| ID | 371 |
|---|---|
| Name | LOW BIRTH WEIGHT BABIES |
| Cause | Causes or factors related to LBW: A. Factors related to premature (preterm) birth. B. Factors related to IUGR Causes of premature birth- 1. Unknown: the cause of premature onset of labour is uncertain in most instances. 2. Foetal causes: a. Congenital malformations, b. Multiple pregnancy, c. Fetal distress. 3. Maternal causes: a Toxemia of pregnancy b Severe maternal illness, c UTI d. Erythroblastosis fetalis e. Incompetent cervix f. Chronic medical illness g. Infections. 4. Placental causes: a. Abruptio placenta, b. Placenta previa. c. Amnionitis. d. Polyhydramnios. e. Premature rupture of membrane. 5. latrogenic causes (Diabetic mellitus, Rh incompatibility). . Causes of IUGR - 1. Unknown cause. 2. Foetal cause: a. Chromosomal disorder e.g. trisomies. b. Ch. foetal infections e.g. TORCHES. c. Radiation injury. d. Multiple pregnancy e.g twin. e. Pancreatic aplasia 3. Maternal causes: a. Toxemia of pregnancy. b. Hypertensive &/or renal disease. c. Hypoxemia (high altitude cyanotic disease). d. Malnutrition. e. Chronic illness. f. Drugs e.g. narcotics, alcohol, cigarette etc. 4. Placental causes. a. Decreased placental weight or cellularity or both. b. Decreased surface area. c. Placental infection (bacterial/viral). d. Placental separation. e. Twin transfusion syndrome. f. Tumors e.g. hydatidiform mole. |
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| Management | Management of L.B.W babies: 5 major aspects- 1. Maintenance of body temperature. 2. Maintenance of respiration. 3. Maintenance of feeding & nutrition. 4. Protection against infection. 5. Prevention of vitamin & iron deficiencies. 1. Maintenance of body temperature: i. The room temperature for a baby of 2kg body weight should be 24°C, for 1.5-2kg baby 26°C and those <1.5kg should be kept in an incubator at 30-32°C. For the babies weighing <1.0kg incubator temperature should be maintained at 34-35°C. Humidity could be maintained at 40-60%. ii. If incubator is not available, and the baby is nursed in a cot, it should have bedding with blanket, warm dress, heat retaining clothes, cap for head, gloves for hands and shocks for feet. The temperature and humidity of the room should be maintained by using room heater or heating lamps. 2. Maintenance of respirations: i. Proper resuscitation- if needed, ii. If respiratory distress-1 -2 litre/mm of O2 is enough to maintain 40% O2 environment, O2 improves both hypoxia & apnoea (O2 should not give useless or inexess as it may cause retrolental fibroplasia) iii. If apnoea - In term baby- sole stimulation is enough. In preterm baby- i.v aminophylline 3-5mg/ kg/day should be given directly very slowly in 10-15 mins. diluted with equal volume of i.v fluid or can be given in drip, iv. If severe birth asphyxia with very low apgar score- see treatment of birth asphyxia in neonatal problems, v. Oropharyngeal suction intermittently- if needed. 3. Maintenance of feeding & nutrition: i. Breast feeding- if the baby is able enough to suck the breast, it is worth to encourage breast feeding. ii. N.G tube feeding- at first wash the stomach with normal saline feed-first feed with 5% dextrose 4-5ml then hourly feeding with EBM (expressed breast milk) or FSM (full strength milk). Calorie- term baby 110-120 kcal/kg/day; preterm baby 120-150 kcal/kg daily. Fluid- requirements in ml/kg/day as below: Day < 1kg l-15kg 1.5-2.5 kg 1st & 2nd 100-120 80-100 60-80 3rd & 4th 130-140 110-120 90-100 5th & 6th 150-160 130-140 110-120 7th & 8th 170-180 150-160 130-140 9th onwards 190-200 170-180 150-160 iii. If the baby is suffering from respiratory distress or very sick, where N.G tube feeding is not advisable, parenteral nutrition should be given for atleast 24-48 hours with 10% dextrose in baby saline (0.225% or 0.45% saline) 60-80ml/kg/day. 4. Protection against infection: i. Premature infants are always susceptible to infection, so, a prophylactic course of a broab-spectrum antibiotic should be given, such as-Cefotaxime (50mg/kg/day in 2 to 4 divided doses), Ceftriaxone (20-50mg/kg/day once daily) or ampicillin (50-l00mg/kg/day in 2 divided doses) plus gentamicin (5-7.5mg/kg/day, in 2 divided doses) can be given i.m or i.v for 5-7 days. ii. Maintenance of aseptic measure in feeding, medication & handling of the baby. iii. Protection from all sorts of nosocomial infection. iv. Umbilical cord should be kept clean and dry. v. Linen & equipments must be protected from dust in cup boards & covered containers, vi. Incubator must also be cleaned with soap & water or fumigated with formaldehyde vapour after use. vii.Daily floor cleaning; weekly wash; monthly wash with antiseptic is essential. 