Download 9.Low Birth Weight Babies

LOW BIRTH WEIGHT BABIES
Dr.M.Chandrasekhar
Asst. Prof. of Paediatrcis
LOW BIRTH WEIGHT BABIES
Def: Babies with a birth weight of less than 2.5 Kgs
irrespective of period of gestation are called as LBW
babies.
Clinical Types : 2
A. Preterm
B. Small for Dates baby
Small for Dates Babies
a) Malnourished small for dates babies
b) Hypo plastic small for dates babies
c) Mixed group
Etiology :CAUSES OF PRETERM BIRTHS :A) Spontaneous :-
a) Maternal factors :
i) Uterine causes
ii) Placental causes
iii) Medical illness
iv) Infections
b) Fetal Factors :
i) Multiple Gestations
ii) Erythroblastosis
iii) Non immune Hydrops
B)
Induced :i) Severe cardiac illness
ii) PIH Eclampsia
iii) Uncontrolled diabetes mellitus
iv) Severe rhesus iso – immunization
C)
IATROGENIC
COMMON DETERMINANTS OF IUGR
A)
Fetal
i) Chromosomal disorders
ii) Chronic fetal infections
iii) Radiation
Placental :i) Structural abnormalities
ii) Disorders of implantation
iii) Infections
iv) Infarction
v) Tumours
Maternal :-
i) Primi or Grand Multipara
ii) Young Mother
iii) Drugs
iv) Malnutrition Chronic illness
VICIOUS CYCLE OF LBW BABIES
Short and light
Under nourished mother
Small Girl
Poor nutritional stores
Anemia
Frequent Pregnancies
Small Boy
Neglect and ill health
Poor Nutrition during childhood
Poor Adolescent Growth Spurt
Clinical features :Features
Pre term
Term
1) Measurements
a) Length
< 47 cm
47-50 cm
b) Head circumference
< 33 cm
34-36 cm
2) Activity
Poor
Good
Sluggish
Good
3) Posture
Extended
Flexed
4) Sole creases
1/3 of scale
2/3 of scale
Reflex Responses
5) Genitals
Male Testes
Scrotum
At External ring
Descendent
or above
Scanty rugosities
Developed
Female
labia majora
covers
widely separated
•
Breast Nodule
•
Face & Head
a) Ear
b) Hair
labia minora
< 5 mm
Soft
> 5 mm
Firm well shaped
Brownish – Black
Silky & Black
Wooly
8) Skin
Thin and Gelatinous
Subcutaneous fat
deficient
Thick
pealing
Abundant
NEW BALLARD SCORE
PHYSICAL MATURITY
SCORE
SIGN
-1
0
1
2
3
4
5
Skin
Sticky,
friable,
transparent
gelatinous,
red,
translucent
smooth pink,
visible veins
superficial
peeling &/or
rash, few
veins
cracking,
pale areas,
rare veins
parchment,
deep
cracking, no
vessels
leathery,
cracked,
wrinkled
Lanu
go
none
sparse
abundant
thinning
bald areas
mostly bald
Plant
ar
Surfa
ce
heel-toe
40-50mm: 1 <40mm: 2
>50 mm
no crease
faint red
marks
anterior
transverse
crease only
creases
ant. 2/3
creases over
entire sole
Brea
st
imperceptab
le
barely
perceptable
flat areola
no bud
stippled areola
1-2 mm bud
Eye /
Ear
lids fused
loosely: -1
tightly: -2
lids open
pinna flat
stays folded
sl. curved
pinna; soft;
slow recoil
well-curved
pinna; soft but
ready recoil
Genit
als
(Male
)
scrotum flat,
smooth
scrotum
empty,
faint rugae
testes in
upper canal,
rare rugae
testes
descending,
few rugae
testes
down,
good rugae
testes
pendulous,
deep rugae
Genit
als
(Fem
ale)
clitoris
prominent &
labia flat
prominent
clitoris & small
labia minora
prominent
clitoris &
enlarging
minora
majora &
minora equally
prominent
majora
large,
minora
small
majora cover
clitoris &
minora
raised
areola
3-4 mm
bud
formed &
firm
instant
recoil
full areola
5-10 mm bud
thick cartilage
ear stiff
TOTAL PHYSICAL MATURITY SCORE
SIG
N
SC
OR
E
Clinical Features of SFD babies
-Alert
-Long thin, Marasmic
-Excessive Skin folds
-Shrunken internal organs
PROBLEMS IN PRETERM BABY
a) Respiratory :i) HMD
ii) Congenital Pneumonia
iii) Apnea
iv) Chronic lung disease
b) CARDIOVASCULAR :i) P D A
ii) Hypo tension
iii) Hypertension
v) Thrombo embolic complications
C) Central Nervous system :i) Intraventricular Haemorhage
ii) Kernicterus
iii) Retinopathy of Prematurity
iv) HIE
v) Seizures
D) GIT :
i)
Difficulties in self feeding
ii)
Abdominal distension Functional
intestinal obstruction
iii)
Hyper bilirubinaemia
iv)
Necrotizing Enterocolitis
E) RENAL : i)
Renal Tubular acidosis
ii)
Hypo Natremia
iii)
Hyper natremia
iv)
Edema
F) Others : Hypothermia
Infections
Nutritional deficiency.
DIFFERENCES BETWEEN PRETERM AND
TERM SFD BABIES
S.No.
Problem
Preterm
TERM SFD
+
+++
a) Birth Asphyxia
+
+++
b) Aspiration in – utero
+
+++
c) HMD
+++
0
d) Apneic attacks
+++
0
a) Inability to suck & Swallow
+++
0
b) Aspiration of feeds
++
0
1. Intrauterine Hypoxia
2. Respiratory difficulties
3. Feeding difficulties
S.No. Problem
Preterm
Term
4. Symptomatic hypoglycemia
+
+++
5. Hypothermia
+++
+
6. Poly cythemia
+
+++
7. Hyperbilirubinemia
+++
+
8. Infections
+++
+
9. Congenitalmalformations
+
+++
10. Hemorrhage
a) Intraventricular
+++
0
b) Pulmonary
+
+++
S.No. Prognosis
a)
b)
Immediate
Preterm
Term
High Mortality
Better Prognosis
Future physical and
mental development
Good
Poor