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

Low Birth Weight: less than 5lb 8oz

Full-term infant LBW Infant

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

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

Why relevant? Increases risk for serious health

problems in newborns Increases risk of death in newborns World Health Organization: 23.8% of all

births

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)

Pathophysiology (Con’t)

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

Contributing Factors To LBW M aternal Factors Maternal Disease Environmental Factors Placental Factors Fetal Factors

Important to remember that LBW is multifactorial

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

How Low Birth Weight Impacts Women’s 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

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 doesn’t 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.

Medical problems (Con’t)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)

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

Preventions (Con’t)

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

key!!!

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

Treatment (Con’t)

Weight 2 times per day: If baby weights > 4lbs, keep in the crips baby weights < 4lbs, keep in the warmer

Breast milk is the only option for babies because breast milk contains growth nutrition for LBW baby

Treatments (Con’t)

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 milk’s volume gradually.

Vitamins Less than 18 years 19-30 years SourcesVitamin A (mcg/d) 750 770 Fruits, cream, butter, green

vegetableVitamin D (mcg/d) 5 5 Fortified milk, margarine,

butter, liverVitamin E (mcg/d) 15 15 Vegetable fats and oils,

whole grains, greens, eggsVitamin K (mcg/d) 75 90 Green leafy vegetable,

liverVitamin C (mg/d) 80 85 Citrus fruit, tomatoes,

strawberries, potatoes.Thiamine (mg/d) 1.4 1.4 Pork, liver, milk, potatoesRiboflavin (mg/d) 1.4 1.4 Milk, liver, eggs, breads,

cerealsNiacin (mg/d) 18 18 Meat, fish, poultry, liver,

whole grainsVitamin B6 (mg/d) 1.9 1.9 Wheat germ, yeast, fish,

liver, pork, tomatoesFolate (mcg/d) 600 600 Green leafy vegetables,

liver, peanutVitamin B12 2.6 2.8 Animal sourcesCalcium (mg/d) 1300 1300 Nuts, dried fruits, dark

green leafy vegetablesPhosphorus (mg/d) 1250 1250 Milk, eggs, meatMagnesium (mg/d) 400 350 Milk, whole grains, dark

green vegetables, nutsIron (mg/d) 27 27 Meat, eggs, whole grainsZinc (mg/d) 12 11 Meat, shellfish, poultryIodine (mcg/d) 220 220 Seafood, iodine saltSelenium (mcg/d) 60 60

Dietary Reference Intakes for Pregnant Females: (Text book)

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

References

March of Dimes Website

www.marchofdimes.com

  World Health Organization Website

www.who.int/en

  Davidson, M. London, M., & Ladewig, P. (2008). Old’s Maternal-Newborn

Nursing & Women’s Health Across the Lifespan (8th ed.) Upper Saddie River: Pearson Prentice Hall. (p. 930-932)

  Gundersan-Lutheran, NICU

http://www.gundluth.org/?id=417&sid=1

  Dahlia Drulia Photography

http://www.flickr.com/photos/drulia/3471051582/

  http://www.nice.org.uk/niceMedia/documents/

low_birth_weight_evidence_briefing.pdf