5. Vitamins, iron & electrolytes- a. Vitamin K- Inj. vitamin-K Img stat i.m to promote synthesis of coagulation factors (II, VIII, IX & X). b. Vitamin E- 10 i.u/kg/day, in 2 or 3 divided doses (vitamin E is a powerful antioxidant & prevents hemolytic amemia by stabilizing RBC wall). c. Multivitamin drops- should be started at 2 wks. of life with 0.6 ml. (10 drops) daily (containing vita-D 400 units, Vita-C 50mg). d. Iron suppliment- preterm baby can develop iron deficiency anemia (anemia of prematurity after a few weeks (6-8 weeks). Iron should not be given before 6-8 weeks as because bone marrow erythropoiesis usually starts from this time; so early iron therapy may remain unutilized & can lead to toxicity. Elemental iron 2-3mg/kg/day in divided doses at 6-8 wks. Folic acid 5mg twice weekly at 2 weeks of age. e. Minerals- in preterm babies demand of calc-ium & phosphate is much more than term babies which can not be provided by breast milk, so supplemental calcium & phosphate should be given (which can be provided by some specialized infant milk formula). f. Weight record- daily weight recording is a sensitive index of well-being of the premature baby. Most preterm babies loose their weight during the first 3 or 4 days (up to a max. of 10% of the birth wt). The next 4 to 5 days wt. remains almost stationary. Then the baby starts gaining weight approximately at a rate of 30gm/day & regains the birth wt. at the end of 2nd wk. of life, if proper feeding is maintaining. |
| Introduction | Low Birth Weight (LEW): Infants weighing less than 2500gm at birth, irrespective of their gestational period, classified as ‘low birth weight babies’ (WHO, 1962). These include both preterm & term small-for-date babies. Very low birth weight (VLBW): Infants weighing I500gm or less at birth, termed as ‘very low birth weight babies’. Preterm: Infants delivered before 3 weeks of gestation (i.e at 37 weeks). Post term: Infants delivered after 42 completed weeks of gestational age. Small- for-date: Any infants which birth weight falls below the 10th centile for the gestational age, is termed as ‘small-for-date’ or small-for-gestational age (SGA). ‘Small-for date’ babies may be at term, preterm or even post-term. Intrauterine growth retardation (IUGR) is the cause of small-for-date babies. Infra-uterine growth retardation (IUGR): An infant which birth weight is abnormally low in relations to the gestational age, where the cause is presummed to be intrauterine undernutrition resulting from placental insufficiency due to any cause (mostly maternal) IUGR also may be due to intraute-rine infections or congenital malformations of the foetus itself. |
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| Complications | Complications of prematurity: A. Immediate problems: 1. Idiopathic respiratory distress syndrome (IRDS) 2. Patent ductus arteriosus (PDA). 3. Intraventricular hemorrhage (IVH). 4. Hyperbilirubinemia. 5. Hypoglycemia. 6. Recurrent apnoea. 7. Early anemia of prematurity. 8. Necrotizing enterocolitis (NEC). 9. Retinopathy of prematurity. 10. Hypocalcemia 11. Entercolitis B. Late complications: 1. Neuro-developmental disorders- mental retardation, cerebral palsy etc. 2. Sensory impairments- hearing loss, visual impairments etc. 3. Seizure disorders. 4. Behavioral disorder. 5. Growth retardation Death in LBW: Major causes- 1. Birth asphyxia. 2. Neonatal infections. 3. Congenital anomalies. 4. Aspiration pneumonia. 5. Intraventricular Haemorrhage 6. RDS |
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