PREMATURITY AND

LOW BIRTH WEIGHT

Presented by:
Sumaiya Bushra
Farzana Mahbub
Afrina Anjuman Saima
 LOW BIRTH WEIGHT
◦ Low birth weight neonates are those who weigh below
2500 gm at birth. They may be mature or premature
◦ MATURE+ LOW BIRTH WEIGHT= IUGR
◦ Small for gestational age (SGA) : Two standard
deviations below the mean for gestational age
◦ Large for gestational age : Two standard deviations
above the mean for gestational age
 CLASSIFICATION OF LBW
◦ A. Depends on gestational age:
◦ Preterm baby: before 37 weeks
◦ Late preterm: 34 upto 37 weeks
◦ Term : 37-42 weeks
◦ Post term: > 42 weeks of gestation

◦ B. Depends on birth weight:

◦ Low birth weight: Birth weight less than 2500 gm
◦ Very low birth weight: Birth weight less than 1500 gm
◦ Extremely low birth weight: Birth weight less than 1000 gm
◦ Impossibly or incredibly Low birth weight : Birth weight less than 750
gm
 PREMATURITY
◦ PREMATURE OR PRETERM neonates are those who are delivered
before the 37th completed week (259th day) from the LMP
◦ INCIDENCE: Among all live births 22.3% were delivered prior to 37
weeks of gestation of which 12.3% were born at 35-36 weeks of
gestation, 7.1% were born at 32-34 weeks and 2.9% were born at
28-31weeks of gestation. Overall the majority of preterm births
(55.1%) were late preterm.
◦ Source: Shah, R., Mullany, L.C., Darmstadt, G.L. et al. Incidence and risk
factors of preterm birth in a rural Bangladeshi cohort. BMC Pediatr 14, 112
(2014). https://doi.org/10.1186/1471-2431-14-112
CAUSES OF LOW BIRTH WEIGHT
The newborn baby maybe LBW because of prematurity and/or intrauterine
growth retardation (IUGR).

A. CAUSES OF PRETERM BIRTH

1. Fetal cause:
◦ Fetal distress
◦ Multiple gestations
◦ Erythroblastosis

2. Placental cause:
◦ Placental dysfunction
◦ Placenta previa
◦ Abruptio placenta
3.Uterine causes
◦ Bicornuate uterus
◦ Incompetent cervix

4.Maternal causes
◦ Teenage mother
◦ Pre-eclampsia
◦ Chronic medical illness ( cyanotic heart disease, renal disease)
◦ Infections ( Listeria monocytogens, group B streptococci, UTI, Chorioamnionitis)

5.Others
◦ Premature rupture of membrane
◦ Polyhydramnios
◦ Iatrogenic (DM, Rh incompatibility)
B. Causes of IUGR
1. Fetal causes
◦ Chromosomal disorders eg trisomies
◦ Chronic fetal infections
◦ Radiation
◦ Multiple gestations
◦ Insulin deficiency

2. Placental causes
◦ Decreased placental weight or cellularity or both
◦ Tumour ( chorioangioma, hydatidiform mole)
◦ Placental separation, infarction
◦ Twin – twin transfusion syndrome
3. Maternal causes
• Toxaemia
• Hypertension or renal disease or both
• Hypoxemia
• Malnutrition
• Drugs (Narcotics, alcohol, cigarettes)
ASSESSMENT OF GESTATIONAL AGE
◦ Calculation of LMP

◦ New Ballard Scoring System

◦ Antenatal ultrasound
NEW
BALLARD
SCORE
JEANE L
BALLARD, MD
AUTHOR OF
NEW BALLARD
SCORE
Neuromuscular maturity:
1. Posture
2. Square window
3. Arm recoil
4. Popliteal angle
5. Scarf sign
6. Heel to ear

