Low Birth Weight Neonates

Prof A Wasunna
Professor of Neonatal Medicine and Pediatrics
 Definition

New born baby weighing < 2500 gm

• VLBW babies: Weight < 1500 gm

• ELBW babies: Weight < 1000 gm
• “Micropremie”: Weight < 750 gm
 Classification

• Term babies (Gestation ≥ 37 completed weeks)

 these are uniformly SGA/IUGR babies
• Preterm babies (Gestation < 37 completed
weeks
 Can be AGA, SGA/IUGR or LGA
 Etiology: Term LBW (SGA/IUGR)
• Maternal
 Poor nutrition in pregnancy
 Smoking
 Drugs: alcohol, amphetamines, heroin, methadone,
warfarin, hydantoin, steroids
 Disease: BP, CV and renal, diabetes, thyroid respiratory,
hematologic, etc
 Genetic
 High altitude
 Chronic stress
 Etiology: Term LBW (SGA/IUGR)
• Placental
 Uteroplacental insufficiency
 Multiple infarcts
 Congenital infections
 malformations
• Fetal
 Fetal abnormalities: CVS, renal, genetic
 Multiple gestation
 Chronic infections
• Unknown/Normal variant
 Etiology: Preterm LBW
• Socio-demographic
 Maternal age <17 years or > 35 years
 Marternal smoking or “drug” use
 Poor socio-economic background
 Low level of formal education
 ?being black
 Etiology: Preterm LBW
• Maternal
 Previous delivery of a preterm baby
 Unexplained 2nd trimester abortions
 Uterine malformations
 Illness: PET, diabetes, infections, renal, CVS
 Poor nutrition
 Inadequate ante natal care
 Uterine malformations
 Etiology: Preterm LBW
• Complications of pregnancy
 Chorioamnionitis
 Cervical incompetence
 Abruptio placentae
 Multiple gestation
 Heavy colonization of birth canal with bacteria
• Fetal
 Significant anomalies
 Problems of Term SGA/IUGR Babies
• Metabolic
 Hyperglycemia
 hypoglycemia
 Hypocalcemia
• Hypothermia
• Perinatal depression/asphyxia
• Depressed immune system
• Polycythemia
• Others: MAS, ARF, PPH, GI perforation due to focal
ischemia
 Problems of Preterm LBW Babies
• Metabolic
 Issues with sugar, calcium/bone metabolism and
electrolyte handling
• Respiratory: RDS, apnea etc
• CVS: BP control, heart failure, PDA etc
• CNS: ICH with associated complications
• Hematologic: anemia, bilirubin handling
• GI: risk for NEC, delayed feeds tolerance
• Nutrition: special needs on feeds
 Problems of Preterm LBW Babies
• Renal: issues with handling solute, acid loads
and electrolytes due to immature glomeruli
• Immunologic: deficiency in all components of
immune system leading to frequent severe
infections
• Ophthalmic: retinopathy of prematurity
Principles of Management of LBW Babies

• Management is largely dependent on the

cause of LBW, gestation and associated
complications.
• Broad areas of management include:
 Appropriate care during delivery and
resuscitation
 Thermal care
 Oxygen therapy
Principles of Management of LBW Babies

 Fluid and electrolyte management

 Nutritional management
 Infection control and management
 Prevention and management of long term
complications:
 Rickets
 Anemia
 Neurodevelopmental issues/growth
 Immunization program
 Prognosis of LBW Babies
• Prognosis depends on
 Cause of LBW
 Gestation: inverse relationship
 Complications in the neonatal period and how
well they are managed
• Adverse outcomes include
 Mortality: inversely related to gestation
 Prognosis of LBW Babies
 Developmental disabilities:
 Major handicaps – CP, mental retardation
 Sensori-neural impairment
 Cerebral dysfunction – ADHD, learning disorders,
behavior and language disorders
 Retinopathy of prematurity
 Poor growth
 Increase in childhood illnesses and readmissions to
hospital