Low birth weight By : - dr . sanjeev

Low birth weight (weight less than 2500g at birth) . CLINICAL TYPES Small for gestational age (SGA) or small for dates (SFD) (weight less than 10th percentile) due to IUGR Preterm (before 37 weeks)

Problems of LBW neonates Preterm Birth asphyxia Hypothermia Infections Feeding difficulties Hyperbilirubinemia Metabolic acidosis Necrotising enterocolitis Respiratory distress due to hylaine membrane disease Apenic spells Small for dates babies Birth asphyxia Hypothermia Infections Meconium aspiration syndrome Hypoglycaemia Polycythemia

Preterm infants characteristics Born before 37 weeks of gestation Small in size (less than 47 cm ) Head (large , suture are widely separated , fontanel is large ) Face : - small Buccal pad of fat : - minimal Subcutaneous fat : - reduced Breast nodule : - less than 5 mm In male ,Testis : - not descended into the scrotal sac

Cont.. In female: Labia majora appears widely separated , exposing the labia minora and the clitoris Sole : - deep creases are not well develop General activity : poor Reflexes : - sluggish Tone : - hypotonia

Clinical hazards of prematurity Immaturity of the nervous system : Lethargic and inactive Poor neonatal reflexes Respiratory problems : Poor cough reflex increases the risk of infection Surfactant deficiency (RDS)

Cont.. G.I. system : Regurgitation (due to incompetent cardio –esophageal sphincter ) Hyperbilirubinemia , hypoglycaemia , and poor detoxification of drugs ( due to immaturity of the liver ) Temperature regulation : - Hypothermia (deficient of brown fat and subcutaneous fat is less ) Immature renal function : Acidosis ( GFR and concentrating ability reduced )

Circulatory system : Intracranial hemorrhage (closure of ductus arteriosus delayed ) Metabolic disturbances : hypoglycaemia poor reserves of glycogen and fat), Hypocalcaemia (hypoparathyroidism ) hypoproteinemia , acidosis and hypoxia

Principles of management of LBW Care at birth : - Prevention of hypothermia Efficient resuscitation Appropriate place of care : - Birth weight more than 1800g (home care) Birth Weight 1500 – 1800g (newborn unit ) Birth weight less than 1500g( ICU)

Thermal protection Warm room Kangaroo mother care maternal contact Delay bathing External heat source (incubator , radiant warmer ) Fluids and feeds : IV fluids for very small babies and those who are sick Direct breastfeeding Expressed breast milk with katori spoon

Monitoring and early detection of complications : Weight and other clinical signs Biochemical monitoring Appropriate management of specific complication

Fluids and feeding to LBW babies Weight less than 1200g Age Less than 30 weeks Intravenous fluids . Try gavage feeds ,if baby is not sick Initial Gavage After 1 – 3 days Later (2 – 4 weeks) Katori – spoon After (4 – 6 weeks) Breast

Gavage (NG tube) Fluids and feeding to LBW babies Initial Weight 1200 -1800g Age 30 – 34 weeks Initial Gavage (NG tube) Katori – spoon After 1 – 3 days Later (2 – 4 weeks) Breast After (4 – 6 weeks) Breast

Fluids and feeding to LBW babies Weight more than 1800g Age more than 34 weeks Breastfeeding. If unsatisfactory , give katori – spoon feeds Initial Breast After 1 – 3 days Breast Later (2 – 4 weeks) After (4 – 6 weeks) Breast

Feeding schedule of moderate sized (more than 1200g )LBW Begin at 60 – 80 mL /kg /day on the 1st day First feed given at 2 hours , then 2 – 3 hourly Increased by 15 mL / kg every day Maximum 180 – 200 mL /kg / day by 7 – 10 days

Neonatal seizures Five major causes : - Hypoglycemia Hypocalcaemia Meningitis Polycythemia Hypoxic ischemic encepalopathy

Causes : - Perinatal complications : - HIE, birth injury, intraventricular hemorrhage , and subarachnoid hemorrhage Perinatal infections : - Meningitis , intrauterine infection Metabolic causes : - Hypoglycemia , hypocalcemia , hypomagnesemia , hyperbilirubinemia , hypo- or hypernatremia ,

Cont.. Developmental defects of the brain : - microcephaly , hydrocephalus , porencephaly (presence of abnormal cavity in the brain filled with CSF ) Narcotic withdrawal syndrome : - Babies born to mothers addicted to narcotics

Treatment : Anticonvulsant :- Phenobarbitone :- Initial dose 20 mg / kg I.V slowly over 10 minutes If no response , two additional doses of 10 mg / kg can be given every 15 minutes. Maximum dose 40 mg /kg If no response : Phenytoin 20 mg / kg I.V slowly over 20 minutes Maintenance therapy of both started 12 hours later in a dose of 5 mg / kg / day as a single dose

Neonatal hypoglycemia Defined as blood glucose of less than 40 mg / dL Causes :- Common : Feeding delay Secondary to polycythemia Stressful condition ( hypothermia , sepsis, asphyxia and respiratory distress )

Clinical features Due to activation of ANS and release of epinepherine : - Sweating Tremors Jitteriness and tachycardia Diminished utilization of glucose in the cerebrum : Lethargy or irritability Restlessness Distubance in sensorium convulsion

Treatment Prevention :- Breastfeeding within one hour of birth Asymptomatic :- Feeding and observation blood sugar checked after 2 hours Symptomatic : - - bolus of 20 mL /kg of 10 % dextrose (200 mg / kg ) With seizure : 4 mL / kg of 25 % dextrose I.V - bolus followed by 4 – 10 mg /kg of glucose per minute till the blood glucose rises above 40 mg /dL