LOW BIRTH WEIGHT

(LBWI)

ALI USMAN
PERINATOLOGY SUBDIVISION
CHILD HEALTH DEPARTEMENT
PADJADJARAN UNIVERSITY
I. BACK GROUND
– THE INCIDENCE OF LBWI IN DEVELOPING
COUNTRY (INDONESIA)
– THE MEAN PROBLEM :
MORBIDITY AND MORTALITY ( )

II. DEFINITION
1. BIRTH WEIGHT
2. LBWI
3. VERY LOW BIRTH WIGHT INFANT
4. VERY VERY LOW BIRTH WIGHT INFANT
5. PRETERM INFANT (PTI)
6. IMMATURE INFANT
7. POST TERM INFANT
8. FULL TERM INFANT
9. LBWI GROUPING :
– FTI, AGA
– FTI, SGA
– POST TI, SGA
– PRE TI, SGA
– PRE TI, LGA
III. ETIOLOGY

A. PRETEM INFANT IN MANY CASES:

LBWI.
MOST CASES UNKNOWN CAUSES

B. LBWI, SGA :
1. MATERNAL FACTORS
2. PLASENTAL LESIONS
3. FETAL FACTORS
IV. INCIDENCE OF LBWI
• IN DEVELOPING COUNTRIES : 20%
(IBRAHIM, 1987)
– INDONESIA : 13%
– RURAL AREA : 10,5%
– RSHS (1998) : 20,23%
– JAKARTA (RSCM,RSHK,RSPAD) : 13,3%

• INDEVELOPED COUNTRY :
USA (PRE TERM INFANT) 9 %
• V. PROBLEM OF PREMATURITY OR
LBW :

WHICH ARE RELATED TO DIFFICULTY

IN EXTRA UTERINE ADAPTATION DUE
TO IMMATURITY OF ORGAN SYSTEM
OR INTRA UTERINE GRWOTH
RETARDATION.
A. LBW, PRE TERM :
– PERINATAL ASPHYXIA
– NEUROLOGY
– RESPIRATORY
– TEMPERATURE REGULATION
– CARDIOVASCULAR
– GASTROINTESTINAL
– METABOLIC PROBLEMS
– HEMATOLOGY
– IMMUNOLOGY
– NEPHROLOGY
– OPHTALMOLOGY
B. LBW, SGA :
– PERINATAL DEPRESSION
– MAS
– LUNG BLEEDING
– PPH
– POLYCITHEMIA
– HYPOTHERMIA
– HYPOGLICEMIA
– HYPOCALCEMIA
– HYPONATREMIA
VI. DIAGNOSTIC LBW / PRETERM
INFANT :
BASED ON:
1. ASSESMENT OF LMP
2. ASSESMENT OF DOBOWITZ /
BALLARD / SIMPLIFIED DUBOWITZ
3. W.H.O (BIRTH TO LOW WEIGHT)

VII. MANAGEMENT OF LBW/ PTI:

A. ANTE PARTUM
B. INTRA PARTUM
C. POST PARTUM
A. ANTE PARTUM :
1. FAETAL DISTRESS:
- INTRAUTERINE RESUSITATION
- TOCOLYTIC DRUGS
- ANTIBIOTIC (INTRAUTERINE INFECTIONS)
2. CORTICOSTEROID
3. COMMUNICATION OBSTETRIC-PEDIATRIC
DEPARTEMENT

B. INTRA PARTUM :
1. RESUSITATION
2. STABILITATION (THERMOREGULATION
AND OXYGENATION)
C. POST PARTUM NEONATAL
MANAGEMENT:

1. THERMO REGULATION
2. OXYGEN THERAPY AND ASSISTED
VENTILATION
3. NUTRITION :
- PARENTERAL
(FLUID AND ELECTROLYTE THERAPY)
- ENTERAL
4. TO PREVENT AND TREATMENT OF
INFECTION
5. TREATMENT OF HYPERBILIRUBINEMIA
6. TREATMENT OF PDA
7. PSYCHOLOGIC REQUIREMENT
8. TO INVOLVE HER/HIS PARENT CARE
9. IMMUNIZATION PROGRAME
NEONATAL INFECTION

ALI USMAN
PERINATOLOGY SUBDIVISION
CHILD HEALTH DEPARTEMENT
PADJADJARAN UNIVERSITY
I. BACK GROUND

- IN DEVELOP OR DEVELOPING COUNTRIES

PERINATAL/NEONATAL INFECTION
FREQUENT
- ETIOLOGI OF INFECTION :
VIRAL, BACTERIAL, PARASITE, FUNGAL
- CLASSIFICATION OF INFECTION :\
A. CONGENITAL INFECTION
B. PERINATAL INFECTION
C. ACQUIRED INFECTION
II. DEFINITION

