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Low Birth Weight

Definition: Birth weight less than 2.5 kg regardless of gestational age taken within a hour of birth
Two main groups: Born Prematurely i.e. short gestation Fetal growth retardation

Low Birth Weight


Apart from the Birth weight, babies can also be classified into 3 groups Pre-Term : Born before the end of 37 weeks gestation (< 259 days) i.e. too early Term: Born from 37 weeks to less than 42 completed wks (259 to 293 days) Post Term: 42 completed wks or anytime thereafter ( 294 days or over of gestation

Low Birth Weight


Pre-Term : Born before the end of 37 weeks gestation (< 259 days) i.e. too early but their intrauterine growth may be normal. If a good neonatal care is given they will catch up the growth of normal child by 2-3 yrs Two third of all LBW babies are Preterm

Causes of preterm
Multiple Births Ac Infections Hard Physical work Hypertensive disorder of Pregnancy

Small for dates


This may be both at Term and Preterm Clearly the result of retarded intrauterine fetal growth Factors : mainly interrelated to mothers Malnutrition, Severe Anemia & heavy Physical work during pregnancy Hypertension, malaria & Toxemia Smoking, Low SE status, Short maternal stature

Small for dates


Very young age, high parity, close birth spacing &low educational status SFD babies have a high risk of dying not only during the neonatal period but during their infancy raising significantly the rate of infant and perinatal mortality. Most of them become victims of malnutrition and infections

LBW Incidence
WHO estimates 25 million LBW babies born each year i.e 17% of all live births 95% of them in developing countries while India contributes 30% Bangladesh 36%, Pakistan 19%, Srilanka 22% USA, UK & Singapore 8% while Switzerland 6% & Sweden 4%

LBW Incidence in India


About 8 million low birth weight are born India 40% global burden In Multicentric ICMR study revealed 38.1% in Rural 41.4% in Urban Slum cohort Pre-maturity (short gestation) 12.7 & 14.4% in rural & urban slum respectively The incidence of term LBW neonates 28.7% in rural areas & 23.7% in Urban cohort (P.Gupta & Ghai. 2007)

Indian Birth Weight


On an average the mean birth weight is 2.7 to 2.9 kg The birth weight of babies born with well-nourished mothers is 3.5 kg and that of malnourished mothers 3 kg Concept of LBW was proposed to maintain uniformity globally. But it has not taken into consideration genetic and environmental factors, which are the important determinants of birth weight

WHO estimates in Indian context


WHO LBW definition has less practical significance in India as
Most LBW are mature by gestation Mean birth weight of mature Indian newborn is 500 gm less than American Newborn. So this criteria of LBW could not be applied for Indian newborn as many feels

Indian Scientists Assessment


Considering the maturity, respiratory distress & feeding problem, 2kg or less should be taken as criterion for LBW With this criteria incidence of LBW was found to be 5.5% as against 25-30% as per the criteria of 2.5 kg

WHA target
Understanding the gravity 34th World Health Assembly recommended reduction of LBW to be targeted to bring down to less than 10% as a HFA goal. Govt of India has also wished to control the problem and reduce the incidence below 10%.

Risk factors
Malnutrition Infection Unregulated Fertility Under the background of poor SE status and environment Too early, Too close & Too many pregnancy Maternal Anemia No rest , sleep & Heavy work during pregnancy Smoking tobacco

Public Health Significance of LBW


Serious challenge in Maternal & Child Health both in developed & developing country due to its High incidence Association with mental retardation High risk of infant & Perinatal mortality & morbidity i.e. half of the perinatal and one third infant deaths

Public Health Significance of LBW


In India nearly 75% (three fourth ) of neonatal deaths occur in LBW babies. This means 11-13 times higher risk of mortality during neonatal period compared to normal birth weight babies (P.gupta & Ghai)

Public Health Significance of LBW


Human wastage & suffering Very high cost of special care and intensive care unit with its association with poor SE status and underdevelopment Most important factor determining the survival of the child. IMR 20 times greater in case of LBW child. Lower the birth weight lower is the survival

Public Health Significance of LBW


Victims of PEM & infections It also reflects inadequate nutrition & care of the mother A strong co-relation was observed between maternal nutritional status, the length of pregnancy and birth weight A high % of LBW indicates poor health status of mother, lack of care during pregnancy as well as newborn care

Prevention
Direct Intervention Identify Pregnant women at risk based on the risk factors already stated Increase food intake: Increase even in the last trimester will improve birth weight Treatment of Anemic mothers increased birth weight in South India

Prevention
Direct Intervention Controlling Infections: It goes unnoticed. Treat for Malaria, UTI,Cytomealovirus,rubella, Syphilis Early detection and treatment of Medical disorders like Hypertension, PET, Diabetes

Prevention
Indirect Intervention F.P., Avoidance of excessive smoking, adolescent health & Nutrition, Prevent too early marriage, too close & too many pregnancies Follow 3 Es

Treatment as per RCH


Incubatory Care Feeding
Prevention of Infection

Primary Newborn Care Strategies


Antenatal Care Safe Delivery Prevent Hypothermia Prevent Infection Breast Feeding Care of small and Sick newborn

ENC Packages
Resuscitation of Asphyxiated Newborn
Prevention of Hypothermia Prevention of infections Exclusive Breast feeding Referral of sick newborn babies

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