PREMATURITY AND
LOWBIRTHWEIGHT
Dr Chiume-Kayuni
OBJECTIVES
Define prematurity and low birth weight
Classify prematurity and low birth weight (LBW)
Describe predisposing factors to premature and LBW babies
Describe the features of preterm and LBW babies
Discuss the complications of prematurity and LBW infants
Discuss the management of premature and LBW
Definitions
Prematurity is when a baby is born before 37 completed weeks of
gestation
A fetus is considered viable when is born after 28 weeks gestation. Birth
before 28 weeks is a miscarriage or abortion.
A low birth weight baby is one with a birth weight of less than 2500g
Categories of low birth weight
VLBW
Predisposing factors of prematurity
Maternal
Teen pregnancy
Hard labour
Poor nutrition
Infections: Malaria, TORCHES
Anaemia
Fetal
Congenital Anomalies
Genetic conditions
Complications of prematurity
Apneic attacks: The baby is prone to these attacks because of immaturity of the
lungs and the respiratory centre..
Respiratory distress syndrome: Atelectasis can develop with the possibility of
developing hyaline membrane disease. Notice that all these lead to respiratory
distress syndrome. Frequent apnoec attacks leads to cyanosis and signify very poor
chance of survival.
Anaemia: The immature bone marrow and that iron stores in the foetus are laid in
the last four weeks of intra-uterine life make premature baby is prone to anaemia.
Jaundice: Due to immaturity of the liver, bilirubin cannot be conjugated
Sometimes the level of unconjugated bilirubin rises to as high as 20mg/100ml and causes
kernicterus. Kernicterus is neurological sequelae that comes as a result of the bilirubin
crossing the blood brain barrier.
Infection: common complication since the immune system is immature.
Preterm babies are prone to food intolerance and more seriously necrotising
enterocolitis.
Complications of prematurity
Cerebral and intraventricular haemorrhage: The fragile capillaries and small
veins easily rupture and the baby may display abnormal neurological function
Heart failure and pulmonary oedema: the poor muscular tone of the baby may
prevent adequate venous return causing accumulation of the blood in the extremities.
Asphyxia adds to the circulatory problems and later the baby goes into heart failure
and pulmonary oedema.
Poor mental and intellectual development in later years:
prolonged asphyxia to which the premature baby is prone can lead to mental retardation and
low intelligence later in life.
Neurological conditions like Kernicterus and Intracranial haemorrage may contribute
Retinopathy of prematurity
The immature retina is at risk of further destruction that may or may not lead to permanent
visual impairment, especially with exposure to high concentrations of oxygen.
Management of a preterm/LBW
Routine care of the newborn is applicable to a preterm baby
Checking respirations of the baby, heart rate, colour , tone/ grimance, cry
Provide warmth
If the baby is stable, she/he is kept on skin to skin contact with the mother and a
comprehensive assessment is done after ninety minutes of birth.
Comprehensive care also includes the following
Cord care with 7.1% chlohexidine,
Eye care with TEO
Administration of Vitamin K according to birth weight intramuscular injection to
prevent haemorrhagic disease of the new-born
Management
Observe for the complications of LBW and Prematurity
Respiratory problems: Because of lung immaturity, the preterm babies are prone to breathing problems and
periods of apnoea.
Birth trauma can also result into intracranial bleeds which can affect the respiratory center. Therefore
manage appropriately and give oxygen if need arises and monitor closely.
Elimination problems: There is also need to observe if the baby is passing stools and urine .
Frequency of stools should be noted and loose stools could be associated with infection.
Feeding:
The maximum amount is normally 200-220 ml/kg per day divided in eight feeds.
Very small babies (< 1500 grams) should be fed every two hours.
Larger babies (> 1500 grams) should be fed every three hours.
As the baby grows and reaches 40 weeks gestation or reaches a weight or 2500 grams), gradually replace
scheduled feeding with feeding on demand.
Observe for signs of food intolerance which include; vomiting of feeds tinged with bile, abdominal distension
and bloody stool. These should be reported, investigated and managed promptly.
Growth monitoring is important and therefore babies have to be weighed on a daily basis. The baby
might lose 10 % of their birthweight by 7- 10 day, and therefore a slight drop in weight is normal
Management
Haematological problems: Haemoglobin is estimated weekly to exclude
anaemia.
Temperature instability:
premature and low birthweight babies require prolonged and continuous skin to
skin contact for more than twenty hours per day to maintain a normal body
temperature, failure of which requires a heater.
Neurological problems:
monitor general behavior of the baby with particular attention to its activity- they
may be inactive or hyper alert.
Also look for seizures. Remember that neonatal seizures may not be so obvious as
they tend to be subtle and may be missed ( usually focal seisures due to the
poorly myelinated nerves)
Management
• Observe for Pathological Neonatal Jaundice
• Jaundice developing in < 24 hours
• after 24 hours and is visible in the palms of the hands and sores of the
feet, that’s regarded severe jaundice
• Jaundice should be managed in hospital under phototherapy. Where
available, the bilirubin levels should be assessed and these will guide
management.
• Those who develop jaundice after 24 hours need to be closely
monitored and advised on exclusive breast feeding as this is
physiological and clears on its own.
Management-Jaundice Kramer Chart
Management
Infections:
Babies must be monitored for signs of infection which are;- rash, discharge from
the eyes, moist umbilical cord, grey color and temperature instability.
Frequent hand washing is encouraged to both the mother and the care giver. The
immune system of premature babies is underdeveloped which makes them
susceptible to infections.
In addition babies could be born preterm or with low birthweight as a result of
intrauterine infections. These neonates are often initiated on antibiotics to treat
infections.
Metabolic disorders:
Preterm and Low birthweight babies are also prone to hypoglycaemia and it is very
important to maintain proper nutrition for the baby. Proper nutrition also assists in
preventing hypothermia. There are different methods of feeding the preterm baby
and this will be discussed in details in the next section.
KANGAROO MOTHER CARE
Kangaroo Mother Care is early, prolonged continuous skin-to-skin
contact between mother (or her surrogate) and her low birth weight
infant. In KMC, the baby is placed skin-to-skin against the mother’s
chest wearing only a nappy, hat and socks, and secured in an upright
position between the mother’s breasts by wrapping a cloth around both
mother and baby.
Benefits of KMC
It has proven benefit in decreasing neonatal mortality
It decreases morbidity by decreasing risk of neonatal infections, improves
cardio-pulmonary circulation, and improves brain development
KMC has psychosocial benefits in that it improves bonding between the child
and the mother.
KMC encourages exclusive breastfeeding
Types of KMC
Continuous KMC
It takes place when the baby is in skin-to-skin position for 24 hours every day (except for
very short periods when the mother has to bath or use the toilet). It is initiated in the hospital
and as soon as baby is stable and other criteria are met, this is continued at home. It requires
the support from family members.
Although there are will known benefits, continuous KMC is labour intensive and not very well
done because of this.
Intermittent KMC
It is when the baby is put in skin-to-skin contact for a few hours each day. When not in KMC
position, the baby is kept warm in an incubator or warmly wrapped. It is mostly used for very
small and sick babies, and/or for mothers who do not want to or are not yet ready or able to
practice continuous KMC
Danger Signs
KMC Education includes teaching mothers danger signs:
Feeding difficulties or not suckling
Hypothermia
Fever
Red, swollen eyelids and pus discharge from eyes
Red swollen and/or pus around the cord or umbilicus
Convulsions/fits
Jaundice/ yellow skin
Convulsions
Breathing problems – apnea, chest in-drawing, grunting, flaring, cyanosis
Lethargy (excessive sleepiness, reduced activity).