A. NEONATAL INFECTION
B. NEONATAL TETANUS
C. NEONATAL OPTHALMIA
D. NOSOCOMIAL INFECTION
E. TORCH INFECTION
III. CLASSIFICATION

A. VIRAL INFECTION
- CONGENITAL INFECTION
- PERINATAL INFECTION
- ACQUIRED
B. BACTERIAL INFECTION:
- EARLY ONSET
- LATE ONSET
IV. ETIOLOGY

A. VIRAL INFECTION :
1. CONGENITAL INFECTION
2. PERINATAL INFECTION

B. BACTERIAL INFECTION :
1. SYSTEMIC INFECTION
2. LOCAL INFECTION
3. ANAEROBIC INFECTION
4. URINARY TRACT INFECTION
C. FUNGAL / PARASITE INFECTION :
1. FUNGAL INFECTION
– MUCOCUTANEUS CANDIDIASIS
– DISSEMINATED CANDIDIASIS
– MALASSEZIA FURFUR

2. PARASITE INFECTION
– CONGENITAL INFECTION
– PERINATAL INFECTION
V. PATHOGENESIS

1. HOST FACTORS
2. AGENT FACTORS
3. ENVIRONMENT FACTOS

ROUTE OF NEONATAL INFECTION :

A. ANTENATAL
B. INTRANATAL
C. POST NATAL
VI. PATHOPHYSIOLOGY
(C/ NEONATAL SEPTICAEMIA)

A. ENDOTOXIN :
1. LIPID A
2. POLYSACARIDE CHAIN
B. ENDOTOXEMIA :
1. SEPTIC FOCUS
2. PORTAL CIRCULATION
3. LIVER DAMAGE
VII. DIAGNOSIS

A. GENERAL MANIFESTATION
B. CENTRAL NERVOUS SYSTEM
C. RESPIRATORY TRACT
D. CARDIOVASCULAR SYSTEM
E. HAEMATOLOGIC
F. SKIN

LABORATORY EXAM
DIAGNOSIS : NEONATAL SEPSIS
(KLASE & FANOROFF, 1986)

1. DEFINITE
2. HIGLY PROBABLE
3. PROBABLE
4. POSIBLE
VIII. TREATMENT

1. GENERAL :
A. KEEP BABY IN ISOLATION
ROOM / INCUBATOR
B. MAINTANCE OF OPTIMUM BODY
TEMPERATURE
C. ALL PROCEDURES ASEPTIC
AND ANTISEPTIC
D. WASHING HAND BEFORE AND
AFTER CARE
2. SPECIAL TREATMENT

A. TO IMPROVE GENERAL CONDITION

–CORRECTION FLUID AND ELECTROLITE
–CORRECTION OF HYPOVOLEMIA,
HYPOCALSEMIA
–ENTERAL NUTRITION
B. BROAD SPECTRUM ANTIBIOTIC :
PRETERM :
•EFFECTIVE
•LOW COST AND VISIBLE
•NON TOXIC
•COULD TROUGH BLOOD BARIER
•COULD RUTE IV LINE
(SEE TEXT BOOK OF NEONATOLOGY)
C. IMMUNOTHERAPY
•GLOBULIN IV LINE
•GRANULOCYTE TRANSFUSION
•EXCHANGE TRANSFUSION
•FFP INFUSION

D. ANOTHER TREATMENT AS ANY

INDICATION
IX. COMPLICATION
1. SEPTIC SHOCK
2. BACTERIAL MENINGITIS
3. CONVULTION STATE
4. RESPIRATORY FAILURE
5. FLUID AND ELECTROLYTE
IMBALANCE
6. NEC
7. CHF
8. BRAIN ABCESS,
VENTRICULITIS, ETC
THERMO REGULATION
HYPOTHERMIA

ALI USMAN
PERINATOLOGY SUBDIVISION
CHILD HEALTH DEPARTEMENT
PADJADJARAN UNIVERSITY
I. BACK GROUND
– NEONATAL HYPOTHERMIA IS MAYOR
PROBLEM DURING NEONATAL PERIODE:
HIGH MORBIDITY AND MORTALITY

– MEDICAL STAFF SHOULD BE CONCERN

(WHAT-WHY-HOW TO MANAGE OF NEONATAL
HYPOTHERMIA)

– HYPOTHERMIA IS A RISK FOR NEWBORN:

IN ANY CLIMATE, WHETER INTROPICS OR IN
COOL MOUNTAINE AREA
II. DEFINITION

– OPTIMUM BODY TEMPERATURE :

36,50-37,50 C

– COLD STRESS : 360-36,40 C

– MODERATE HYPOTHERMIA :
320-35,90 C

– SEVERE HYPOTHERMIA : < 320 C

III. ETIOLOGY

1. INCORRECT CARE OF THE BABY

IMMEDIATELY AFTER BIRTH :
A. TOO FAST BATHING OF THE BABY
B. DELAY DRYING AND COVERING OF
THE BABY
C. SEPARATION OF MOTHER FROM BABY
AFTER BIRTH

