Care of Low Birth Weight Babies

Neonatal Care Topics Introduction Classification Initial Care Monitoring Complications Prevention & Risk Factors

Care of Low Birth Weight (LBW) Babies

Definition & Epidemiology

• Low birth weight (LBW): Birth weight < 2500g regardless of gestational age
• Global prevalence: 15-20% of all births
• Higher prevalence in developing countries (up to 30-40%)
• Major contributor to neonatal mortality and morbidity

Key Principles of Care

• Early recognition and risk assessment
• Immediate stabilization and thermoregulation
• Prevention of complications
• Optimizing nutrition and growth
• Regular monitoring and follow-up

Classification of LBW Babies

Based on Birth Weight

• Low Birth Weight (LBW): < 2500g
• Very Low Birth Weight (VLBW): < 1500g
• Extremely Low Birth Weight (ELBW): < 1000g

Based on Gestational Age and Weight

• Small for Gestational Age (SGA): Weight < 10th percentile for gestational age
• Appropriate for Gestational Age (AGA): Weight between 10th and 90th percentile
• Preterm LBW: Born before 37 weeks with weight < 2500g
• Term LBW: Born at ≥ 37 weeks with weight < 2500g

Initial Care & Stabilization

Immediate Care (Golden Hour)

• Temperature maintenance:
  • Pre-warmed radiant warmer
  • Plastic wrapping for VLBW babies
  • Maintaining delivery room temperature at 25-26°C
• Respiratory support:
  • Early CPAP if needed
  • Oxygen therapy as indicated
  • Monitoring oxygen saturation
• Cardiovascular support:
  • Assessment of heart rate and perfusion
  • Early recognition of shock
  • Fluid management

Essential Equipment

• Radiant warmer with servo control
• Resuscitation equipment
• Pulse oximeter
• CPAP/ventilator
• Monitoring devices

Monitoring Parameters

Vital Parameters

• Temperature: Every 2-4 hours
• Heart rate: Continuous monitoring
• Respiratory rate: Every 2-4 hours
• Blood pressure: As per protocol
• Oxygen saturation: Continuous monitoring

Growth Monitoring

• Daily weight measurement
• Weekly length and head circumference
• Growth velocity calculation
• Plotting on appropriate growth charts

Laboratory Monitoring

• Blood glucose: Initially every 4-6 hours
• Serum electrolytes
• Complete blood count
• Blood gases as needed
• Bilirubin levels

Common Complications

• Respiratory:
  • Respiratory distress syndrome (RDS)
  • Bronchopulmonary dysplasia (BPD)
  • Apnea of prematurity
• Metabolic:
  • Hypoglycemia
  • Hypocalcemia
  • Metabolic acidosis
• Neurological:
  • Intraventricular hemorrhage (IVH)
  • Periventricular leukomalacia (PVL)
• Others:
  • Necrotizing enterocolitis (NEC)
  • Retinopathy of prematurity (ROP)
  • Infections

Prevention & Risk Factors

Preventable Risk Factors

• Maternal malnutrition
• Smoking and substance abuse
• Inadequate antenatal care
• Maternal infections
• Short interpregnancy interval

Preventive Strategies

• Regular antenatal check-ups
• Maternal nutrition supplementation
• Iron and folic acid supplementation
• Treatment of maternal infections
• Avoiding harmful substances

Further Reading

• WHO Guidelines on LBW Care
• UpToDate: Small for Gestational Age Infant
• NIH: Low Birth Weight Information

