Define LOW BIRTH WEIGHT ( LBW) & classify list risk factors list problems experienced by premature babies what are the steps to be taken to prevent low birth weight -Spm from park textbook
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LOW BIRTH WEIGHT (LBW) - Park's Textbook of Preventive & Social Medicine
DEFINITION
By international agreement, Low Birth Weight (LBW) is defined as a birth weight of less than 2.5 kg (up to and including 2499 g), the measurement being taken preferably within the first hour of life, before significant postnatal weight loss has occurred.
"The birth weight of an infant is the single most important determinant of its chances of survival, healthy growth and development."
- Park's Textbook of Preventive and Social Medicine, p. 625
CLASSIFICATION
A. Classification by Birth Weight
| Category | Birth Weight |
|---|---|
| Low Birth Weight (LBW) | < 2500 g |
| Very Low Birth Weight (VLBW) | < 1500 g |
| Extremely Low Birth Weight (ELBW) | < 1000 g |
A LBW infant is any infant with a birth weight of less than 2.5 kg regardless of gestational age. It includes two kinds of infants:
1. Preterm babies - Born too early (before 37 weeks); their intrauterine growth may be normal
2. Small-for-Date (SFD) / Small for Gestational Age (SGA) babies - Born at term or preterm but weigh less than the 10th percentile for gestational age; result of retarded intrauterine foetal growth
B. Classification by Gestational Age
| Category | Gestational Age |
|---|---|
| Preterm | Before 37 completed weeks (< 259 days) |
| Term | 37 to < 42 completed weeks (259-293 days) |
| Postterm | ≥ 42 completed weeks (≥ 294 days) |
Sub-categories of preterm birth:
- Extremely preterm: < 28 weeks
- Very preterm: 28 to < 32 weeks
- Moderate to late preterm: 32 to 37 weeks
RISK FACTORS
Maternal Factors
- Maternal malnutrition and severe anaemia
- Short maternal stature
- Very young age (adolescent pregnancy) or advanced maternal age
- High parity and close birth spacing (short inter-pregnancy interval)
- Heavy physical work/activity during pregnancy
- Low education and low socio-economic status
Medical/Obstetric Factors
- Hypertension, toxaemia, pre-eclampsia
- Diabetes and thyroid disease
- Asthma
- Maternal infections: malaria, urinary tract infections, syphilis, HIV, bacterial vaginosis, cytomegalovirus, toxoplasmosis, rubella
- Cervical incompetence
- Multiple gestation (twins, higher-order pregnancies)
Placental Factors
- Placental insufficiency
- Placental abnormalities
Foetal Factors
- Foetal abnormalities / chromosomal abnormality
- Intrauterine infections
Lifestyle/Behavioural Factors
- Smoking
- Excess alcohol consumption
- Recreational drug use
Psychological Factors
- Depression
- Violence against women
Genetic Factors
- Family history of preterm birth (strong risk factor - genetic, epigenetic and environmental interaction)
PROBLEMS EXPERIENCED BY PREMATURE BABIES
Premature babies are born before their bodies and organ systems have completely matured. The problems include:
1. Temperature Instability
- Inability to stay warm due to low body fat
2. Respiratory Problems
- Hyaline membrane disease / Respiratory Distress Syndrome (RDS) - air sacs cannot stay open due to lack of surfactant
- Chronic lung disease / Bronchopulmonary Dysplasia (BPD) - long-term respiratory problems caused by injury to lung tissue
- Air leaking out of normal lung spaces into other tissues
- Incomplete lung development
- Apnoea (stopping breathing) - occurs in about half of babies born at or before 30 weeks
3. Cardiovascular Problems
- Patent Ductus Arteriosus (PDA) - causes blood to divert away from lungs
- Too low or too high blood pressure
- Low heart rate - often occurs with apnoea
4. Blood and Metabolic Problems
- Anaemia - may require blood transfusion
- Jaundice - due to immaturity of liver and gastrointestinal function
- Electrolyte imbalances - too low or too high levels of calcium, glucose and other substances in blood
5. Gastrointestinal Problems
- Difficulty feeding - many cannot coordinate suck and swallow before 35 weeks gestation
- Poor digestion
- Necrotizing Enterocolitis (NEC) - serious disease of the intestine, common in premature babies
6. Neurological Problems
- Intraventricular haemorrhage (IVH) - bleeding in the brain
- Periventricular leukomalacia (PVL) - softening of brain tissues around the ventricles
- Poor muscle tone
- Seizures - may be due to bleeding in the brain
- Retinopathy of Prematurity (ROP) - abnormal growth of blood vessels in the baby's eye
7. Infections
- Premature infants are more susceptible to infection and may require antibiotics
PREVENTION OF LOW BIRTH WEIGHT
Experts state that the rates of LBW babies could be reduced to not more than 10% in all parts of the world. Since the problem is multifactorial, there is no universal solution - interventions have to be cause-specific.
A. DIRECT INTERVENTION MEASURES
Pregnant women "at risk" must be identified early in pregnancy. The Mother's Health Card (usable by primary health care workers) is a useful screening tool. Risk factors screened: maternal malnutrition, heavy workload, diseases/infections, high blood pressure.
(i) Increasing Food Intake
- Even a relatively small dietary improvement in the malnourished pregnant mother, even during the last trimester, can result in significant improvement in birth weight
- Supplementary feeding programmes
- Distribution of iron and folic acid tablets
- Fortification and enrichment of foods
(ii) Controlling Infections
- Many maternal infections go unrecognized - should be diagnosed and treated
- Targeted infections: malaria, urinary tract infection, cytomegalovirus, toxoplasmosis, rubella, syphilis
- Prevention of infections affecting foetal growth
(iii) Early Detection and Treatment of Medical Disorders
- Hypertension, toxaemias, and diabetes must be identified and managed promptly
B. INDIRECT INTERVENTION MEASURES
- Family planning - avoidance of too many and too frequent pregnancies; ensuring adequate birth spacing
- Avoidance of excessive smoking
- Improved sanitation measures
- Improving the health and nutrition of young girls - addressing the problem from its roots
- Improvements in socio-economic and environmental conditions
- Better distribution of health and social services, especially in under-served areas
- Government support through policies and programmes
Key public health fact from Park: LBW is responsible for half of all perinatal deaths and one-third of all infant deaths. The infant mortality rate is about 20 times greater for LBW babies than for other babies. In India, approximately 18.6% of babies are born with LBW (Rapid Survey Report on Children, 2014).
Source: Park's Textbook of Preventive and Social Medicine, Chapter 11 - pp. 625-628
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