LOW BIRTH

WEIGHT
INFANTS
CLINICAL TYPES

1 Low Birth Weight

2 Preterm

Small for date/small for gestation age

(Babies born before 37 weeks)
(Babies having intra-uterine growth retardation)
PRETERM INFANTS

Infants born before 37 weeks of gestation

are known as preterm babies.

FEATURES

• Size

• Posture
SPECIFICATION
A preterm baby is small in size, usually less than 47cm and weight less than 2.5 kg

Head
The preterm infant lies in a "relaxed attitude", limbs are extended. The head is relatively large, sutures
are widely separated and fontanels are large.

Hair
Hair of preterm are fine, fuzzy and wooly.

Skin
Skin of preterm is thin, pinkish and appears shiny due to generalized edema is covered with abundant
lanugo and there is little vernix caseosa.

Ear
In preterm infants ear cartilage is poorly developed and ear may fold easily
SPECIFICATION
Breast
The breast nodule is absent or less than 5mm wide.

Sole
The sole of foot of preterm infant appears more turgid and may have only wrinkles. The creases
are absent.

Female genitalia

The female infant's clitoris is prominent and labia majora are poorly developed and gaping.

Male genitalia
In preterm male infant, the scrotum is undeveloped and not pendulous, minimal rugae are
present and testes may be in the inguinal canal or in t abdominal cavity.
Etiology of Preterm Birth

Fetal Placental Uterine Maternal Other

Factors Factors Factors Factor Factors
• Fetal distress • Pre-eclampsia • Premature rupture
• Placental • Bicornuate uterus
• Multiple gestation of membranes
dysfunction • Chronic medical
• Incompetent cervix
illness • Polyhydramnios
• Erythroblastosis • Placenta previa
fetalis • Infections • latrogenic
• Abruptio placenta
• Nonimmune • Drug abuse (Cocaine) • Trauma
hydrops
 PHYSIOLOGICAL HANDICAPS OF PREMATURITY OR PROBLEMS
ASSOCIATED WITH PREMATURITY

Respiratory Cardiovascular Gastrointestinal

Problems Problems Problems

• Hyaline membrane disease • Patent ductus arteriosus • Poor Gastrointestinal function

• Bronchopulmonary dysplasia • Hypotension • Necrotizing enterocolitis

• Pneumothorax • Bradycardia • Hyperbilirubinemia

• Incompetent cardioesophageal
• Pneumonia
sphincter leading to regurgitation
• Apnea
 PHYSIOLOGICAL HANDICAPS OF PREMATURITY OR PROBLEMS
ASSOCIATED WITH PREMATURITY

Central Nervous Problems associated Other problems

System Problems with renal system

• Intraventricular hemorrhage • Hyponatremia/Hypernatremia • Hypothermia

• Seizures • Hyperkalemia • Nutritional deficiencies

• Retinopathy of prematurity • Renal tubular acidosis • Increased susceptibility to

infections
• Deafness • Renal glycosuria

• Hypotonia • Edema
 SMALL-FOR-DATE/SMALL-FOR-GESTATIONAL AGE BABIES

A baby whose birth weight falls below the 10th percentile on intrauterine growth curves is known as small-for-
date or small-for-gestational age (SFD or SGA).
Classification of Small-for-date
SFD or SGA babies are of 3 types: Do malnourished le but date infants: Growth arrest in later part of pregnancy
leads toreduction in cell size buenotubell number, resulting in small and malnourished baby, Such baby looks
marasmic and has less subcutaneous fat and poor muscle mass.
Hypoplastic small for dood bables:
Growth retardation in early part of pregnancy leads to reduction in number of body cells resulting in hypoplastic
small for date bables. These bables are proportionately smaller in all parameters including head size. 3. Mixed:-
When adverse factors operate during early and mid pregnancy, reduction in both cell number and size occurs
leading to mixed small for date baby.
 Etiology of Small-for-Date baby/IUGR

Fetal Factors Placental Factors Maternal Factors

• Toxemia of pregnancy
• Chromosomal anomalies • Placental weight or cellularity
• Hypertension or renal disease
(size)
• Infections (congenital
• Hypoxemia (cyanotic cardiac or
rubella, syphilis) • Infraction
pulmonary disease)

• Infarction • Abruptio Placenta • Malnutrition

• Multiple gestation • Infection of placenta • Short stature of mother

• Pancreatic hypoplasia • Primi or grand multipara

• Insulin deficiency • Young mother (below 20 years)

