1. Low birth weight
By : - dr . sanjeev

2. 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)

3. 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

4. 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

5. 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

6. 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)

7. 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 )

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

9. 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)

10. 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

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

12. 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

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

14. 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

15. 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

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

17. 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 ,

18. 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

19. 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

20. 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 )

21. 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

22. 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