Low birth weight

Definition: Low birth weight has been defined by the WHO as weight at birth of less than 2,500 grams (5.5 pounds). This is based on epidemiological observations that infants weighing less than 2,500 g are approximately 20 times more likely to die than heavier babies.

Definitions: Very LBW is less than 1,500 g. Extremely LBW is less than 1,000 g.

The incidence of LBW: is defined as the percentage of live births that weigh less than 2,500 g out of the total of live births during the same time period. incidence rate therefore is=

Overview: More common in developing than developed countries. The goal of reducing LBW incidence by at least one third between 2000 and 2010 is one of the major goals in ‘A World Fit for Children’,. Forms an important contribution to the Millennium Development Goal (MDG) for reducing child mortality.

Overview: More than 20 million infants worldwide, representing 15.5% of all births, are born LBW, 95.6 % in developing countries. LBW is closely associated with: foetal and neonatal mortality and morbidity, inhibited growth and cognitive development, and chronic diseases later in life.

Risk factors for LBW: Mother's Malnutrition Heavy work load High blood pressure Infection and diseases Unregulated fertility.

Causes and consequences of LBW ) Preterm babies: There are babies born too early before 37 weeks of gestation, their intrauterine growth may be normal, that is their, weigh, length and development may be within normal tomtits for the duration of gestation. Given good neonatal care, these babies can catch up growth and by 2 to 3 years of age will be of normal size and performance.

Approximately 2 thirds of all babies of LBW in developed countries are estimated to be preterm the causation of preterm babies is multifactoral. There include multiple births, hard physical works hypertensive disorders of pregnancy. But it is often preventable by such measures as good prenatal screening and care.

Small for dates (SFD): These babies are result of intrauterine fetal growth. The factors associated with intra uterine growth retardation are multiple and interrelated to mother, placenta or to foetus.

Factors affecting birth weight: The maternal factors: Include malnutrition. Anaemia. Heavy physical work-during pregnancy. Hypertension. Malaria. Toxaemia. Smoking.

The maternal factors: : Low economic status. Short maternal stature. Young age. High parity. Dose birth spacing. Low education status.

Factors related to placenta: Placental insufficiency. Placental abnormalities.

The foetal causes: Foetal abnormality. Intra uterine infections. Chromosomal abnormalities. Multiple gestation.

SFD babies has a high risk of dying not only during the neonatal period but during their infancy, thus significantly raising the rate of infant and prenatal mortality. Most of them become victims of protein energy mal nutrition and infection.

Importance: LBW is one of the most serious challenges in maternal and child health indevelped and developing countries.

Its public health significance may be ascribed, to numerous factors: Its high incidence. Its association with mental retardation. A high risk of prenatal and infant mortality and morbidity.

Its public health significance may be ascribed, to numerous factors: LBW is the single most important factor determining the survival chances of the child (the infant mortality rate is about 20 times greater for all breast fed babies..

Its public health significance may be ascribed, to numerous factors: Many of them become victims of protein – energy – malnutrition and infection. There is a strong and significant positive status and the length of pregnancy and birth weight

Prevention: The rates of LBW could not be reduced to more than 10 percent in all parts of the world. There is no universal solution, interventions have to be case specific.

In recent years good attention has been given to ways and means of preventing LBW through good prenatal care and interventions programmes rather than treatment of low birth weigh babies born later.

Direct intervention measures: (mothers ) 1. Increasing food intake 2. Controlling infection 3. Early detection and treatment of medical disorders

Prevention: Indirect intervention: 1. Family planning 2. Improved sanitation 3. Improving health and nutrition of young girls 4. Improvement of socio-economic conditions 5. Government support (maternity leave)

Treatment: From the point of view of treatment. LBW babies can be divided into 2 groups. Those under 2 kg. Those between 2 – 2.5 kg. The first group require first class modern neonatal care which is hardly available

globally in an intensive care unit their weight reaches the weight of the second group. The second group may need an intensive care unit for a day or two.

The intensive care comprises of: Incubatory care, that adjust temp, humility oxegen supply (low levels of oxygen in the blood steam can produce cerebral palsy. If it is excessive leads to retrolenta fit roplasia).

Feeding: Nasal catheter. Prevention of infection: Infection can cause death in the first few hours (respiratory infection so prevention of infection is there fore one of the most important functions of an intensive care unit.

The leading causes of death in low birth weight babies: Atelectasia. Malformation. Pulmonary haemorrhage. Intracranial bleeding. Pneumonia and other infections. The development of perinatal intensive care units has been associated with a decline in neonatal mortality.

