Low Birth Weight Infant
Low Birth Weight Infant
Low birth weight (LBW):
Birth weight <2,500 gm.
Very low birth weight (VLBW):
Birth weight <1,500 gm.
Extremely low birth (ELBW):
Birth weight < 1,000 gm .
Growth charts against gestation are
used to determine whether an infant’s
weight is appropriate for gestational
Low Birth Weight Infant
Causes:
Prematurity (GA<37 weeks).
Growth restriction (below 10th
percentile)
Both.
The two main groups of LBW infants
have different problems so early
accurate assessment is necessary.
Preterm
Infants
Prematurity
Prematurity is one of the major causes of
neonatal morbidity and mortality.
Morbidity:
RDS
IVH
Sepsis
PDA
ROP
The risk of these morbidities and mortality
increase with decreasing gestational age.
Learning Objectives
By the end of this session, each participant
should be able to:
1. Obtain and record accurately a complete
neonatal history to identify the causes of
preterm birth.
2. Perform and record accurately a complete
neonatal physical examination to identify
the problems of the premature infant.
3. Identify the laboratory investigations
needed in cases of prematurity.
4. Identify the radiological investigations
needed in cases of prematurity.
Learning Objectives
5. Anticipate and manage problems during
delivery.
6. Provide an appropriate thermal
environment.
7. Provide adequate respiratory support.
8. Adjust fluids and electrolytes as necessary.
9. Identify appropriate methods of feeding
premature infants.
10. Manage complications of prematurity such
as infection, PDA and hyperbilirubinemia.
Causes
Fetal:
Fetal distress.
Multiple gestation.
Erythroblastosis.
Nonimmune hydrops.
Placental:
Placental previa.
Abruptio placentae.
Causes (cont.)
Uterine:
Bicornate uterus.
Incompetent cervix.
Maternal:
Pre-eclampsia.
Chronic medical illness (e.g., heart
disease).
Infection (e.g., Listeria monocytogenes,
UTI).
Drug abuse.
Causes (cont.)
Others:
Premature rupture of membranes.
Polyhydramnios.
Iatrogenic.
Problems
Temperature instability:
Increased heat loss.
Reduced subcutaneous fat.
Large surface area to body weight
ratio.
Reduced heat production because of
inadequate brown fat and inability to
shiver.
Problems (cont.)
Respiratory difficulties:
Deficiency of pulmonary surfactant
leading to respiratory distress
syndrome.
Risk of aspiration due to poor gag
and cough reflexes, uncoordinated
suckling and swallowing.
Pliable thorax and weak respiratory
muscles.
Periodic breathing and apnea.
Problems (cont.)
Gastrointestinal & nutritional problems
Poor sucking and swallowing reflexes especially before
34 weeks.
Decreased intestinal motility.
Delayed gastric emptying.
Reduced digestion and absorption of fat-soluble
vitamins.
Deficient lactase enzymes in intestinal brush border.
Diminished body stores of calcium, phosphorus,
proteins and iron.
Increased risk of NEC.
Problems (cont.)
Hepatic immaturity:
Impaired conjugation and excretion
of bilirubin.
Deficiency of vitamin K dependent
clotting factors.
Problems (cont.)
Renal immaturity:
Inability to excrete a large solute load.
Accumulation of inorganic acids with
metabolic acidosis.
Renal elimination of drugs may be
diminished.
Electrolyte imbalance e.g., hyponatremia or
hypernatremia, hyperkalemia or renal
glycosuria.
Problems (cont.)
Immunologic immaturity
High risk of infection due to:
Premature infants lack the
transplacental transfer of maternal IgG
in the third trimester.
Impaired phagocytosis.
Decreased complement factors.
Problems (cont.)
Neurological problems:
Immature sucking and swallowing reflexes.
Decreased intestinal motility.
Recurrent apnea and bradycardia.
IVH and periventricular leukomalacia.
Poor regulation of cerebral perfusion.
Hypoxic ischemic encephalopathy.
Retinopathy of prematurity.
Seizures.
Hypotonia.
Problems (cont.)
Cardiovascular problems:
Patent ductus arteriosus (PDA)
Hypotension or hypertension.
Problems (cont.)
Hematological problems:
Anemia (early or late onset).
Hyperbilirubinemia, mainly indirect.
Disseminated intravascular
coagulation.
Hemorrhagic disease of the
newborn.
Problems (cont.)
Metabolic problems:
Hypoglycemia or hyperglycemia.
Hypocalcemia.
Investigations
Laboratory:
CBC with differential.
Serial glucose measurement.
Serial Na, K, calcium.
Serial bilirubin measurement.
Arterial blood gases.
CRP and cultures if needed.
Investigations (cont.)
Radiological:
Chest x-ray.
Cranial ultrasound.
Echo if needed.
Management
In the delivery room
Delivery should be in an appropriately
equipped and staffed hospital.
Resuscitation and stabilization require
the immediate availability of qualified
personnel and equipment.
Adequate oxygenation and
maintenance of temperature are of
extreme importance.
Management (cont.)
In the neonatal Care Unit
Thermal regulation should be directed
towards achieving a neutral thermal
environment according to protocol.
Oxygen therapy and assisted ventilation
Fluid and electrolyte therapy should
replace high insensible water losses and
maintain proper hydration and normal
glucose and plasma electrolyte
concentration.
Management (cont.)
In the neonatal care unit (cont.)
Nutrition:
• Gavage feeding.
• Parenteral nutrition.
Hyperbilirubinemia:
• Monitor bilirubin levels
• Phototherapy.
• Exchange transfusion( severe cases).
Management (cont.)
In the neonatal care unit (cont.)
Broad-spectrum antibiotics should be
started when suspicion of infection is
strong.
Consider antistaphylococcal antibiotics
for VLBW who have undergone
multiple procedures or who have
remained for a long time in the
hospital.
Management (cont.)
In the neonatal care unit (cont.)
Patent ductus arteriosus:
• Initial management is usually
conservative: adequate oxygenation,
fluid restriction and diuretics
• In more symptomatic cases, a
prostaglandin antagonist such as
indomethacin may be needed
• In the most symptomatic cases, surgical
ligation may be necessary
Summary
1. Obtain and record accurately a complete
neonatal history to identify the causes of
preterm birth.
2. Perform and record accurately a complete
neonatal physical examination to identify the
problems of the premature infant.
3. Identify the laboratory investigations needed
in cases of prematurity.
4. Identify the radiological investigations needed
in cases of prematurity.
Summary
5. Anticipate and manage problems during
delivery.
6. Provide an appropriate thermal
environment.
7. Provide adequate respiratory support.
8. Adjust fluids and electrolytes as
necessary.
9. Identify appropriate methods of feeding
premature infants.
10. Manage complications of prematurity such
as infection, PDA and hyperbilirubinemia.
Thank you