• Smoking, alcohol or drug abuse

 Problems of Small-for-Date infants

• Birth asphyxia • Uteroplacental perfusion during labor chronic

fetal hypoxia-acidosis, meconium aspiration
• Polycythemia and hyperviscosity of blood
syndrome
• Hypothermia • Erythropoietin level due to intrauterine fetal

• Congenital malformations hypoxia

• Hypoglycemia, poor subcutaneous fat and
• Pathogenesis (Reason)
hypoxia
• Hypoxía, acidosis, infection, lethal anomaly • Chromosomal-genetic defects,
oligohydramnios, TORCH infection
 Principles of Management of Low Birth Weight Infants
1. Care at birth
Select a suitable place for delivery which has optimum facilities for handling LBW baby. In
case, premature labor is indicated administer betamethasone (12 mg IM, 2 doses interval of
18 hours) or Hydrocortisone 100 mg to the mother, as they help in improving the lung
maturity and reduces the incidence of hyaline membrane disease in newborn, Avoid
administration of sedatives to the mother, as they can depress baby's respiration.
• A good episiotomy should be given to prevent intracranial birth injury.
• Delayed cord clamping to help improve iron stores of baby and prevent anemia.
• Efficient resuscitation.
• Administration of vitamin K 0.5 mg IM to reduce incidence of hemorrhage in baby.
• Prevent hypothermia.
 Principles of Management of Low Birth Weight Infants
2. Appropriate place of care
• If birth weight 1800 gm-Home care, if baby is well.
• If birth weight 1500-1800 gm-Secondary level new born unit (Level II)
• If birth weight 1500 gm-Tertiary level new born care (Level III)

3. Thermal protection
• Delay bathing up to 48-72 hours of birth or even more till the baby is stable.
• Maternal skin-to-skin contact or kangaroo care.
• Warm delivery room.
• External heat source
 Principles of Management of Low Birth Weight Infants
4. Appropriate place of care
• Intravenous fluids for very small babies and those who are sick.
• Expressed breast milk with Nasogastric tube or katori and spoon.
• Direct breast feeding, if possible for the baby to suck and swallow.

5. Monitoring and early detection of complications

• Weight and other clinical signs.
• Electronic monitoring like heart rate, temperature, oxygen saturation etc.
• Biochemical monitoring like Hemoglobin, Serum bilirubin, blood sugar etc.
Nursing interventions
1. Nursery care

At birth, measures are needed to clear the

airway, initiate breathing, care of umbilical cord
and eyes and administration of Vitamin K.
Special care is required to maintain a patent
airway and oxygen saturation in blood. 2. Thermal control

Survival rate of LBW infants is higher when they

are cared for in thermoneutral environment.
Incubators or radiant warmers should be used
to maintain normal body temperature. Also
kangaroo mother care can be given to stable
low birth weight babies.
 APNEA OF PREMATURITY

Definition

Apnea may be defined as cessation of

respiration for 20 seconds with or without
and cyanosis. ita common problem in
preterm neonates. It occurs in preterm
neonates between 2nd-5th days of life due
to immaturity of developing brain.
Types
1. Primary Apnea 2. Secondary Apnea

When an infant is deprived of oxygen, an If after primary apnea, asphyxia continues,

initial brief period of rapid breathing the infant develops deep gasping
occurs. If the asphyxia continues, the respiration, the heart rate continues to fall,
respiratory movements cease, the heart blood pressure also falls and infant
rate begins to fall. neuromuscular apnea. becomes nearly flaccid. The respiration
tone gradually diminishes and infant becomes weaker and weaker, until the
enters a period of apnea known as infant takes a last gasp and enters a period
primary apnea. of secondary apnea.
Types
According to the etiology, apnea is of three types:

1. Central 2. Obstructive 3. Mixed type

apnea
Central apnea occurs because
It occurs due to blockage Episodes of apnea of
of pathological causes like
of airway due to secretions, prematurity may start as
sepsis, metabolic problems
improper positioning like either obstructive or
(hypoglycemia, hypocalcemia),
hyper flexed neck or hyper central, but then involve
temperature instability,
extended neck of baby. elements of both and
respiratory diseases, anemia
becomes mixed in nature.
and polycythemia.
Incidence
Apnea of prematurity occurs in at least 85% of infants who are born before
34 weeks of gestation.

