newborns are those born weighing less than
2,500 grams, either because they are
premature (less than 37 weeks' gestational
age) or growth retarded (birth weight less
than the 10th percentile for gestational age).
Nearly 70 percent of all infant
mortality is associated with low birth weight.
Some minority women, especially African
American women, have substantially higher
rates of low-birth weight babies than white
Primary cause of low birth weight
Premature birth (being born before 37 weeks
Being born early means a baby has less time
in the mother's uterus to grow and gain
weight. Much of a baby's weight is gained
during the latter part of pregnancy.
Intrauterine growth restriction (IUGR).
Maternal malnutrition and anaemia
Too frequent child birth
Low maternal weight gain
Factors that can also contribute
to the risk of very low birth
Race - African-American babies are two times
more likely to have low birth weight than
Age - Teen mothers (especially those younger
than 15 years old) have a much higher risk of
having a baby with low birth weight.
Multiple birth - Multiple birth babies are at
increased risk of low birth weight because they
often are premature. Over half of twins and
other multiples have low birth weight.
Mother's health - Babies of mothers who are
exposed to illicit drugs, alcohol, and cigarettes
are more likely to have low birth weight. Mothers
of lower socioeconomic status are also more
Babies with low birth weight look much
smaller than other babies of normal birth
A low birth weight baby's head may appear to
be bigger than the rest of the body
General activity of the baby is poor
Eyes remains closed and protruded
Ears are soft
Skin is thin and shiny
Nipples and areola are flat
Nails are short and not grown up to the finger
Alteration of respiratory function :- respiration
is rapid, shallow, irregular with apnoea and
Immaturity of nervous system :- babies are
inactive, lethargic, and have poor cough reflex.
Disturbances of circulatory function :- closure of
ductus arteriosus may be delayed. Intracranial
hemorrhage may occur. Hypofunction of bone
marrow may cause hemorrhagic problems.
Impaired thermo regulation :- hypothermia due
to poorly developed heat regulating centre.
gastrointestinal and hepatic
functions :- capacity of the stomach is poor.
Abdominal distension and functional intestinal
obstruction are found due to hypotonia.
Hypoglycemia is common.
Metabolic disturbances :- they are prone to
hypoxia,acidosis and hypoproteinemia.
Impaired renal function :- they may be
dehydrated due to inability to conserve water.
Urination may be delayed.
Drugs toxicity :- reduced renal clearance lead to
toxic effects of drugs.
The height of the fundus
Height can be measured
from the pubic bone. This measurement in
centimeters usually corresponds with the
number of weeks of pregnancy after the 20th
week. If the measurement is low for the
number of weeks, the baby may be smaller
It is a more accurate method
of estimating fetal size. Measurements can
be taken of the fetus' head and abdomen and
compared with a growth chart to estimate
Specific management for low
birth weight will be determined by your
baby's physician based on:
i. Baby's gestational age, overall health, and
I. Baby's tolerance for specific medications,
procedures, or therapies
II. Opinion or preference
1) AT BIRTH
and prevention of hypothermia are important
aspect of care at birth. Delayed cord
clamping may improve the iron stores.
Warmth should be maintained by heat
source. Vitamin k 0.5mg should be
2) CARE AT NICU
NICU should be warm,
free from excessive sound, and have soothing
light. Aseptic measures and hand washing
should be there. Rough handling and painful
procedures should be avoided.
3) MAINTANANCE OF BREATHING
Baby should be positioned with neck slightly
extended and air passage to be cleared by
gentle suctioning to remove the secretion.
Oxygen therapy is administered whenever
necessary. Respiration rate, rhythm, signs of
distress, chest retraction, apnea, cyanosis,
oxygen saturation, etc… to be monitored at
4) MAINTANANCE OF STABLE BODY
Baby should be received
in a pre warmed radiant warmer or incubator.
Environmental temperature should be
maintained according to the baby’s weight
and age. Kangaroo mother care can be
provided. All measures to be taken to
prevent heat loss.
KANGAROO MOTHER CARE
Kangaroo care is a technique
practiced on newborn, usually preterm,
infants wherein the infant is held, skin-toskin, with an adult. . Kangaroo care was
initially developed to care for preterm infants
in areas where incubators are either
unavailable or unreliable.
The kangaroo position provides
ready access to nourishment. The parent's
stable body temperature helps to regulate
the neonate's temperature more smoothly
than an incubator, and allows for readily
It has proven successful in
improving survival rates of premature and
low birth weight newborns and in lowering
the risks of nosocromial infection, severe
illness, and lower respiratory tract disease. It
also increased exclusive breast feeding and
for a longer duration and improved maternal
satisfaction and confidence.
Typically in kangaroo care, the
baby wears only a diaper and is tied in a headup position to the mother’s bare chest with a
strip of cloth in a manner that extends the
baby’s head and neck to prevent apnea.
The mother wears a shirt or hospital gown with
opening to the front. The cloth wraps around
and under the baby’s bottom to create
The tight bundling is enough for the mother’s
breathing and chest movement to stimulate
the baby’s breathing.
Because of the close confines
of being attached to its mother’s chest, the
baby is enclosed in a high carbon dioxide
environment which also stimulates breathing.
Fathers can also use the skin-to-skin contact
5) MAINTANANCE OF NUTRITION AND
After first 1-2 weeks of life most
preterm babies require 120-150 Kcal/kg/day
to maintain satisfactory growth. Feeding
should be initiated early. Expressed milk can
Nasogastric tube feeding can
be given with expressed breast milk to all
babies with poor sucking reflex. IV dextrose
solution can be given to babies weighing less
than 1200 gm or sick babies.
6) PREVENTION OF INFECTION
are to be prevented. Thorough hand washing,
separate baby articles, wearing of shoes and
sterile gown and mask by care giver,
restriction of visitors can be done. Infected
babies should be kept separate. Antiseptic
cleaning of all instruments are necessary.
7) PREVENTION, EARLY DETECTION, AND
PROMPT MANAGEMENT OF
Baby should be observed for respiration,
skin colour, activity, passage of stool and
urine, etc… weight should be recorded.
Position should be changed every 2 hourly.
Baby should placed on right side after feeding
to prevent regurgitation and aspiration.
8) FAMILY SOPPORT, DISCHARGE PLANNING,
FOLLOW UP AND HOME CARE.
Baby’s condition and progress should be
explained to the parents to reduce their
anxiety. Parents should be informed about
home care, need of warmth, cleanliness,
infection prevention, immunization etc…a
community health nurse should visit the
family every week for a month and provide
necessary guidance and support.
It is a key factor in preventing
preterm births and low birth weight babies.
At prenatal visits, the health of both mother
and fetus can be checked. Because maternal
nutrition and weight gain are linked with fetal
weight gain and birth weight, eating a
healthy diet and gaining the proper amount
of weight in pregnancy are essential.
Mothers should also avoid alcohol,
cigarettes, and illicit drugs, which can
contribute to poor fetal growth, among other
Prenatal multivitamin supplements are
associated with a significantly reduced risk of
babies with a low birth weight compared with
prenatal iron-folic acid supplementation.