Prematurity and low birth weight can result from babies being born prematurely before 37 weeks or being small-for-gestational-age. Complications of prematurity include respiratory issues, temperature instability, hypoglycemia, jaundice, brain hemorrhages, and infections. Small babies may be growth-restricted due to conditions that interfere with placental function such as maternal hypertension, malnutrition, or infections. Both preterm and growth-restricted infants are at risk of feeding difficulties, apnea, hypothermia, and long-term developmental delays.

1. LBW / PREMATURITY
Semester 6
Pediatrics and child health

2. Definitions
• Premature: live newborn delivered before
37 weeks from the 1st day of last
menstrual period.
• LBW: Low birth weight for a given
gestation indicating failure of growth in
utero.
• Low birth weight: <2500grams
• VLBW: <1500grams
• ELBW: <1000grams

3. Causes of LBW
Premature (Preterm) birth:
Babies born before 37 completed weeks of
pregnancy .
IUGR
Full-term but are underweight

4. Causes of preterm birth
• Fetal
• Fetal distress
• Multiple gestation
• Erythroblastosis
• Non immune hydrops
• Placental
• Placental dysfunction
• Placenta previa
• Abruptio placenta
• Uterine
• Biconuate
• Incompetaent cervix

5. Causes of preterm birth
• Maternal
• Pre ecclamsia
• Chronic medical illness (renal dx,cyanotic heart dx,
Asymptomatic infections-UTI,GBS,Listeria
monocytogen,bacterial vaginosis,chorioamnionitis)
• Drug abuse (cocaine)
• Other
• PROM
• Polyhydramnious
• Iatrogenic
• Trauma

6. Clinical features
• Immaturity of external appearance –breast
nipple development, planter crease
• Immaturity of neurological development-
muscle tone

7. Care of preterm babies
• Thermoregulation
• Monitoring vital signs and oxygen
saturation
• Fluid and electrolyte therapy and
monitoring
• Nutritional support( caloric requirement
120kcal/kg/day, expected wt gain 10-
30g/day)
• Manage complications

8. Assessment of gestation age
• Accurate recall of LNMP is the best indicator of GA
• Neurological maturity in the absence of asphyxia
correlates well with the GA despite reduced fetal weight.
• Physical signs can be useful in estimating GA at birth.
• Ballard score commonly used is accurate to ± 2wks
• Ballad score has two components eg physical
characteristic and neurological maturity scores in the to
groups are added and correlated with maturity rating to
get GA
• Colorado intrauterine score (Height and weight)
• Parkins method (external appearance)
• Dubowitz ( external and neurological)

9. Complications
1.Respiratory problems; (RDS)
• Immaturity of higher centers
• Hypoxia and maternal sedation
• Inadequate surfactant
• Maternal infections-( pneumonia)

10. Complications
2.Temperature instability:
• Inadequate stores of glycogen and fats- poor
temp regulation.
• Large surface area
• Poor muscle tone
• Inability to shiver
Cold predisposes to: hypoxia, metabolic acidosis,
hypoglycemia, hypotension, decreased
surfactant production and increased FFA
predisposing to bilirubin encephalopathy.

11. Complications
3. Hypoglycemia
• Inadequate glycogen storage
• Poor fat storage
It promotes hypothermia
4. Hepatic immaturity
Neonatal jaundice (Hyperbilirubinemia)- increased red blood cell
turnover and destruction, an immature liver that has physiologically
impaired conjugation and elimination of bilirubin.
In addition, most preterm infants have reduced bowel motility due to
inadequate oral intake, which delays elimination of bilirubin-
containing meconium, coupled with increased enterohepatic
circulation of conjugated bilirubin that enters the intestinal tract.
Bleeding tendencies (Vit K dependent coagulation factors II,VII,IX,X
deficiency.

12. Complications
5.Edema
6.Feeding difficulties
7.Intraventricular hemorrhage
• Grade I - Germinal matrix hemorrhage
• Grade II - IVH without ventricular dilatation
• Grade III - IVH with ventricular dilatation
• Grade IV - IVH with extension into the parenchyma
Delicate rich unsupported capillaries
8. Ischemic brain damage
• Severe Hypoxia
• Hypotension
• Poor cerebral perfusion
PVL-cysts in PV area on USS ( no and size reflects degree and
extent of injury

13. Complications
9.Immaturity of immune system
10.polycythemia
11.Renal immaturity
Low GFR and tubular function- inability to excrete water and solute load
12. Gastrointestinal problems such as necrotizing enterocolitis
13.Retinopathy and associated visual loss or blindness .Occurs mainly in
babies born before 32 weeks.
14.Bronchopulmonary dysplasia (BPD)
15.Heart disease (PDA)

14. Small-for-date babies …
small-for-gestational age or growth-restricted
– These babies may be full-term but are underweight.
– Some of these babies are healthy, even though they
are small.
– They may be small simply because their parents are
smaller than average.
– Others have low birth weight because something
slowed or halted their growth in the uterus.

15. Risk factors for IUGR
• Low socioeconomic status
• maternal under nutrition,
• anemia,
• illness,
• inadequate prenatal care
• Drug misuse
• Obstetrics complications
• Maternal hx of reproductive inefficiency (abortions, stillbirth,
premature or lbw
• 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.

16. Who is affected by low birthweight?
• Race - African-American babies are two times more
likely to have low birthweight than Caucasian babies.
• Age - Teen mothers (especially those younger than 15
years old) have a much higher risk of having a baby with
low birthweight.

17. IUGR
• poor intrauterine growth-LBW
• Is associated with medical conditions that interfere with
the circulation and efficiency of placental causing fetal
nutrition or oxygen deprivation
• Is associated with decreased insulin production insulin
action at a receptor level
• Symmetrical IUGR – early onset, associated with
diseases that seriously affect cell number (chromosomal,
genetic, malformations, teratogenic, infections, maternal
hypertensive etiologies.
• Asymmetrical IUGR (sparing head growth) is associated
with poor maternal nutrition or late onset/late
exacerbation of maternal vascular disease

18. Clinical features-IUGR
• Bwt <10th centile for the GA
• Features of causative condition (genetic,
infection, alcohol)
• Loss of subcutaneous fat and vernix
caseosa
• Thick desquamating skin
• Increased muscle tone
• Dirty green appearance of cord due to
meconium

19. Common problems in Preterm and Underweight for Gestational Age Infants
Preterm UGA
Birth asphyxia + ++
Meconium aspiration - ++
Polycythaemia - ++
Hypothermia ++ +
Hypoglycaemia ++ ++
Hyaline membrane disease ++ -
Apnoea ++ -
Poor feeding ++ -
Patent ductus arteriosus ++ -
Birth trauma + -
Periventricular haemorrhage ++ -
Jaundice ++ +
Infection ++ -
Congenital abnormalities + ++
Retarded postnatal growth + ++
Retarded postnatal
development
+ ++