Low Birth Weight Infants

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Low Birth Weight Infants

• By Quang Pham, Emily Spencer, Melissa Warren,
  and Sherita Green

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Low Birth Weight less than 5lb 8oz

• Full-term infant

• LBW Infant

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Why?

• Premature Birth (birth before 37 weeks)
• Pregnancy with twins, triplets or more
• Birth Defects
• Fetal Growth Restriction/Intrauterine Growth
  Restriction
• Drug/alcohol use
• Smoking

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• Inadequate maternal weight gain
• Age (under 17 or over 35)
• Placental problems
• Low income
• Lack of education
• Race (African-Americans are at highest risk)
• Infections in the mother/fetus

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• Why relevant?
• Increases risk for serious health problems in
  newborns
• Increases risk of death in newborns
• World Health Organization 23.8 of all births

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Pathophysiology

• Birth weight governed by two major processes
  duration of gestation, and intrauterine growth
  rate
• Therefore low birth weight is caused by either
  short gestation or retarded intrauterine growth
  (or a combo)

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Pathophysiology (Cont)

• Premature infants- at far greater risk for
  developing hyaline membrane disease, apnea,
  intracranial hemorrhage, sepsis and other
  conditions related to physiological immaturity
• IUGR- more likely to exhibit permanent growth
  deficiencies as well as subtle cognitive
  deficiencies

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Contributing Factors To LBW

• M aternal Factors
• Maternal Disease
• Environmental Factors
• Placental Factors
• Fetal Factors
• Important to remember that LBW is multifactorial

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Cultural Factors

• Income
• Education
• Asian and Indian- have some of the highest rates
  of LBW possibly due to short stature and low
  pre-gestational weight of mothers
• African Americans have highest rate of LBW in
  the United States

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How Low Birth Weight Impacts Womens
Heath/Neonatal Health

• 10,000 per day in Colorado
• Assisted reproductive technology often results in
  multiple births (causing low birth weight) and
  there is also a higher risk for low birth weight
  when using this technology

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Medical problems of low birth weight babies

• Respiratory Distress Syndrome
• Due to low surfactant production can be treated
  with oxygen. In severe cases, intubation and and
  administration of surfactant.
• Bleeding in the brain
• Patent ductus arteriosus
• Heart condition caused by the non-closure of the
  PDA. Can be treated with indomethacin or
  ibuprofen. If the medication doesnt work,
  surgery is the next step.
• Necrotizing Enterocolitis
• Infection of the intestines that usually appear
  2-3 weeks after birth. Can cause abdominal
  swelling and difficulty feeding. Treatment
  involves antibiotics and the use of IV nutrition
  until the intestines can heal.
• Retinopathy of prematurity
• Eye disease that is caused by the overgrowth of
  veins in the retina. Most cases heal by
  themselves, and in severe cases will need
  cryosurgery. In some infants, it can lead to
  blindness.

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Medical problems (Cont)Medical problems of low
birth weight babies

• Asphyxia
• Aspiration syndrome
• Hypothermia
• Hypoglycemia
• Polycythemia
• May be at risk for certain chronic conditions in
  adulthood (ex high BP, diabetes, heart disease)

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Preventions

• Avoid smoking, drugs, and alcohol during
  pregnancy
• Follow regular prenatal check ups
• Every 4 weeks for the first 28 to 32 weeks
• Every 2 weeks from 32 to 36 weeks
• Every week from 36 to 40 weeks

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Preventions (Cont)

• Monitor pre-pregnancy weight
• Monitor maternal nutrition
• Ultrasound
• Education about all risk factors is key!!!

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Treatments

• Baby gestational age, overall health, medical
  history
• Care in the NICU
• Check blood sugar constantly because glucose is
  the main source to keep baby warm
• Check temperature constantly If baby is loosing
  heat, glucose level decreases

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Treatment (Cont)

• Weight 2 times per day
• If baby weights gt 4lbs, keep in the crips
• baby weights lt 4lbs, keep in the warmer
• Breast milk is the only option for babies because
  breast milk contains growth nutrition for LBW
  baby

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Treatments (Cont)

• IV feeding tube might be required when baby can
  eat without IV tube, start feeding slowly to see
  if baby can tolerate it, if so, then can start
  increasing milks volume gradually.

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Dietary Reference Intakes for Pregnant Females
(Text book)
Vitamins Less than 18 years 19-30 years Sources
Vitamin A (mcg/d) 750 770 Fruits, cream, butter, green vegetable
Vitamin D (mcg/d) 5 5 Fortified milk, margarine, butter, liver
Vitamin E (mcg/d) 15 15 Vegetable fats and oils, whole grains, greens, eggs
Vitamin K (mcg/d) 75 90 Green leafy vegetable, liver
Vitamin C (mg/d) 80 85 Citrus fruit, tomatoes, strawberries, potatoes.
Thiamine (mg/d) 1.4 1.4 Pork, liver, milk, potatoes
Riboflavin (mg/d) 1.4 1.4 Milk, liver, eggs, breads, cereals
Niacin (mg/d) 18 18 Meat, fish, poultry, liver, whole grains
Vitamin B6 (mg/d) 1.9 1.9 Wheat germ, yeast, fish, liver, pork, tomatoes
Folate (mcg/d) 600 600 Green leafy vegetables, liver, peanut
Vitamin B12 2.6 2.8 Animal sources
Calcium (mg/d) 1300 1300 Nuts, dried fruits, dark green leafy vegetables
Phosphorus (mg/d) 1250 1250 Milk, eggs, meat
Magnesium (mg/d) 400 350 Milk, whole grains, dark green vegetables, nuts
Iron (mg/d) 27 27 Meat, eggs, whole grains
Zinc (mg/d) 12 11 Meat, shellfish, poultry
Iodine (mcg/d) 220 220 Seafood, iodine salt
Selenium (mcg/d) 60 60
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Implications on Nursing Practice

• Have to play the role of an educator
• In the Community- provide follow up care
• In hospital- monitor infants closely and pay
  meticulous attention to physiologic parameters
• Try to prevent long-term disorders

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References

• March of Dimes Website
• www.marchofdimes.com
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• World Health Organization Website
• www.who.int/en
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• Davidson, M. London, M., Ladewig, P. (2008).
  Olds Maternal-Newborn Nursing Womens Health
  Across the Lifespan (8th ed.) Upper Saddie
  River Pearson Prentice Hall. (p. 930-932)
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• Gundersan-Lutheran, NICU
• http//www.gundluth.org/?id417sid1
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• Dahlia Drulia Photography
• http//www.flickr.com/photos/drulia/3471051582/
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• http//www.nice.org.uk/niceMedia/documents/low_bir
  th_weight_evidence_briefing.pdf
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