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Low Birthweight Infant
Low Birthweight Infant
Julniar M Tasli
Herman Bermawi
Afifa Ramadanti
OBJECTIVE
1. Student must be able to understand the definition
and classification of low birth weight infant.
2. Student must be able to recognize risk factors
which predispose of low birth weight infant.
3. Student must be able to diagnose low birth weight
infant.
4. Student must be able to manage low birth weight
infant.
NEWBORN INFANT CLASSIFED
ACCORDING TO :
1. Birthweight
# < 2500 g : Low birthweight (LBW)
# < 1500 g : Very low birthweight (VLBW)
# < 1000 g : Extremely low birthweight (ELBW)
2. Gestational age
# < 37 weeks : Preterm
# 37 – 42 weeks : Term
# ≥ 42 weeks : Post term
3. Size for gestasional age
# Weight beween 90th & 10th centile for gestation : AGA
# Weight < 10th centile for gestation : SGA
# Weight > 90th centile for gestation : LGA
Ballard’s Score
b Ballard’s Score
FIGURE 3-2. Classification of newborns (both sexes) by intrauterine growth and gestational age. (Reproduced, with permission, from Battaglia FC, Lubchenco LO: A
practical lassification for newborn infants by weight and gestational age. J Pediatr1967;71:159; and Lubchenco LO et al: Intrauterine growth in length and head circumference
as estimated from live births at gestational ages from 26 to 42 weeks. Pediatrics 1966;37:403. Courtesy of Ross Laboratories, Columbus, Ohio 43216.)
THE LOW
BIRTH WEIGHT INFANT
Definition :
A low birth infant baby is one who weight less
than 2500 grams at birth
The low birth infant divided into two clinical
types :
1. The preterm infant ( prematurity )
2. The small for gestational age infant
( small for dates, light for dates )
1. Premature or preterm :
# A baby born before the 37th week of
pregnancy.
# May not be ready to live outside the uterus
and may have difficulty initiating breathing,
sucking, figting infection and stay warm.
2. Women who :
# Had a LBW baby before
# Are under weight and have poor nutrition.
# Have health problem ( hypertension, anemia )
FACTOR ASSOSIATED WITH
LOW BIRTH WEIGHT
3. Women who have pregnancy problem such as :
# Severe anemia
# Pre-eclampsia or hypertension
# Infection during pregnancy ( Urinary tract infection,
HIV/AID, malaria )
# Multiple gestation
1. Birth asphyxia
2. Thermal instability
3. Lack of primitive survival reflexes, suck, swallow, and
gag with high incidence of milk aspiration.
4. Jaundice
5. Pulmonary disease : apnoe, hyaline membrane disease,
transient tachypnoea of newborn, pneumothorax,
pneumonia, Wilson-Mikity syndrome and
bronchopulmonary dysplasia.
6. Metabolic disturbances: hypoglycaemia, hypocalcaemia,
hypomagnesaemia, hyponatraemia, hypernaetremia.
7. Patent ductus arteriosus : congestive heart failure.
8. Intracranial haemorrhage, especially intraventricular
haemorrhage and subarachnoid haemorrhage.
9. Susceptibility to infection
10. Gastrointestinal intolerance and necrotizing enterocolitis
11. Opthalmic problems : retrolental fibroplasia, myopia,
strabismus
12. Surgical lesions : undescended testes, inguinal and
umbilical hernia
13. Haematological problems : haemorrhagic disease of
prematurity, disseminated intravascular coagulation,
iron deficiency anaemia
14. Renal immaturity : inability to concentrate urine, and
inability to excrete an acid load with low renal
bicarbonate threshold results in late (feeding) metabolic
asidosis .
SUPORTIVE CARE
Resuscitation
The Obstetrician and Paediatrician should ideally function
as a perinatal team during premature labor appropriate
assessment of perinatal asphyxia and resuscitation can be
performed.
Monitoring
Heart rate and respiratory rate, blood pressure and
temperature must be monitored continuously
Monitoring
• Total intake-output of fluids should be recorded every 24
hours in critically ill infants.
• Head circumference is measured twice weekly and plotted
on a percentile graph.
• Daily weights are measured and recorded.
Thermoregulation
• Body temperature must be maintained in the normal range
(36,5-37,0˚C per axilla) by nursing infant in incubator.
Feeding
• Infants < 34 weeks gestation should be fed via an oro-
gastric/naso-gastic tube.
• Prematures with small gastric volumes require frequent
feeding (every 2 hours) and should be started on
2ml/kg/feed and increased in increment of 1-2ml/kg/every
feed, as tolerated.
• Gastric aspirate must be checked before the next feed.
• The preterm infant should ideally be fed his own mother’s
expressed breast milk.
Parenteral fluids
• Sick babies and infants < 1500 g may need parenteral
feeding
• Parenteral fluid requirements can only be determined by
close observation of urine-output, urine osmolality, body
weight and electrolytes.
• In general, fluid volumes for healthy preterm infants given
enterally are: 60ml/kg-day 1; 80ml/kg-day 2; 100ml/kg-day
3; 120ml/kg-day 4; 140ml/kg-day 5; 160ml/kg-day 6;
180ml/kg-day 7.
Electrolytes
• Preterm infants receiving parenteral fluids should receives
maintenance electrolytes after they have passed urine.
• Normally they require: sodium 2,5-3,0 mmol/kg/day;
potassium 2,0-2,5 mmol/kg/day; calcium 45mg/kg/day.
Vitamins
• A single intramuscuar dose 0,5 – 1,0 mg IM Vit.K1 at birth
• Preterm babies being fed with breast milk or vitamin
fortified formulae will all need additional vitamin C (by
day 3) and vitamin D.
Respiratory Distress Syndrome (RDS)
• RDS should be managed with humidified oxygen given in a
controlled fashion via a head box, nasl CPAP or
mechanical ventilation.
• Babies of birthweight < 2000g with RDS should be
managed in an intensive care nursery.
Jaundice
• Extremely common in the preterm infant and must be
followed with frequent bilirubin estimations.
• The treatment sheet provides guidelines for management
of hyperbilirubinaemia.
Anemia
• The venous haematocrit should be maintained at > 40% in
all sick babies.
• All preterm infants < 2500 g or 34 weeks gestation should
receive supplemental iron in a dose of 30 mg daily from the
age of three weeks.
THE SMALL FOR
GESTASIONAL AGE INFANT
INSIDEN
Varies between countries, usually :
3-7% of all infants are SGA
20% of stillborn infants are SGA
25% of SGA Infants are Type I
75% of SGA infants are type II
ETIOLOGY
Symmetrical Asymmetrical