Low%20birth%20weight

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Low birth weight
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Definition

• Low birth weight has been defined by the WHO as
  weight at birth of less than 2,500 grams (5.5
  pounds).
• This is based on epidemiological observations
  that infants weighing less than 2,500 g are
  approximately 20 times more likely to die than
  heavier babies.

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Definitions

• Very LBW is less than 1,500 g .
• Extremely LBW is less than 1,000 g .

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The incidence of LBW

• is defined as the percentage of live births that
  weigh less than 2,500 g out of the total of live
  births during the same time period.
• incidence rate therefore is

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Overview

• More common in developing than developed
  countries.
• The goal of reducing LBW incidence by at least
  one third between 2000 and 2010 is one of the
  major goals in A World Fit for Children,.
• Forms an important contribution to the Millennium
  Development Goal (MDG) for reducing child
  mortality.

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Overview

• More than 20 million infants worldwide,
  representing 15.5 of all births, are born LBW,
  95.6 in developing countries.
• LBW is closely associated with foetal and
  neonatal mortality and morbidity, inhibited
  growth and cognitive development, and chronic
  diseases later in life.

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Risk factors for LBW

• Mother's Malnutrition
• Heavy work load
• High blood pressure
• Infection and diseases
• Unregulated fertility.

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Causes and consequences of LBW

• ) Preterm babies
• There are babies born too early before 37 weeks
  of gestation, their intrauterine growth may be
  normal, that is their, weigh, length and
  development may be within normal tomtits for the
  duration of gestation.
• Given good neonatal care, these babies can catch
  up growth and by 2 to 3 years of age will be of
  normal size and performance.

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• Approximately 2 thirds of all babies of LBW in
  developed countries are estimated to be preterm
  the causation of preterm babies is multifactoral.
  There include multiple births, hard physical
  works hypertensive disorders of pregnancy. But it
  is often preventable by such measures as good
  prenatal screening and care.

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• Small for dates (SFD)
• These babies are result of intrauterine fetal
  growth.
• The factors associated with intra uterine growth
  retardation are multiple and interrelated to
  mother, placenta or to foetus.

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Factors affecting birth weight

• The maternal factors
• Include malnutrition.
• Anaemia.
• Heavy physical work-during pregnancy.
• Hypertension.
• Malaria.
• Toxaemia.
• Smoking.

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The maternal factors

• Low economic status.
• Short maternal stature.
• Young age.
• High parity.
• Dose birth spacing.
• Low education status.

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Factors related to placenta

• Placental insufficiency.
• Placental abnormalities.

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The foetal causes

• Foetal abnormality.
• Intra uterine infections.
• Chromosomal abnormalities.
• Multiple gestation.

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• SFD babies has a high risk of dying not only
  during the neonatal period but during their
  infancy, thus significantly raising the rate of
  infant and prenatal mortality.
• Most of them become victims of protein energy
  mal nutrition and infection.

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Importance

• LBW is one of the most serious challenges in
  maternal and child health indevelped and
  developing countries.

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Its public health significance may be ascribed,
to numerous factors

• Its high incidence.
• Its association with mental retardation.
• A high risk of prenatal and infant mortality and
  morbidity.

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Its public health significance may be ascribed,
to numerous factors

• LBW is the single most important factor
  determining the survival chances of the child
  (the infant mortality rate is about 20 times
  greater for all breast fed babies.
• .

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Its public health significance may be ascribed,
to numerous factors

• Many of them become victims of protein energy
  malnutrition and infection.
• There is a strong and significant positive status
  and the length of pregnancy and birth weight

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Prevention

• The rates of LBW could not be reduced to more
  than 10 percent in all parts of the world. There
  is no universal solution,
• interventions have to be case specific.

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• In recent years good attention has been given to
  ways and means of preventing LBW through good
  prenatal care and interventions programmes rather
  than treatment of low birth weigh babies born
  later.

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Direct intervention measures (mothers )

• Increasing food intake
• Controlling infection
• Early detection and treatment of medical
  disorders

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Prevention

• Indirect intervention
• Family planning
• Improved sanitation
• Improving health and nutrition of young girls
• Improvement of socio-economic conditions
• Government support (maternity leave)

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Treatment

• From the point of view of treatment. LBW babies
  can be divided into 2 groups.
• Those under 2 kg.
• Those between 2 2.5 kg.
• The first group require first class modern
  neonatal care which is hardly available

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• globally in an intensive care unit their weight
  reaches the weight of the second group.
• The second group may need an intensive care unit
  for a day or two.

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• The intensive care comprises of
• Incubatory care, that adjust temp, humility
  oxegen supply (low levels of oxygen in the blood
  steam can produce cerebral palsy. If it is
  excessive leads to retrolenta fit roplasia).

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• Feeding Nasal catheter.
• Prevention of infection Infection can cause
  death in the first few hours (respiratory
  infection so prevention of infection is there
  fore one of the most important functions of an
  intensive care unit.

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The leading causes of death in low birth weight
babies

• Atelectasia.
• Malformation.
• Pulmonary haemorrhage.
• Intracranial bleeding.
• Pneumonia and other infections.
• The development of perinatal intensive care
  units has been associated with a decline in
  neonatal mortality.