Pathophysiology
Respiratory efforts are primarily dependent on response to increased level
of carbon dioxide (CO₂) and Lactic acid in blood. A secondary stimulus is
hypoxia. Response to these stimuli is impaired in premature infants due to
under development of respiratory center of brain, thereby leading to
apnea.
Management
Drugs like Aminophylline, Theophylline, Caffeine and Doxapram are used to treat apnea of
prematurity. Supportive measures include:
1.Monitoring:
In hospital, the preterm should be monitored for respiratory movements, heart rate and oxygen
saturation.
2. Respiratory support
• Raising the infant's level of alertness by simple tactile stimulation (by touching the skin or
patting the infant) may stop an apneic episode.
• Increasing environmental oxygen level by placing the infant in oxygen hood with
supplemental oxygen can reduce the frequency of apnea.
• CPAP (Continuous Positive Airway Pressure) is sometimes used for apnea when medications
and supplemental oxygen are not sufficient.
PNEUMO THORAX

Definition
A pneumothorax is the accumulation of entrapulmonary air with in the pleural
cavity. Pneumothorax is one of the most Common air Lock syndromes that occlus
more frequently in the neonatal period than in any other period of lite and is a life-
threatening condition associated with a high incidence of morbidity and mortality

Causes
• pulmonary hypoplasia, High ventilatory support- Meconium aspiration
syndrome.
• congenital pneumonia.
• cystic fibrosis.
Clinical manifestation

Flaring Cyanosis Hypotension

Grunting Tachypnea. Decreased Bradycardia,

oxygen Hypoxemia.
saturation
Asphyxia neonatorum

Asphyxia neonatorum refers to a condition

in newborns characterized by impaired
breathing or lack of oxygen at birth,
leading to inadequate oxygen supply to the
baby's tissues and organs. This can occur
during labor or immediately after delivery
Causes

Umbilical cord problems Birth trauma or prolonged

(e.g., cord prolapse or labor
wrapping around the neck)

Placental issues Maternal conditions

(e.g., placental abruption (e.g., infections,
or insufficiency) hypertension)
 Signs and Symptoms of Asphyxia Neonatorum

• Poor or Absent Breathing: The newborn may not breathe spontaneously or have
irregular, shallow breaths.
• Cyanosis: Bluish discoloration of the skin, lips, and extremities due to low oxygen
levels.
• Bradycardia: Slow heart rate, typically less than 100 beats per minute.
• Poor Muscle Tone: Limp or floppy appearance, with little or no movement.
• Weak Reflexes: Lack of response to stimuli, such as a weak or absent cry.
• Pale Skin: Pale or grayish skin color, especially if oxygen deprivation is severe.
 Management of Asphyxia Neonatorum
Immediate Resuscitation:
Airway: Ensure the airway is open, typically by positioning the baby
with the head slightly extended.
Breathing: Positive pressure ventilation (PPV) is started within the first
minute if spontaneous breathing is absent or inadequate.
Circulation: If heart rate remains below 60 beats per minute after
ventilation, chest compressions may be started.
Drugs: Administer epinephrine if the heart rate remains low despite
ventilation and compressions.
 Management of Asphyxia Neonatorum
Oxygenation:
• Administer 100% oxygen if the newborn is not responding to air
ventilation.
• Monitor oxygen saturation and blood gases to guide further oxygen
therapy.

Therapeutic Hypothermia:
In cases of moderate to severe hypoxic-ischemic encephalopathy (brain
damage due to lack of oxygen), controlled cooling of the baby’s body
can reduce brain injury and improve outcomes.
 Management of Asphyxia Neonatorum
Intravenous Fluids and Medications:
• Supportive care with IV fluids and medications to stabilize blood
pressure, glucose, and electrolyte levels.
• Monitor for and treat seizures if they occur, often with
anticonvulsant medications.

