After completion of this session the participant should be able to:
14% of babies in Malawi are born with low birth weight; therefore all health care providers must be
familiar with the care of this group of infants.
A neonate who weighs less than 2500 g is a low birth weight baby. Nearly 75% of neonatal deaths
occur among low birth weight neonates. Even after recovering from neonatal complications, some LBW
babies remain more prone to malnutrition, recurrent infections and neurodevelopmental handicaps.
Infants with LBW may be small due to either prematurity or intra uterine growth retardation (IUGR).
IUGR results in a baby who is small for gestational age (SGA). It is helpful to try and decide if the baby is premature or SGA as the management is slightly different. SGA babies are symmetrically small. Remember of course they may be both premature and SGA. There are maturity charts or scoring systems that can help to decide the gestational age of a baby.
Very low birth weight infants- less than 1500 g at birth.
Extremely low birth weight – less than 1000 g at birth.
Often the gestational age of newborn infants is not clear and approximations have to be made. The most accurate way to do this is to use a maturity chart. Approximate gestational age can be estimated by adding the scores of the following features shown below (Parkin Score 2)
Approximate gestational age based on physical characteristics
|SKIN TEXTURE||Very thin||Thin and smooth||Smooth, medium thickness
Rash and superficial peeling
superficial cracking and peeling
especially of hands and feet
superficial or deep cracking
|SKIN COLOUR||Dark red||Uniformly pink||Pale pink||Pale, nowhere really pink except ear, lips, palms, soles|
|EAR FIRMNESS||Soft pinna
No springing back into position spontaneously
|Soft pinna along
Slow spontaneous return into position
|Thin Cartilage in pinna edge
Readily springs back into position
|Firm Pinna with definite cartilage|
|BREAST SIZE||No breast tissue palpable||Breast tissue palpable on one/ both sides neither being >0.5cm in diameter||Breast tissue palpable on both sides 0.5-1 cm in diameter||Breast tissue palpable on both sides >1cm in diameter|
The delivery of an expected LBW baby should be in hospital. Premature labour as well as intrauterine growth retardation is an indication for referral before the baby is born of the mother (in-utero transfer), to a better equipped facility.
The mother and the family under the supervision of a health care worker can manage an otherwise healthy LBW newborn with a birth weight of 1800 grams or above at home. Infants below this weight are at risk of hypothermia, feeding problems, apnoea, respiratory distress syndrome and necrotizing enterocolitis. The risks associated with keeping the child in hospital (e.g. hospital-acquired infections) should be balanced against the potential benefit of better care, such as reviewing the infants at least twice a day to assess feeding ability, fluid intake or the presence of any danger signs. The risk of hospital-acquired infection can be reduced by using Kangaroo Mother Care.
The indications for hospitalization of a LBW neonate include the following:
|Supplement||Route||Timing and duration|
|0.5mg in pre term neonates IM||Birth|
|0.3-0.6ml (5-10 drops)/ day (which usually provides vitamin A of 1000 iu/day and vitamin D 400 iu/day)||When taking full feeds until 6 months|
Start iron supplements at 2 weeks of age if tolerating full enteral feeds at a dosage of 2–4 mg/kg per day until 6 months of age.
Syrup usually contains 50mg iron in 5 mls or 10mg per ml so a 2 kg baby will get 0.5 mls
|2 weeks until 6 months|
Key facts for providers– discharge of the LBW/preterm infant
A well LBW baby can be discharged when:
Write in the health passport
Follow-up schedule (at home or as close to home as possible)
Scheduled visits for assessing growth and monitoring for illness. These visits should be at weekly intervals till the infant reaches 2.5kg weight.
Vaccinations in LBW/ preterm babies
If the LBW baby is not sick, the vaccinations schedule is the same as for term
Counselling for care of LBW at home.
Counsel on exclusive breast feeding, keeping baby warm and to seek health care early if they identify any of the danger signs in-between postnatal care visits. Ask the parent to repeat the danger signs so that you know they have remembered them. Discuss about her own nutrition and health.