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Internal Medicine

Low-birthweight (LBW) babies

Low birth weight (LBW; birth weight less than 2500 g)


Aetiology

  • Preterm birth (< 37 completed weeks of gestation)
  • Intrauterine growth restriction (IUGR) 

Complications

Preterm babies

  • Hypothermia
  • Perinatal asphyxia
  • Respiratory:
    • Hyaline membrane disease, pulmonary hemorrhagepneumothorax, bronchopulmonary dysplasia, pneumonia
  • Bacterial sepsis
  • Apnea of prematurity
  • Metabolic:
    • Hypoglycemia, hypocalcemia
  • Hematologic:
    • Anemia, hyperbilirubinemia
  • Feeding problems and poor weight gain

Babies with IUGR

  • Perinatal asphyxia
  • Meconium aspiration
  • Hypothermia
  • Hypoglycemia
  • Feed intolerance
  • Polycythemia
  • Poor weight gain

Management

Prolonged Hospital Stay

  • Screening tests
  • Nutrition supplements
  • Immunization
    • With BCG, Hep B and OPV
  • Monitor:
    • Anthropometric indicators:
      • Weight gain
      • Weight, length and head circumference
    • Feeding
    • “Danger signs”
      • Difficulty in feeding
      • Lethargy
      • Temperature < 35.5°C or ≥ 37.5°C
      • Tachypnoea (> 60bpm)
      • Severe chest indrawing
      • Convulsions
  • Temperature regulation
  • Follow-up (within 3-7 days)

Feeding

feeding
Initial mode of feeding
Progression of oral feeding in preterm LBW infants
Progression of oral feeding in preterm LBW infants. Term and near-term sick infants started on intravenous (IV) fluids can be initiated on breastfeeding once they are hemodynamically stable

Nutrition supplementation

Nutrients:

  • LBW babies (1500-2499g)
    • Do not require multinutrient supplementation
    • Vitamin D and iron should still be supplemented
  • VLBW babies (<1500g)
    • For infants on EBM:
      • Calcium (140-160 mg/kg/day)
      • Phosphorus (70-80 mg/kg/day)
    • Multivitamin drops:
      • Vitamin D (400 IU / day)
      • Vitamin B complex
      • Zinc (about 0.5 mg/day)
    • Folate (about 50 μg/kg/day)
    • Iron (2 mg/kg/day)

Methods:

  • Supplementing individual nutrients
  • Fortification of expressed breast milk with human milk fortifiers (HMF)

Growth monitoring

Growth chart

  • Preterm VLBW infants:
    • Wright’s and Ehrenkranz’ charts
  • Once the preterm LBW infants reach term gestation (40 weeks):
    • WHO growth charts 

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