1 CLASSIFICATION
1. Preterm
2. Small
for date (SFD)
1.1.1 PRETERM
Babies those are who are born before the end of
37 Weeks of gestation and whose rate of
intrauterine growth was normal. They are small only because labour began before
the end of 37 weeks.
About 67 percent of low-birth weight babies are
premature (1,500 grams) have the high risk for health problems. 1.1.2 SMALL FOR DATE
SFD are infants whose rate was slow (retarded)
and whose were delivered at term or later These babies are called
growth-restricted, small-for-gestational age or small-for-date. These babies may be full term, but they are
underweight. 2 CAUSES OF LOW BIRTH WEIGHT BABY
l Had
a premature baby in a previous pregnancy
l Have
certain abnormalities of the uterus or cervix
2.1.1 Other factors that may contribute to premature birth and/or fetal growth restriction include:-
l Birth
defects: Babies with certain birth defects
are more likely to be growth restricted because genetic conditions and
structural abnormalities may limit normal development. Babies with birth
defects also are more likely to be born prematurely
l Chronic
health problems in the mother: Maternal high blood
pressure, diabetes,
and heart, lung and kidney problems sometimes can reduce birth weight .
l Smoking: Pregnant women
who smoke cigarettes are nearly twice as likely to have a low-birth weight
baby as women who do not smoke . Smoking slows fetal growth & increases the
risk of premature delivery
l Alcohol and illicit drugs: Alcohol and
illicit
drugs can limit fetal growth and can cause birth defects (2, 3). Some
drugs, such as cocaine, also may increase the risk of premature delivery.
l Infections
in the mother: Certain infections, especially those involving the uterus,
may increase the risk of preterm delivery
l Infections
in the fetus: Certain viral and parasitic infections, including cytomegalovirus,
rubella,
chickenpox
and toxoplasmosis,
can slow fetal growth and cause birth defects
l Placental
problems: Placental
problems can reduce flow of blood and nutrients to the fetus, limiting
growth. In some cases, a baby may need to be delivered early to prevent serious
complications in mother and baby.
l Inadequate
maternal weight gain: Women who don’t gain enough weight during pregnancy
increase their risk of having a low-birth weight baby .
l Socioeconomic
factors: Low income and lack of education are associated with increased
risk of having a low-birth weight baby, although the underlying reasons for
this are not well understood. women under
18yrs and over 35 years of age also are at increased risk
3 CLINICAL FEATURE
l Weight
less than 2500gms.
l Length
less than 44cms.
l Head
and abdomen are large.
l The
skull bones are soft with wide sutures and posterior fontanelle.
l Head
circumference disproportionaly exceeds than the chest.
l Pinnae
of ears soft and flat.
l Eyes
are kept closed.
l Skin
is thin, red and shiny due to lack of subcutaneous fat.
l Muscle
tone poor.
l Nail
are not grown upto the finger tips.
l Reflexes
are not proper developed.
l Plantar
creases are not visible before 34 weeks.
l The
testicles are undescended
l The
labia minora are exposed because the labia majora are not in contect.
3.1 Medical problems are common in low-birth weight babies?
l Thermoregulation
:-As a result of a high body surface area–to–body weight ratio, decreased brown
fat stores, and decreased glycogen supply, infants with extremely low birth
weights (ELBWs) are particularly susceptible to heat loss immediately
after birth. Hypothermia may result in hypoglycemia, apnea, and metabolic
acidosis.
l Hypoglycemia:-Fetal
hypoglycemia (maintenance of normal blood glucose levels) is maintained during
pregnancy by the mother via the placenta. Infants with extremely low
birth weights have difficulty maintaining glucose levels within
reference range after birth, when the maternal source of glucose has been lost.
In addition, these infants are usually under increased stress compared with
their term counterparts and have insufficient levels of glycogen stores.
