Low birth weight By dr sanjeev Low birth

Low birth weight By : - dr. sanjeev

Low birth weight (weight less than 2500 g at birth). CLINICAL TYPES Preterm (before 37 weeks) Small for gestational age (SGA) or small for dates (SFD) (weight less than 10 th percentile) due to IUGR

Problems of LBW neonates • • • Preterm Birth asphyxia Hypothermia Infections Feeding difficulties Hyperbilirubinemia Metabolic acidosis Necrotising enterocolitis Respiratory distress due to hylaine membrane disease Apenic spells • • • Small for dates babies Birth asphyxia Hypothermia Infections Meconium aspiration syndrome Hypoglycaemia Polycythemia

Preterm infants characteristics • Born before 37 weeks of gestation • Small in size (less than 47 cm ) • Head (large , suture are widely separated , fontanel is large ) • Face : - small • Buccal pad of fat : - minimal • Subcutaneous fat : - reduced • Breast nodule : - less than 5 mm • In male , Testis : - not descended into the scrotal sac

Cont. . • • • In female: Labia majora appears widely separated , exposing the labia minora and the clitoris Sole : - deep creases are not well develop General activity : poor Reflexes : - sluggish Tone : - hypotonia

Clinical hazards of prematurity • • Immaturity of the nervous system : Lethargic and inactive Poor neonatal reflexes Respiratory problems : Poor cough reflex increases the risk of infection Surfactant deficiency (RDS)

Cont. . • • G. I. system : Regurgitation (due to incompetent cardio – esophageal sphincter ) Hyperbilirubinemia , hypoglycaemia , and poor detoxification of drugs ( due to immaturity of the liver ) Temperature regulation : Hypothermia (deficient of brown fat and subcutaneous fat is less ) Immature renal function : Acidosis ( GFR and concentrating ability reduced )

Circulatory system : • Intracranial hemorrhage (closure of ductus arteriosus delayed ) Metabolic disturbances : • hypoglycaemia poor reserves of glycogen and fat), • Hypocalcaemia (hypoparathyroidism ) • hypoproteinemia , acidosis and hypoxia

Principles of management of LBW • • • Care at birth : Prevention of hypothermia Efficient resuscitation Appropriate place of care : Birth weight more than 1800 g (home care) Birth Weight 1500 – 1800 g (newborn unit ) Birth weight less than 1500 g( ICU)

Thermal protection • • • Warm room Kangaroo mother care maternal contact Delay bathing External heat source (incubator , radiant warmer ) Fluids and feeds : • IV fluids for very small babies and those who are sick • Direct breastfeeding • Expressed breast milk with katori spoon

Monitoring and early detection of complications : • Weight and other clinical signs • Biochemical monitoring Appropriate management of specific complication

Fluids and feeding to LBW babies Age Weight less than 1200 g Less than 30 weeks Initial After 1 – 3 days Later (2 – 4 weeks) After (4 – 6 weeks) Intravenous fluids. Try gavage feeds , if baby is not sick Gavage Katori – spoon Breast

Fluids and feeding to LBW babies Age Weight 1200 -1800 g 30 – 34 weeks Initial After 1 – 3 days Gavage (NG tube) Katori – spoon Later (2 – 4 weeks) Breast After (4 – 6 weeks) Breast

Fluids and feeding to LBW babies Age Weight more than 1800 g more than 34 weeks Initial After 1 – 3 days Later (2 – 4 weeks) After (4 – 6 weeks) Breastfeeding. If unsatisfactory , give katori – spoon feeds Breast

Feeding schedule of moderate sized (more than 1200 g )LBW • Begin at 60 – 80 m. L /kg /day on the 1 st day • First feed given at 2 hours , then 2 – 3 hourly • Increased by 15 m. L / kg every day • Maximum 180 – 200 m. L /kg / day by 7 – 10 days

Neonatal seizures • • • Five major causes : Hypoglycemia Hypocalcaemia Meningitis Polycythemia Hypoxic ischemic encepalopathy

Causes : Perinatal complications : HIE, birth injury, intraventricular hemorrhage , and subarachnoid hemorrhage Perinatal infections : Meningitis , intrauterine infection Metabolic causes : Hypoglycemia , hypocalcemia , hypomagnesemia , hyperbilirubinemia , hypo- or hypernatremia ,

Cont. . Developmental defects of the brain : microcephaly , hydrocephalus , porencephaly (presence of abnormal cavity in the brain filled with CSF ) Narcotic withdrawal syndrome : Babies born to mothers addicted to narcotics

Treatment : • Anticonvulsant : Phenobarbitone : • Initial dose 20 mg / kg I. V slowly over 10 minutes • If no response , two additional doses of 10 mg / kg can be given every 15 minutes. • Maximum dose 40 mg /kg If no response : • Phenytoin 20 mg / kg I. V slowly over 20 minutes • Maintenance therapy of both started 12 hours later in a dose of 5 mg / kg / day as a single dose

Neonatal hypoglycemia • Defined as blood glucose of less than 40 mg / d. L Causes : Common : • Feeding delay • Secondary to polycythemia • Stressful condition ( hypothermia , sepsis, asphyxia and respiratory distress )

Clinical features Due to activation of ANS and release of epinepherine : • Sweating • Tremors • Jitteriness and tachycardia Diminished utilization of glucose in the cerebrum : • Lethargy or irritability • Restlessness • Distubance in sensorium • convulsion

Treatment Prevention : • Breastfeeding within one hour of birth Asymptomatic : Feeding and observation blood sugar checked after 2 hours Symptomatic : - bolus of 20 m. L /kg of 10 % dextrose (200 mg / kg ) With seizure : 4 m. L / kg of 25 % dextrose I. V - bolus followed by 4 – 10 mg /kg of glucose per minute till the blood glucose rises above 40 mg /d. L