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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