Preterm infants are generally considered hypoglycemic when plasma glucose
levels are lower than 45 mg/dL.
l Fluids
and electrolytes:-maintenance of fluid and electrolyte balance is essential
for normal organ function. Disturbances may result in or exacerbate morbidities,
such as patent ductus arteriosus (PDA), intraventricular hemorrhage (IVH), and
chronic lung disease, which is also known as bronchopulmonary dysplasis
(BPD). Compared with full-term newborns, infants with extremely low birth
weights have proportionally more fluid in the extracellular fluid compartment
than the intracellular compartment, and a larger proportion of their body
weight is attributable to water. During the first days after birth, diuresis
may result in a 10-20% weight loss, which can be exacerbated by iatrogenic
causes (eg, radiant warmers, phototherapy).
l Nutrition:-Initiating
and maintaining growth of these infants is a continuing challenge. Infants are
commonly weighed daily, and body length and head circumference are usually
measured weekly to track growth. The growth rate often lags because of
complications such as pulmonary disease and sepsis. An additional
contributing factor is inadequate caloric and protein intake. Concern that early feeding may
be a risk factor for necrotizing enterocolitis (NEC) often defers initiation of enteral feeding,
although nutritional management of such
infants is marked by a lack of uniformity of practice. Parenteral nutrition may
provide the primary source of energy and protein in infants with
extremely low birth weights in the first few weeks after birth.
l Hyperbilirubinemia:-Most
infants with extremely low birth weights develop clinically significant
hyperbilirubinemia (jaundice) that requires treatment. Hyperbilirubinemia
develops as a result of increased RBC turnover and destruction in the
context of an immature liver that has physiologically impaired conjugation and
elimination of bilirubin. In addition, most preterm infants have reduced bowel
motility due to inadequate oral intake, which delays elimination of
bilirubin-containing meconium, coupled with increased enterohepatic circulation
of conjugated bilirubin that enters the intestinal tract.
l Apnea
of prematurity:- is common in infants with extremely low birth
weights and is defined as cessation of respiratory activity of more than
20 seconds, with or without bradycardia or cyanosis. These episodes are usually
random and may be difficult to distinguish from the gestationally normal
pattern of periodic breathing demonstrated in this age group. Apneic episodes
are considered clinically significant if greater than 20 seconds in duration
and/or accompanied by bradycardia or change in color or oxygenation. The
incidence of AOP is inversely correlated with gestational age and weight,
occurring in as many as 90% of infants who weigh less than 1000 g at birth.
l Respiratory
distress syndrome (RDS): This breathing problem is common in babies born
before the 34th week of pregnancy. Babies with RDS lack a protein called
surfactant that keeps small air sacs in the lungs from collapsing. Treatment
with surfactant helps affected babies breathe more easily. Babies with RDS may
need additional oxygen and mechanical breathing assistance to keep their lungs
expanded.
l Bleeding
in the brain (called intraventricular hemorrhage or IVH): Bleeding in the
brain occurs in some very low- birth weight premature babies, usually in the
first three days of life. Brain bleeds usually are diagnosed with an
ultrasound. Most brain bleeds are mild and resolve themselves with no or few lasting
problems.
l Patent
ductus arteriosus (PDA):- PDA is a heart problem that is common in
premature babies. Before birth, a large artery called the ductus arteriosus
lets the blood bypass the baby’s nonfunctioning lungs. The ductus normally
closes after birth so that blood can travel to the lungs and pick up oxygen.
l Necrotizing
enterocolitis (NEC):- This potentially dangerous intestinal problem usually
develops two to three weeks after birth. It can lead to feeding difficulties,
abdominal swelling and other complications. Babies with NEC are treated with
antibiotics and fed intravenously (through a vein) while the intestine heals.
In some cases, surgery is necessary to remove damaged sections of intestine.
l Retinopathy
of prematurity (ROP):- ROP is an abnormal growth of blood vessels in the
eye that can lead to vision loss. It occurs mainly in babies born before 32
weeks of pregnancy. Most cases heal themselves with little or no vision loss.
In severe cases, the ophthalmologist .
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