1. LOW BIRTH WEIGHT BABIES Dr.M.Chandrasekhar Asst. Prof. of Paediatrcis

2. LOW BIRTH WEIGHT BABIES Def: Babies with a birth weight of less than 2.5 Kgs irrespective of period of gestation are called as LBW babies. Clinical Types : 2 A.Preterm B.Small for Dates baby

3. Small for Dates Babies a)Malnourished small for dates babies b)Hypo plastic small for dates babies c)Mixed group

4. Etiology :- CAUSES OF PRETERM BIRTHS :- A)Spontaneous :- a)Maternal factors : i) Uterine causes ii) Placental causes iii) Medical illness iv) Infections b)Fetal Factors : i) Multiple Gestations ii) Erythroblastosis iii) Non immune Hydrops

5. B)Induced :- i) Severe cardiac illness ii) PIH Eclampsia iii) Uncontrolled diabetes mellitus iv) Severe rhesus iso – immunization C)IATROGENIC COMMON DETERMINANTS OF IUGR A)Fetal i) Chromosomal disorders ii) Chronic fetal infections iii) Radiation iv) Pancreatic Aplasia v) Insulin deficiency.

6. Placental :- i) Structural abnormalities ii) Disorders of implantation iii) Infections iv) Infarction v) Tumours Maternal :-i) Primi or Grand Multipara ii) Young Mother iii) Drugs iv) Malnutrition Chronic illness

7. VICIOUS CYCLE OF LBW BABIES Short and light Under nourished mother Small Girl Poor nutritional stores Small Boy Anemia Neglect and ill health Frequent Pregnancies Poor Nutrition during childhood Poor Adolescent Growth Spurt

8. Clinical features :- Features Pre termTerm 1)Measurements a)Length < 47 cm 47-50 cm b)Head circumference < 33 cm34-36 cm 2)ActivityPoor Good Reflex ResponsesSluggishGood 3)Posture ExtendedFlexed 4)Sole creases 1/3 of scale2/3 of scale 5)Genitals At External ringDescendent Male Testes or above Scrotum Scanty rugosities Developed Labiamajora Cover the widly scparated labia minora

14. Female labia majora covers widely separated labia minora Breast Nodule 5 mm Face & Head a)Ear Soft Firm well shaped b)Hair Brownish – Black Silky & Black Wooly 8)Skin Thin and Gelatinous Thick pealing Subcutaneous fat deficient Abundant

15. PHYSICAL MATURITY SIGN SCORE SIG N SC OR E 012345 Skin Sticky, friable, transparent gelatinous, red, translucent smooth pink, visible veins superficial peeling &/or rash, few veins cracking, pale areas, rare veins parchment, deep cracking, no vessels leathery, cracked, wrinkled Lanu go nonesparseabundantthinningbald areasmostly bald Plant ar Surfa ce heel-toe 40-50mm: - 1 <40mm: - 2 >50 mm no crease faint red marks anterior transverse crease only creases ant. 2/3 creases over entire sole Brea st imperceptab le barely perceptable flat areola no bud stippled areola 1-2 mm bud raised areola 3-4 mm bud full areola 5-10 mm bud Eye / Ear lids fused loosely: -1 tightly: -2 lids open pinna flat stays folded sl. curved pinna; soft; slow recoil well-curved pinna; soft but ready recoil formed & firm instant recoil thick cartilage ear stiff Genit als (Male ) scrotum flat, smooth scrotum empty, faint rugae testes in upper canal, rare rugae testes descending, few rugae testes down, good rugae testes pendulous, deep rugae Genit als (Fem ale) clitoris prominent & labia flat prominent clitoris & small labia minora prominent clitoris & enlarging minora majora & minora equally prominent majora large, minora small majora cover clitoris & minora TOTAL PHYSICAL MATURITY SCORE NEW BALLARD SCORE

18. Clinical Features of SFD babies -Alert -Long thin, Marasmic -Excessive Skin folds -Shrunken internal organs

20. PROBLEMS IN PRETERM BABY a)Respiratory :- i) HMD ii) Congenital Pneumonia iii) Apnea iv) Chronic lung disease b)CARDIOVASCULAR :- i) P D A ii) Hypo tension iii) Hypertension v) Thrombo embolic complications

21. C)Central Nervous system :- i)Intraventricular Haemorhage ii)Kernicterus iii)Retinopathy of Prematurity iv)HIE v)Seizures D)GIT :i)Difficulties in self feeding ii)Abdominal distension Functional intestinal obstruction iii)Hyper bilirubinaemia iv)Necrotizing Enterocolitis

22. E)RENAL :i)Renal Tubular acidosis ii)Hypo Natremia iii)Hyper natremia iv)Edema F)Others :Hypothermia Infections Nutritional deficiency.

23. DIFFERENCES BETWEEN PRETERM AND TERM SFD BABIES S.No. Problem Preterm TERM SFD 1.Intrauterine Hypoxia ++++ 2.Respiratory difficulties a) Birth Asphyxia ++++ b) Aspiration in – utero++++ c) HMD+++0 d) Apneic attacks +++0 3.Feeding difficulties a)Inability to suck & Swallow +++0 b)Aspiration of feeds ++0 c)Functional obstruction+++

24. S.No.Problem Preterm Term 4.Symptomatic hypoglycemia ++++ 5.Hypothermia ++++ 6.Poly cythemia ++++ 7.Hyperbilirubinemia ++++ 8.Infections ++++ 9.Congenitalmalformations ++++ 10.Hemorrhage a)Intraventricular+++0 b)Pulmonary ++++

25. S.No.Prognosis Preterm Term a) Immediate High Mortality Better Prognosis b) Future physical and mental development Good Poor