Prematurity and low birth weight is a major problem for neonatologists. Taking care of a premature baby is a furious challenge for both parents and doctors. They are at risk of developing sepsis, hypothermia, hypoglycemia, jaundice and many other problems.
What is Low Birth Weight Baby?
Babies with a birth weight of < 2.5 kg irrespective of gestational age are called Low Birth Weight Baby. Most normal babies weigh 5.5 pounds by 37 weeks of gestation. At birth, most babies weigh 6 to 8 pounds. There is really nothing special to do for preventing Low Birth Weight Baby. But the following measures will surely help to prevent it. Proper nutrition, adequate rest, and avoidance of cigarettes, drugs, and alcohol will contribute to the development of a healthier child. It is often confused with premature birth. It simply refers to a baby’s weight at birth, while premature birth refers to a birth occurring before 37 weeks. If you had a premature baby in a previous pregnancy, your risk of having another is somewhat increased. But it depends on the cause of poor Birth Weight. Make sure to solve the problem before the next pregnancy.
- Small for the date.
Nice to know:
Weight of a healthy baby at birth:
- Macrosomia or Large baby: 4.00 kg or more.
- Normal birth weight: 2.5-3.99kg
- Low birth weight: less than 2.5 kg
- Very low birth weight: less than 1.5 kg.
What are the causes of Low Birth Weight?
The causes of prematurity are unknown in most cases but premature delivery (and also LBW) is associated with the following conditions:
1. Low socio economic status.
- Women under age 16 or over 35.
- Maternal activity requiring long periods of standing or physical stress.
- Acute or chronic maternal illness is associated with early delivery.
- Multiple gestational births.
- The prior poor birth outcome is the single strongest predictor of poor birth outcome. The premature first birth is the best predictor of the preterm second birth.
- Obstetrics factors such as
- Uterine malformations
- Uterine trauma
- Placenta previa
- Abruptio placentae
- Incompetent cervix
- Fetal conditions: Erythroblastosis, fetal distress, IUGR.
- Inadvertent early delivery.
How to Manage an LBW Baby?
A. Immediate postnatal management:
1. Delivery in an appropriately equipped & staffed hospital is most important.
2. Resuscitation & stabilization require the immediate availability of qualified personnel & equipment.
B. Neonatal management
1. Maintenance of body temperature
- Keep the labour room warm & dust free.
- Resuscitation should be done in a warm draught free room, preferably under radiant heater & away from the window & air-conditions.
- Dry all babies & wrap in a warm dry cloth.
- Try to keep the core temperature of the baby as close to 370C by measuring the rectal temperature every 3-6 hrs.
- The room temperature for a baby of 2kg body weight should be 240C, for 1.5-2 kg baby 260C & those below 1.5 kg in an incubator at 30-320C.
- If the incubator is not available the temperature & the humidity can be maintained by use of blankets.
2. Feeding low birth weight babies:
Nutritional requirements of the preterm neonate
Calories 130 kcal/kg/day, out of which 40-60% should come from carbohydrate, 10-15% from protein & 50% from fat.
Milk for the preterm neonate
- Breast milk or expressed breast milk.[Recommended]
- Fortified breast milk.
- Preterm or premature formula milk.
Breastfeed your baby. This is one of the best things you can do to help her grow up to be healthy.
The management of hypotension includes volume support with colloid or crystalloids, ionotropic agents –dopamine or dobutamine & steroids.
Hypoglycemia should be watched, prevented & managed carefully.
5. Patent ductus arteriosus:
Usually requires only conservative management, adequate oxygenation, fluid restriction & possibly intermittent diuresis. In symptomatic cases, indomethacin may be necessary & in severe cases, surgical ligation may be required.
Manage with careful monitoring of bilirubin level & when required by the use of phototherapy &/or exchange transfusion.
- Infection: Avoid unnecessary handling, washing hand before handling, visitor’s restriction & umbilical care.
- Retinopathy of prematurity: All babies of birth weight <1.5 kg & <32 weeks gestational age should be screened every 2 weeks, commencing at 6 weeks postnatal age, continuing until peripheral vascularization of the retina.
- Immunization: DPT, polio, hepatitis B & Hib vaccines are given in doges based on their chronologic age.
- 10. Vitamins & minerals:
From day 1: Inj vit. K, 1 mg IM or IV, or oral vit K, 2 mg stat to prevent hemorrhagic disease of the newborn.
Vit E 1mg/kg/day for first 1-2 week to prevent hemolytic anaemia & retinopathy of prematurity.
From day 14: Multivitamin drops 0.6 mg/day for 2-3 months.
Folic acid 1 mg daily.
Elemental iron 3 mg/kg/day for 3 months.
Complications of LBW:
The below complications are mainly for the students to memorize. How your baby is affected depends on what caused the low birth weight, and whether she was premature when she was born. Most babies who are term and who have an LBW have no ongoing problems. Most are simply small because it runs in the family.—Reference from www.babycentre.co.uk
- Respiratory distress syndrome-RDS.
- Congenital pneumonia
- Patent ductus arteriosus-PDA
- Anemia (early or late onset).
- Subcutaneous organ hemorrhage
- Vitamin K deficiency.
- Poor gastrointestinal function-poor motility
- Necrotizing enterocolitis
- Central Nervous System
- Intraventricular hemorrhage
- Periventricular leukomalacia
- Hypoxic-ischemic encephalopathy
- Retinopathy of prematurity
- Neurodevelopmental disorder-mental retardation, cerebral palsy
- Behavioral problem.
Essential E-Book Download on Low Birth Weight:
Optimal feeding of low-birth-weight infants
Authors: Edmond, Karen; Bahl, Rajiv; World Health Organization
Number of pages: 121
Publication date: 2006
ISBN: 9241595094; 9789241595094
Kangaroo mother care: a practical guide
Authors: World Health Organization, Dept. of Reproductive Health and Research
Number of pages: 48
Publication date: 2003
Languages: English, French, Spanish
ISBN: 9241590351 (English); 9242590355 (French); 9243590359 (Spanish)
WHO reference number: WS 410 2003KA (English); WS 410 2003KA-1 (French); WS 410 2003KA-2 (Spanish)
Low birth weight in babies – Baby Centre – http://goo.gl/YQbMB
University of Maryland Medical Center – http://goo.gl/TN9oK
WHO | Care of the preterm and/or low-birth-weight newborn – http://goo.gl/xxner
Wikipedia, the free encyclopaedia – http://goo.gl/7NtzT
A complete guide: Raising A Healthy Preemie written by Jenny Silverstone