Physical maturity:
1. Skin
2. Lanugo
3. Plantar surface
4. Breast
5. Eye/Ear
6. Genitals male
7. Genitals female
■Observe in the supine
position at rest
■Score is assigned
based on the degree of
flexion of arms , knees
and hips
■Increased flexion and
hip adduction with
increased gestational
age
■Infants hand is flexed on
the forearm between the
thumb and index finger of
the examiner
■Apply enough pressure to
get full flexion without
rotating the wrist
■Angle between the
forearm and the palm is
measured
This maneuver focuses on
passive flexor tone of the
biceps muscle by
measuring the angle of
the recoil following very
brief extension of the
upper extremity.
Flex the neonates arms
for 5 seconds while in the
supone position
Fully extend the arms by
pulling on the hands and
release
The degree of arm flexion
and strength of recoil are
measured. Full term can
flex hand completely
upto face.
Place infant in supine
position with the pelvis on
the mattress
Using the thumb and index
finger of one hand
examiner holds the knee
adjacent to the chest and
abdomen.
Gently extend the leg with
the index finger.
Look at the angle between
the lower leg, thigh and
posterior knee.
Place infant in supine
position with head in mid
line position.
Grasp the infants hand
and pull the arm across
the chest around the
neck.
Look at the relationship of
the elbow to midline of
body when arm pulls
across the chest.
Place the infant in
supine position with
pelvis flat on table.
Grasp one foot with
thumb and index
finger and draw foot
as near to head as
possible.
Note the distance
between the foot and
head as well as
degree of knee
extension.
WHEN YOU JUST CAME OUT OF THE WOMB
AND EVEN BEFORE CGPA SCORE THE
DOCTOR STARTS JUDGING YOU ON THE
BASIS OF APGAR SCORE, BALLARD SCORE....
 MANAGEMENT OF LBW BABY
1. DELIVERY OF LBW BABIES
◦ Delivery should be conducted in a hospital by trained health professionals
◦ Resuscitation equipment like suction, catheters, bag and mask, oxygen
cylinder, laryngoscope etc should be kept ready before hand.

2. MAINTENANCE OF BODY TEMPERATURE

◦ Baby should be well wrapped by two or three layers of clothes and the
room should be kept warm, feet should be covered with socks, head with a
cap, radiant warmer or incubator may be used.
◦ Kangaroo-mother care : baby is held upright and prone between mother’s
breast and baby’s head is under mother’s chin.
◦ Regular monitoring of axillary or skin temperature with a thermometer should
be carried out.
3. FEEDING:
I. Well preterm or LBW with gestational Age >34 weeks and/or weight >
2kg- breastfeeding
II. 30-34 weeks : 1.2-2 kg NG tube feed
III. <30 weeks and <1.2kg – NPO , I/V fluid for 72 hours and then trophic
feeding

4. HYPOGLYCEMIA: If blood glucose is <2.2 mmol/L administer 10%

dextrose

5. HYPERBILIRUBINEMIA: Phototherapy, ET

6. INFECTION: Broad spectrum antibiotic

7. ROP SCREENING: if <1.5kg weight or <32 weeks

8. CONGENITAL HEART DISEASE: Patent Ductus Arteriosus~ Indomethacin
is given
7. ROP SCREENING: if <1.5kg weight or <32 weeks

8. CONGENITAL HEART DISEASE: Patent Ductus Arteriosus~ Indomethacin is

given.

9. NUTRITIONAL SUPPLEMENTS:
• Vitamin K 2 mg orally or 1 mg IM/IV at birth and another dose 4-7 days
later.
• Vitamin A and D are required in doses of 1000 IU and 400 IU everyday
respectively from 2 weeks of age.
• Iron supplements should be started in a dose of 2 mg/kg/ day from 8
weeks of age.
COMPLICATIONS OF LBW BABY
◦ A. Immediate Problems/ Complications:
1. Respiratory
◦ Respiratory distress syndrome (RDS) / Hyaline membrane disease (HMD)
◦ Pneumothorax
◦ Congenital pneumonia
◦ Apnea
2. Cardiovascular
◦ Patent ductus arteiosus
3. Hematologic
• Anaemia (Early or late onset)
• Hyperbilirubinemia
• Subcutaneous, organ (liver, adrenal ) hemorrhage
• Disseminated intravascular coagulopathy
• Vitamin K deficiency

4. Gastrointestinal
• Poor motility
• Necrotizing enterocolitis

5. Metabolic/ Endocrine
• Hypothermia
• Hypocalcemia
• Hypoglycemia
6. Central nervous system:
• Intraventricular hemorrhage
• Periventricular leukomalacia
• Hypoxic ischaemic encephalopathy
• Seizures
• Retinopathy of Prematurity
• Hypotonia

7. Renal
• Hyponatremia
• Hypernatremia
• Hyperkalemia

8. Others:
• Infections : Congenital, Perinatal, Nosocomial, Bacterial, Viral, Fungal
B. LATE COMPLICATIONS
• Neurodevelopmental disorder – mental retardation, cerebral palsy
• Seizure
• Behavioural problem
 OUTCOME
◦ Depends on gestational age- the more the age, the better is the
outcome.
1. Developmental delay-
◦ Cerebral palsy
◦ Mental retardation
◦ Hearing or visual impairment
◦ Language disorders
2. Retinopathy Of Prematurity
3. Poor growth
4. Chronic lung disease
5. Congenital anomalies
 Prevention of Prematurity
◦ Identifying mothers at risk for preterm labor

◦ Prenatal education of the symptoms of preterm labor

◦ Avoiding heavy or repetitive work or standing for long periods of

time which can increase the risk of preterm labor

◦ Early identification and treatment of preterm labor