Post-Resuscitation Care:
• Continuous monitoring in a neonatal intensive care unit (NICU).
• Support for organ systems, including respiratory and cardiovascular
support if needed.
Meconium Aspiration Syndrome (MAS)

Definition

It is a condition that occurs when a newborn inhales

a mixture of meconium (the baby's first stool) and
amniotic fluid into the lungs during or shortly after
delivery. Meconium in the lungs can cause breathing
difficulties, lung inflammation, and infection. MAS
typically occurs in term or post-term babies,
especially in those who experience fetal distress.
Causes of Meconium Aspiration Syndrome (MAS)

• Fetal Distress: Fetal distress, often due to lack of oxygen (hypoxia), can cause the fetus to pass
meconium into the amniotic fluid before or during labor. The baby may then gasp and inhale the
meconium.
• Post-term Pregnancy: Babies born after 40 weeks of gestation have a higher chance of passing
meconium into the amniotic fluid, increasing the risk of aspiration.
• Prolonged or Difficult Labor: Complications during labor, such as prolonged labor or umbilical cord
compression, can lead to fetal stress and meconium passage.
• Intrauterine Hypoxia: Any condition that reduces oxygen supply to the baby during pregnancy or
labor, such as placental insufficiency, placental abruption, or maternal hypertension, can increase
the likelihood of fetal meconium passage and subsequent aspiration.
Causes of Meconium Aspiration Syndrome (MAS)

• Maternal Health Conditions: Conditions such as preeclampsia, diabetes, and infections (e.g.,
chorioamnionitis) can increase the risk of fetal stress and meconium aspiration.
• Decreased Amniotic Fluid (Oligohydramnios): Reduced amniotic fluid can increase the
likelihood of meconium becoming concentrated, which can be inhaled by the baby during
labor.
• Umbilical Cord Issues: Problems such as umbilical cord prolapse or a cord wrapped around the
baby's neck can lead to reduced oxygen supply and fetal stress, triggering meconium release.
• Intrauterine Growth Restriction (IUGR): Babies with IUGR, who have not grown adequately
during pregnancy, are at higher risk of stress and meconium aspiration.
 Signs and Symptoms of Meconium Aspiration Syndrome

Respiratory Cyanosis Low Apgar

Distress Scores

• Rapid or labored breathing • Bluish tint to the skin, lips, • Babies with MAS may have
(tachypnea) and nails due to low oxygen low Apgar scores (below 7) at
levels. 1 and 5 minutes due to
• Grunting or gasping for air
respiratory compromise.
• Flaring nostrils and chest
retractions
 Signs and Symptoms of Meconium Aspiration Syndrome

Barrel-Shaped Decreased Breath Amniotic Fluid Stained

Chest Sounds with Meconiumcores

• Due to trapped air in the • Lung sounds may be • Green or yellow discoloration
lungs, the chest may appear diminished on auscultation, of the amniotic fluid during
overinflated. indicating areas of collapse delivery suggests the
or consolidation. presence of meconium.
 Management of Meconium Aspiration Syndrome
Immediate Post-Delivery Care:

• Suctioning: If meconium is present in the amniotic fluid and the baby

shows signs of respiratory distress, immediate suctioning of the
airway may be performed to remove meconium, especially from the
trachea. This may be done via endotracheal intubation and
suctioning.
• Stimulation: If the baby is not breathing adequately, stimulation and
resuscitation may be necessary.
 Management of Meconium Aspiration Syndrome
Respiratory Support:

• Oxygen Therapy: If the baby shows signs of respiratory distress or

cyanosis, oxygen may be administered.
• Positive Pressure Ventilation (PPV): If the baby is not breathing
effectively, assisted ventilation is initiated.
• Mechanical Ventilation: In severe cases, the baby may require
intubation and mechanical ventilation to support breathing.
• Surfactant Therapy: Surfactant may be administered to improve lung
function and reduce inflammation in the lungs.
 Management of Meconium Aspiration Syndrome

Antibiotic Therapy:

• Since MAS can increase the risk of lung infections, antibiotics may be
given prophylactically or if infection is suspected.
• Extracorporeal Membrane Oxygenation (ECMO): In severe cases
where conventional ventilation is not effective, ECMO (a heart-lung
bypass machine) may be used to provide oxygenation and support
lung recovery.
 Management of Meconium Aspiration Syndrome

Monitoring and Support:

• Continuous monitoring of oxygen saturation, blood gases,

and respiratory effort in the neonatal intensive care unit
(NICU).
• Supportive care, including maintaining hydration,
electrolyte balance, and blood pressure.
 Prognosis
The prognosis for MAS varies depending on the severity of
the aspiration and how quickly the baby receives treatment.
Mild cases often resolve with supportive care, while more
severe cases can lead to complications like persistent
pulmonary hypertension of the newborn (PPHN), lung
damage, or long-term respiratory issues.

Preventive measures during labor, such as monitoring fetal

distress and managing meconium-stained amniotic fluid, can
reduce the risk of MAS.
Thanks for attention