Feeding of infants: Breast feeding: 1. Ideal 2. Protect from infection and malnutrition 3. Reduces infant mortality

Advantages: Safe, clean,cheap, and available in correct temp. Meets nutritional requirement of infant in first months of life Antimicrobial factors Easily digested,has biochemical advantages. Promotes bonding Protects against obesity Sucking is good for development of jaws & teeth Prevents malnutrition Child spacing

Artificial feeding: Dried milk,cow`s milk Indications: 1. Failure of breast milk 2. Prolonged illness 3. Death of mother

Comparison between breast milk and cow's milk Cow's milkBreast milkconstituent ↑↓proteins ==fats ↓↑carbohydrates ↑↓Minerals ↓↑vitamins

Weaning: Gradual process starts around 4-5 months Supplementary foods If not done properly,diarrhoea and growth failure Solid foods introduced at age of one year Nutrition education Promoting home-made weaning foods.

Thank you

Nutritional surveillance

first came into prominence at the World Food Conference in 1974, since then the concept has evolved and has been applied in many developing countries. Nutritional surveillance is defined as “to watch over nutrition in order to make decisions that lead to the improvement in nutrition in populations”

Another Definition: The continuous collection and analysis of nutritional status data in order to give warning of impending crisis or to make policy and programmatic decisions that will lead to improvement in the nutrition situation of the population Objectives: 1- to aid long-term planning. 2- to provide input for management and evaluation. 3- to give timely warning and interventions.

Growth Monitoring The practice of following a child’s physical development, by regular measurement of certain indicators (usually weight and sometimes length) in order to maintain good health by detecting growth faltering and intervening in a timely manner Nutrition Status – Is the balance between nutrient intake and nutrient requirements and/or the degree to which an individual’s physiological needs for nutrients are being met from the food they eat.

Growth monitoring & surveillance Preservation of normal growth Educational – motivational All infants Starts before 6 month. Small groups. No trained worker Simple card Detection of malnutrition Diagnostic- interventional Sample Representative ages Any size. Trained worker Precise.

Growth monitoring & surveillance Maintaining good nutrition Early home interventions. Brief response time PHC interventions. Referral to health system for check up Detect malnutrition. Nutritional rehabilitation Long response time. Community –wide food supplements. Referral to rehabilitation centers.

INDICATORS Nutritional Status Indicators Socio-economic indicators Quality of housing Water supply Sanitation Diseases and Epidemics Mortality Literacy levels

Food security indicators Ecological zone Farm size Use of extension services Food prices Population response to food shortages

Nutritional status indicators: Phenomenon maternal nutrition Infant and preschool Child nutrition School child nutrition Indicator birth weight % of breastfed babies. Mortality rates. Height for age Weight for height. Height for age Weight for height at school admission Clinical signs.

Assessment of nutritional status; Clinical examination. Anthropometry. Biochemical evaluation. Functional assessment. Assessment of dietary intake. Vital and health statistics. Ecological studies.

Assessment of nutritional status; Clinical examination. Anthropometry. Biochemical evaluation. Functional assessment. Assessment of dietary intake. Vital and health statistics. Ecological studies.

1- Clinical examination: WHO classification of clinical signs: 1- not related to nutrition e.g alopecia 2- that need further investigation e.g corneal vascularisation. 3- known to be of value e.g angular stomatitis

Drawbacks of clinical signs 1- malnutrition cannot be quantified. 2- many deficiencies lack clinical signs. 3- lack of specificity.

2- anthropometry 1- height 2- weight. 3- skinfold thickness. 4- arm circumference Additional in children 5- head circumference 6- Chest circumference.

3- laboratory and biochemical assessment: Lab. Hb%,stools and urine Biochemical applied to measure: 1- nutrient concentration e.g serum iron. 2- metabolites in urine e.g urinary iodine. 3- enzymes e.g ribofavin deficiency. Disadvantages: Time-consuming, expensive,cannot be applied on large scale,and reveal only current status.

4- Functional indicators Structural integrity. Host defense. Homeostasis. Reproduction. Nerve function Work capacity.

5- Assessment of dietary intake Weighment of raw foods Weighment of cooked foods. Oral questionnaire method.

6- Vital statistics Morbidity data Mortality data

7- Assessment of ecological factors food balance sheet. Socioeconomic factors. Health and educational services. Conditioning influences.