ears are
soft and flat.
- Skin is thin, red &
shiny due to lack of subcutaneous fat and is covered
by plenty of lanugo, vernix caseosa.
- Muscle tone is poor.
- Plantar creases are
not visible.
- Testes are
undescended, labia minora exposed.
- General activity is
poor and neonatal reflexes such as moro, sucking
and swallowing are sluggish.
Complications:
- Asphyxia
- Hypothermia,
hypoglycemia
- RDS, intraalveolar
haemorrhage, pulmonary oedema.
- Cerebral haemorrhage
- Fetal shock
- Heart failure
- Oliguria, anuria
- Infection
- Jaundice
Management of Preterm Babies:
- Observation:
Vital sign including body temperature, pulse, heart rate
etc.
- Skin:
Cyanosis, redness, rashes, oedema, purpura.
- Jaundice
- Cramps,
fracture.
- Muscles
tone.
- Vomiting,
sucking.
- Urine
& stool.
Preparation:
- Incubator
to prevent from hypothermia.
- Baby
should e managed under radiant warmer.
- Room
temperature should also be maintained.
- Resuscitation
set should be ready.
Action:
- Cord is to be
clamped quickly to prevent hypervolemia.
- Give vit ‘k’1 mg to
prevent haemorrhage.
- Take proper handover
from OT, GW, or emergency staff about
mother
name, DOB, Age/sex, WT, gestational age Apgar score,
any resuscitation and abnormalities.
- Management of
incubator.
- Investigation of
blood, CXR should be sent including other
investigation
as ordered by doctor.
- Check RBS and manage
accordingly.
- Body position should
be change 2 hour (must preferred prone as to
relieve abdominal discomfort).
- Preterm are unable
to suck and swallow so require gavage feeding
or
parental nutrition. Avoid formula feeding.
- O2 therapy as
required.
- Prevention of
nosocomial infection.
- Advices on discharge
such as feeding, schedule hygiene,
immunization, follow up medication etc.
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