BBLR
Low birth weight (LBW)
• Definition : Birth weight
<2500 g
• Incidence : 30% of neonates
LBW: Significance
• 75% neonatal deaths and 50% infant
deaths occur among LBW infants
• LBW babies are more prone to:
– Malnutrition
– Recurrent infections
– Neuro developmental delay
LBW babies have higher mortality and morbidity
Types of LBW
2 types based on the origin
Preterm/prematur Small-for-date
(SFD) / (IUGR)
• < 37 completed • < 10th centile for
weeks of gestation gestational age
• Account for 1/3rd of • Account for 2/3rd of
LBW LBW neonates
Intrauterine growth chart
4400
4000 90th percentile
LARGE FOR DATE
3600
Birth weight (grams)
3200
APPROPRIATE FOR DATE
2800
2400
10th percentile
2000
1600
SMALL FOR DATE
1200
800 PRETERM TERM POST-TERM
400
31 33 35 37 39 42 44 45
Gestation (weeks)
Causation: LBW
Etiology of prematurity
• Low maternal weight, teenage / multiple
pregnancy
• Previous preterm baby, cervical
incompetence
• Antepartum hemorrhage, acute systemic
disease
• Induced premature delivery
• Majority unknown
Causation: LBW
Etiology of SFD / IUGR
• Poor nutritional status of mother
• Hypertension, toxemia, anemia
• Multiple pregnancy, post maturity
• Chronic malaria, chronic illness
• Tobacco use
LBW: Identification of
types
Prematurity
• Date of LMP
• Physical features
– Breast nodule
– Genitalia
– Sole creases
– Ear cartilage / recoil
Preterm LBW
Breast nodule
Preterm Term
Preterm Term
Preterm LBW
Male genitalia
Preterm
Preterm Term
Term
Preterm LBW
Female genitalia
Preterm Term
Preterm LBW
Sole creases
Preterm Term
Preterm LBW
Ear Cartilage
Preterm Term
LBW: Identification of
types
SFD / IUGR
• Intrauterine growth chart
• Physical characteristics
– Emaciated look
– Loose folds of skin
– Lack of subcutaneous tissue
– Head bigger than chest by > 3cm
Identification: SFD /
IUGR
2.1 Kg - IUGR 3.2 Kg - AFD
LBW (Preterm) :
Problems
• Birth asphyxia • Retinopathy of
prematurity
• Hypothermia
• Apneic spells
• Feeding difficulties
• Intraventricular
• Infections
hemorrhage
• Hyperbilirubinemia
• Hypoglycemia
• Respiratory
distress • Metabolic acidosis
LBW (SFD) : Problems
• Birth asphyxia
• Meconium aspiration syndrome
• Hypothermia
• Hypoglycemia
• Infections
• Polycythemia
LBW: Issues in delivery
• Transfer mother to a well-equipped
centre before delivery
• Skilled person needed for effective
resuscitation
• Prevention of hypothermia - topmost
priority
LBW: Indications for
hospitalization
• Birth weight <1800 g
• Gestation <34 wks
• Unable to feed*
• Sick neonate*
* Irrespective of birth weight and gestation
LBW: Keeping warm at
home
Birth weight (Kg) Room
temperature (0C)
1.0 – 1.5 34 – 35
1.5 – 2.0 32 – 34
2.0 – 2.5 30 – 32
Skin-to-skin contact > 2.5 28 - 30
Convection
Evaporation
Radiation
Conduction
Prevent heat losses Baby warmly wrapped
LBW: Keeping warm at
home
Well covered newborn
LBW: Keeping warm in
hospital
• Skin-to skin method
• Warm room, fire or
electric heater
• Warmly wrapped
Radiant warmer
Heated water-filled mattress Air-heated Incubator
LBW: Keeping warm in
hospital
Overhead
Radiant warmer
Nutritional problem of preterm infant
Greater Organ
morbidity immaturit
y
NEC • Gavage feeding
• Motility &
absorption
Smaller
Greater nutritional
nutritional
requirement and IWL reserve
Question ??
• Route chosen : parenteral, enteral / oral
feeding ?
• When to begin feeds ?
• Formula type?
• Frequency of feeding ?
• Amount given ?
• Rate of advancement ?
When to begin feed ?
• Depend on the infants condition
- Stable CV and respiratory status
- Evidence of gut function
- Take several days to achieve
stability
Guidelines of enteral feeding
Birth weight < 1000 g
• Only IFVD for 48 hrs
• Gavage feeding after
• Priming/trophic feeding : ≤ 10 mL/kg/day
• EBM/preterm formula
• Feeding is advanced if tolerated well : increment
0,5-1 mL, interval 1 hr, every 24 hr
…guidelines
Birth weight 1000-1500 g
• Only IFVD for 24 hours
• Gavage feeding (healthy)
• Priming/trophic feeding : ≤ 10 mL/kg/day
• EBM/preterm formula
• Feeding is advanced if tolerated well : increment
1-2 mL, interval 2 hr, every 24 hr
…guidelines
Birth weight 1500-2000 g
• Gavage feeding/oral
• Priming/trophic feeding : ≤ 10 mL/kg/day
• EBM/preterm formula
• Feeding is advanced if tolerated well : increment
2-4 mL, interval 3 hr, every 12-24 hr
…guidelines
Birth weight 2000-2500 g
• Capable of feeding effectively per oral
• EBM/term formula
Sick infant :
– Priming/trophic feeding : ≤ 10 mL/kg/day
– Feeding is advanced if tolerated well :
increment 3-5 mL, interval 3 hr, every 8 hr
Possibility of GI pathology
• Any amount of bile-stained residual
• A residual of undigested formula or breast milk
more than 1-2 mL/kg ( > 15-20 % of total
volume)
• Vomiting
• Distended abdomen, especially if bowel loops
are visible
• Guiac-positive stools
• Symptoms suggesting infection or sepsis, such
as increasing frequency of apnea / bradycardia
episodes
When Premature Infants To Be
Discharged
• Body weight 1800 g
• Stable : no underlying disease
• Growth
• Parents are ready for the baby
LBW: Feeding
Gavage feeding
LBW: Feeding
Katori-spoon feeding
Danger signals (Early
detection and referral)
• Lethargy, refusal to feed
• Hypothermia
• Tachypnea, grunt, gasping, apnea
• Seizures, vacant stare
• Abdominal distension
• Bleeding, icterus over palms/soles
Transportation of LBW baby
• Adequate warmth
• Life support
• With mother
• Referral note
Prognosis
• Mortality
– Inversely related to birth weight and
gestation
– Directly related to severity of
complications
• Long term
– Depends on birth weight, gestation and
severity of complications