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Feeding of infants

• Breast feeding
• Ideal
• Protect from infection and malnutrition
• Reduces infant mortality

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Advantages

• Safe, clean ,cheap, and available in correct
  temp.
• Meets nutritional requirement of infant in first
  months of life
• Antimicrobial factors
• Easily digested ,has biochemical advantages.
• Promotes bonding
• Protects against obesity
• Sucking is good for development of jaws teeth
• Prevents malnutrition
• Child spacing

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Artificial feeding

• Dried milk,cows milk
• Indications
• Failure of breast milk
• Prolonged illness
• Death of mother

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Comparison between breast milk and cow's milk
Cow's milk Breast milk constituent
? ? proteins
fats
? ? carbohydrates
? ? Minerals
? ? vitamins
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Weaning

• Gradual process starts around 4-5 months
• Supplementary foods
• If not done properly ,diarrhoea and growth
  failure
• Solid foods introduced at age of one year
• Nutrition education
• Promoting home-made weaning foods.

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• Thank you

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Nutritional surveillance
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Nutritional surveillance

• first came into prominence at the World Food
  Conference in 1974, since then the concept has
  evolved and has been applied in many developing
  countries.
• Nutritional surveillance is defined as to watch
  over nutrition in order to make decisions that
  lead to the improvement in nutrition in
  populations

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Another Definition

• The continuous collection and analysis of
  nutritional status data in order to give warning
  of impending crisis or to make policy and
  programmatic decisions that will lead to
  improvement in the nutrition situation of the
  population
• Objectives
• 1- to aid long-term planning.
• 2- to provide input for management and
  evaluation.
• 3- to give timely warning and interventions.

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Growth Monitoring

• The practice of following a childs physical
  development, by regular measurement of certain
  indicators (usually weight and sometimes length)
  in order to maintain good health by detecting
  growth faltering and intervening in a timely
  manner
• Nutrition Status Is the balance between
  nutrient intake and nutrient requirements and/or
  the degree to which an individuals physiological
  needs for nutrients are being met from the food
  they eat.

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Growth monitoring surveillance

• Preservation of normal growth
• Educational motivational
• All infants
• Starts before 6 month.
• Small groups.
• No trained worker
• Simple card

• Detection of
• malnutrition
• Diagnostic-interventional
• Sample
• Representative ages
• Any size.
• Trained worker
• Precise.

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Growth monitoring surveillance

• Maintaining good nutrition
• Early home interventions.
• Brief response time
• PHC interventions.
• Referral to health system for check up

• Detect malnutrition.
• Nutritional rehabilitation
• Long response time.
• Community wide food supplements.
• Referral to rehabilitation centers.

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INDICATORS

• Nutritional Status Indicators
• Socio-economic indicators
• Quality of housing
• Water supply
• Sanitation
• Diseases and Epidemics
• Mortality
• Literacy levels

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Food security indicators

• Ecological zone
• Farm size
• Use of extension services
• Food prices
• Population response to food shortages

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Nutritional status indicators

• Phenomenon
• maternal nutrition
• Infant and preschool
• Child nutrition
• School child nutrition

• Indicator
• birth weight
• of breastfed babies.
• Mortality rates.
• Height for age
• Weight for height.
• Height for age
• Weight for height at school admission
• Clinical signs.

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Assessment of nutritional status

• Clinical examination.
• Anthropometry.
• Biochemical evaluation.
• Functional assessment.
• Assessment of dietary intake.
• Vital and health statistics.
• Ecological studies.

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Assessment of nutritional status

• Clinical examination.
• Anthropometry.
• Biochemical evaluation.
• Functional assessment.
• Assessment of dietary intake.
• Vital and health statistics.
• Ecological studies.

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1- Clinical examination

• WHO classification of clinical signs
• 1- not related to nutrition e.g alopecia
• 2- that need further investigation e.g corneal
  vascularisation.
• 3- known to be of value e.g angular stomatitis

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Drawbacks of clinical signs

• 1- malnutrition cannot be quantified.
• 2- many deficiencies lack clinical signs.
• 3- lack of specificity.

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2- anthropometry

• 1- height
• 2- weight.
• 3- skinfold thickness.
• 4- arm circumference
• Additional in children
• 5- head circumference
• 6- Chest circumference.

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3- laboratory and biochemical assessment

• Lab.
• Hb,stools and urine
• Biochemical applied to measure
• 1- nutrient concentration e.g serum iron.
• 2- metabolites in urine e.g urinary iodine.
• 3- enzymes e.g ribofavin deficiency.
• Disadvantages
• Time-consuming, expensive ,cannot be applied
  on large scale ,and reveal only current status.

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4- Functional indicators

• Structural integrity.
• Host defense.
• Homeostasis.
• Reproduction.
• Nerve function
• Work capacity.

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5- Assessment of dietary intake

• Weighment of raw foods
• Weighment of cooked foods.
• Oral questionnaire method.

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6- Vital statistics

• Morbidity data
• Mortality data

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7- Assessment of ecological factors

• food balance sheet.
• Socioeconomic factors.
• Health and educational services.
• Conditioning influences.

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Thank you
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