Care of Low Birth Weight and ELBW Babies

1. What is the definition of low birth weight (LBW)?
   Birth weight less than 2500 grams
2. What is the definition of very low birth weight (VLBW)?
   Birth weight less than 1500 grams
3. What is the definition of extremely low birth weight (ELBW)?
   Birth weight less than 1000 grams
4. Which intervention has significantly reduced mortality in ELBW infants?
   Antenatal corticosteroid administration
5. What is the recommended initial temperature for the delivery room resuscitation of ELBW infants?
   23-25°C (73-77°F)
6. Which method is most effective in preventing heat loss in ELBW infants immediately after birth?
   Polyethylene occlusive wrap or bag
7. What is the recommended initial FiO2 for resuscitation of ELBW infants?
   21-30% (room air to low oxygen concentration)
8. Which respiratory support mode is preferred for initial stabilization of ELBW infants?
   Continuous positive airway pressure (CPAP)
9. What is the recommended initial CPAP pressure for ELBW infants?
   5-6 cm H2O
10. Which surfactant administration technique is associated with reduced need for mechanical ventilation in ELBW infants?
    LISA (Less Invasive Surfactant Administration) or MIST (Minimally Invasive Surfactant Therapy)
11. What is the recommended initial glucose infusion rate for ELBW infants?
    4-6 mg/kg/min
12. Which nutritional intervention has been shown to improve neurodevelopmental outcomes in ELBW infants?
    Early aggressive parenteral nutrition
13. What is the recommended daily protein intake for ELBW infants in the first week of life?
    3.5-4.0 g/kg/day
14. Which complication is most commonly associated with rapid advancement of enteral feeds in ELBW infants?
    Necrotizing enterocolitis (NEC)
15. What is the recommended daily enteral feeding advancement rate for ELBW infants?
    15-20 mL/kg/day
16. Which intervention has been shown to reduce the incidence of severe intraventricular hemorrhage in ELBW infants?
    Delayed cord clamping
17. What is the recommended hemoglobin threshold for red blood cell transfusion in ventilated ELBW infants in the first week of life?
    Hemoglobin <12 g/dL
18. Which medication is used for pharmacological closure of patent ductus arteriosus in ELBW infants?
    Indomethacin or ibuprofen
19. What is the recommended daily calcium intake for ELBW infants?
    120-140 mg/kg/day
20. Which screening test is recommended for early detection of retinopathy of prematurity in ELBW infants?
    Retinal examination at 31 weeks postmenstrual age or 4 weeks chronological age, whichever is later
21. What is the recommended daily vitamin D supplementation for ELBW infants?
    400-1000 IU/day
22. Which intervention has been shown to reduce the incidence of bronchopulmonary dysplasia in ELBW infants?
    Vitamin A supplementation
23. What is the recommended screening method for early detection of cerebral injury in ELBW infants?
    Serial cranial ultrasounds
24. Which antibiotic regimen is commonly used for empiric treatment of early-onset sepsis in ELBW infants?
    Ampicillin and gentamicin
25. What is the recommended initial dose of caffeine citrate for prevention of apnea of prematurity in ELBW infants?
    20 mg/kg loading dose followed by 5-10 mg/kg/day maintenance
26. Which intervention has been shown to reduce the risk of nosocomial infections in ELBW infants?
    Early initiation of enteral feeds with human milk
27. What is the recommended screening method for patent ductus arteriosus in ELBW infants?
    Echocardiography at 24-72 hours of life
28. Which complication is associated with rapid correction of hyponatremia in ELBW infants?
    Central pontine myelinolysis
29. What is the recommended daily iron supplementation for ELBW infants once full enteral feeds are established?
    2-4 mg/kg/day of elemental iron
30. Which intervention has been shown to improve neurodevelopmental outcomes in ELBW infants?
    Kangaroo mother care (skin-to-skin contact)

Additional Resources

• WHO: Low Birth Weight
• StatPearls: Low Birth Weight
• NICHD: Low Birth Weight
• UpToDate: Short-term complications of the premature infant
• AAP: Low Birth Weight

• NICHD: Treatments for Preterm Labor and Birth
• WHO: Guidelines on optimal feeding of low birth-weight infants in low- and middle-income countries
• UpToDate: Management of the extremely preterm infant
• Review: Nutrition of the Extremely Low Birth Weight Infant
• CDC: Guidelines for Disinfection and Sterilization in Healthcare Facilities