At the end of the session, the students shall be able to What are the various measurements in assessing the growth and maturity of the baby Describe the purpose of neonatal screening Identify at-risk infant Define low birth weight. Enumerate the causes of LBW and discuss the prevention and treatment of LBW babies.

1. Preventive Medicine in
Obstetrics, Paediatrics and
Geriatrics
Dr. Jayaramachandran S
Associate Professor
Department of Community Medicine

2. At the end of this session, you will be able to
ü What are the various measurements in assessing the growth and
maturity of the baby
ü Describe the purpose of neonatal screening
ü Identify at-risk infant
ü Define low birth weight. Enumerate the causes of LBW and
discuss the prevention and treatment of LBW babies.

3. Anthropometric measurements
• Weight – kg
• Length – Total height, sitting height, heel knee-length
• Perimeters – head, chest, abdomen , arm , calf
• Diameters – biacromial, bicristal, biepiconeylar, bistyloid, bicondylar
• Skinfold thickness – triceps, biceps, superiliac, subscapular.

4. Neonatal Screening
• Primarily to detect infants with treatable genetic, developmental and
other abnormalities
• Secondarily to provide their parents with genetic counselling.
• The Apgar score & routine clinical examinations are simple screening
tests which should be carried out on all newborn infants.
• Common – PKU, Neonatal hypothyroidism, Sickle cell or other
haemogobinopathies, Congenital dislocation of hip

5. Identify the "at-risk" infants
A. Working mother / one parent
B. Twins
C. Birth weight less than 2.5 kg
D. All the above

6. Identification of "at-risk" infants
• Birth weight less than 2.5 kg
• Twins
• Birth order 5 and more
• Artificial feeding
• Weight below 70 % of the expected weight
• Failure to gain weight during three successive months;
• Children with PEM / diarrhoea
• Working mother / one parent

7. Identify the Low Birth Weight baby
A. < 2800 g
B. < 3 kg
C. < 2 kg
D. < 2.5 kg

8. Low Birth weight
• < 2500 g
a) Those born prematurely (short gestation)
b) Those with foetal growth retardation
• Preterm : Babies born before the end of 37 weeks gestation
• Term : Babies born from 37 to < 42 completed weeks of gestation.
• Post-term : Babies born at or after 42 completed weeks of gestation.

9. Preterm
• Preterm is defined as babies born alive before 37 weeks of pregnancy
are completed.
There are sub-categories of preterm birth, based on gestational age :
• Extremely preterm (<28 weeks)
• Very preterm (28 to <32 weeks)
• Moderate to late preterm (32 to 37 weeks)

10. Difference between Small For Date & Preterm Infants
Characteristic Small for gestational age infant Preterm infant
Gestational age 24-44weeks Younger than 37 weeks
Birth weight Under 10th percentile Normal for age
Congenital malformations Strong possibility Possibility
Pulmonary problems
Meconium aspiration, pulmonary
hemorrhage, pneumothorax
Respiratory distress syndrome
Hyperbilirubinemia Possibility Very strong possibility
Hypoglycemia Very strong possibility Possibility
Intra cranial hemorrhage Strong possibility Possibility
Apnea episodes Possibility Very strong possibility
Feeding problems
Most likely due to accompanying problems
like hypoglycemia
Small stomach capacity, immature sucking
reflex
Weight gain in nursery Rapid Slow
Future restricted growth
Possibly always under 10th percentile due
to poor organ development
Not likely to be restricted in growth as
“catch up” growth occurs

11. Preterm Babies: Causes
• Multiple birth
• Acute infection
• Hard physical work
• Hypertensive disorders of pregnancy

12. Small for date (SFD) babies
• Born at term or preterm
• Weight less than 10th percentile for the gestational age
• Result of IUGR

13. Small for date (SFD) babies – Causes
Maternal factors:
• Short maternal stature
• High parity
• Smoking
• Very young age
• Close birth intervals
• Hard physical labour during
pregnancy
Fetal factors:
• Multiple pregnancy
• Congenital anomalies
Placental factors:
• Placenta previa
• Placental Insufficiency
• Abruptio placenta

14. Risk factors for LBW
• Malnutrition
• Infection
• Unregulated fertility (due to poor socio economic and environmental
conditions)

15. Importance of LBW
• Higher incidence
• Mental retardation
• Perinatal and infant mortality and morbidity (Atelectasis, pneumonia,
pulmonary haemorrhage)
• Human wastage and sufferings
• High cost of special care and intensive care units

16. Treatment
• Those < 2 kg: Intensive care therapy till weight reaches above 2kg
• Between 2-2.5: Intensive care therapy for 1 to 2 day.
Intensive care
• Incubatory care – temperature, humidity and oxygen supply
• Feeding – nasal catheter
• Prevention of infection

17. Kangaroo mother care (KMC)
• It is the care provided by the recently delivered mother to her LBW
newborn baby.
4 essential components:
• Akin to skin positioning of a baby on the mother’s chest
• Adequate nutrition through breast feeding
• Ambulatory care as a result earlier discharge from hospital
• Support mother and her family in caring for the baby

18. Prevention
Prevention of LBW through good prenatal care and
intervention programs should be practiced rather than
‘treatment’

19. Direct Intervention Measures
• Identify pregnant women at risk
• Mother’s health card
• Increased food intake
• Controlling maternal infections (malaria, UTI , CMV, Rubella)
• Early detection and treatment of medical disorders like hypertension,
toxemia, diabetes

20. Indirect intervention
• Family planning
• Avoidance of smoking
• Improved health and nutrition of young girls
• Improvement of socio-economic and environmental conditions
• Health and social services in underserved areas
• Maternity leave with full wages and child benefits

21. Leading causes of death in LBW babies
• Atelectasis
• Malformation
• Pulmonary haemorrhage
• Intracranial bleeding secondary to anoxia or birth trauma
• Pneumonia and other infections.

22. Any Questions?