2. TEMPERATURE OF DELIVERY AND BABY

ROOM LOW
3. PRETERM (LBWI)
4. PERINATAL ASPHYXIA
5. SISTEMIC INFECTION
6. BIRTH INJURY
7. CONGENITAL ANOMALY (CHD)
8. MOTHER GET ANAESTHETIC DRUGS
9. INADEQUATE WARMING PROCEDURES
BEFORE AND DURING TRANPORT OF
INFANT
IV. EPIDEMIOLOGY
• NEONATAL COLD INJURY OCCURS
THROGHOUT THE WARD.
• ETHIOPIA : 67% LBWI & HIGH RISK INFANT
IN HCU/NICU HYPOTHERMIA
• NEPAL : 80% LBWI HYPOTHERMIA, 50%
STILL HYPOTHERMIA DURING 24 HOURS
• INDIA : NEONATAL HYPOTHERMIA DEATH 2
TIMES THAN HEALTHY BABIES
• ENGLAND : ALL BABY REFFER TO HOPITAL
MORBIDITY & MORTALITY 
• INDONESIA: LBWI , MORBIDITY OF
HYPOTHERMIA .
V. PATHOPHYSIOLOGY

A. HEAT SOURCES OF PRODUCTION

B. PROBLEM OF NEONATE
1. NEONATE COMPARE OLD BABY
2. AT LBWI/PRETERM BABY
C. THE PROCESS OF HEAT LOSS
1. EVAPORATION
2. CONDUCTION
3. CONVECTION
4. RADIATION
D. THE EFFECT OF COLD STRESS

1. PHYSIOLIGIC RESPOND
2. PATHOLOGIC RESPOND
- FAST / ACUTE REACTION
- CHRONIC REACTION
VI. CLINICAL MANIFESTATION

1. COLD STRESS
- BODY TEMPERATURE 360-36,40 C
- LEGS FEEL COLD
- LETHARGY
- LESS ACTIVITY
- WEEK CRYING
- SUCKING ABILITY WEAK
2. HYPOTHERMIA :

A. MODERATE HYPOTHERMIA
–BODY TEMPERATURE 32-35,90 C
–SOMNOLENT
–LOWER ACTIVITY AND CRYING
–PETECHIE, PURPURE
–LEGS FEEL COLD
–WEAKEN SUCKING
A. SEVERE HYPOTHERMIA

–BODY TEMPERATURE < 320 C

–SOMNOLENT
–CRYING ± / -
–SKIN HARD AND RED COLOUR
–WHOLE BODY COLD
–SCLEREMA
–NO BREAST FEED
–FATAL COMPLICATION
VII. BIOCHEMICAL RESPOND

–HYPOGLYCEMIA
–INCREASE CATABOLISM
–ELEVATE BUN
–INCREASE OXYGEN UTILIZATION
–DECREASE pH and PaO2
–THROMBOCYTOPENIA
–INCREASE OF CALORY UTILIZATION
FATAL COMPLICATION :

–SYSTEMIC INFECTION
–RENAL FAILURE
–APNEA ATTACK
–INTRACRANIAL BLEEDING
–INTRA PULMONAL BLEEDING
VIII. DIAGNOSTIC OF HYPOTHERMIA

–DEFINITION HYPOTHERMIA (WHO,

1993)
–CLINICAL FINDING
–BIOCHEMICAL RESPOND
IX. MEASURING OF HYPOTHERMIA

• RESPECT MEASUREMENT OF BODY

TEMPERATURE IS IMPORTANT IN THE
ASSESING AN INFANT’S HEAT BALANCE
• SLOW READING THERMOMETER SHOULD BE
USED FOR ALL MEASUREMENT :
A. AXILLARY TEMPERATURE
B. RECTAL TEMPERATURE
C. SUBLINGUAL TEMPERATURE
(NOT RECOMMENDED)
X. FREQUENCY OF MEASUREMENT
MINIMUM SCHEDULE:
• IMMEDIATELY AFTER COMPLETENCE OF
INIATED CARE
• UPON ARRIVAL IN THE NURSERY OR
POST NATAL WARD
• HEALTHY BABIES WITH ROOMING IN :
NO FURTHER ROUTINE MEASUREMENT
EXCEPT THE BABY’S FEET FEEL COLD
•SICK/HIGH RISK BABIES: MOREFREQUENT
• INFANT UNDER RADIANT HEATER :
EVERY 30 MINUTE
XI. MANAGEMENT OF HYPOTHRMIA

A. TO PREVENT HYPOTHERMIA :
“ 6 WARMS CHAIN”

B. TREATMENT OF HYPOTHERMIA :
1. AT HOME
2. IN THE PRIMARY HEALTH CARE
3. IN THE HOPITAL