Transcript Low birth weight

Low birth weight
Definition:
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Low birth weight has been defined by the
WHO as weight at birth of less than 2,500
grams (5.5 pounds).
This is based on epidemiological
observations that infants weighing less than
2,500 g are approximately 20 times more
likely to die than heavier babies.
Definitions:
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Very LBW is less than 1,500 g .
Extremely LBW is less than 1,000 g .
The incidence of LBW:
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is defined as the percentage of live births
that weigh less than 2,500 g out of the total
of live births during the same time period.
incidence rate therefore is=
Overview:
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More common in developing than developed
countries.
The goal of reducing LBW incidence by at least
one third between 2000 and 2010 is one of the
major goals in ‘A World Fit for Children’,.
Forms an important contribution to the Millennium
Development Goal (MDG) for reducing child
mortality.
Overview:
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More than 20 million infants worldwide,
representing 15.5% of all births, are born
LBW, 95.6 % in developing countries.
LBW is closely associated with: foetal and
neonatal mortality and morbidity, inhibited
growth and cognitive development, and
chronic diseases later in life.
Risk factors for LBW:
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Mother's Malnutrition
Heavy work load
High blood pressure
Infection and diseases
Unregulated fertility.
Causes and consequences of LBW
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) Preterm babies:
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There are babies born too early before 37
weeks of gestation, their intrauterine growth
may be normal, that is their, weigh, length and
development may be within normal tomtits for
the duration of gestation.
Given good neonatal care, these babies can
catch up growth and by 2 to 3 years of age will
be of normal size and performance.
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Approximately 2 thirds of all babies of LBW
in developed countries are estimated to be
preterm the causation of preterm babies is
multifactoral. There include multiple births,
hard physical works hypertensive disorders
of pregnancy. But it is often preventable by
such measures as good prenatal screening
and care.
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Small for dates (SFD):
These babies are result of intrauterine fetal
growth.
The factors associated with intra uterine
growth retardation are multiple and
interrelated to mother, placenta or to
foetus.
Factors affecting birth weight:
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The maternal factors:
Include malnutrition.
Anaemia.
Heavy physical work-during pregnancy.
Hypertension.
Malaria.
Toxaemia.
Smoking.
The maternal factors:
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Low economic status.
Short maternal stature.
Young age.
High parity.
Dose birth spacing.
Low education status.
Factors related to placenta:
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Placental insufficiency.
Placental abnormalities.
The foetal causes:
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Foetal abnormality.
Intra uterine infections.
Chromosomal abnormalities.
Multiple gestation.
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SFD babies has a high risk of dying not
only during the neonatal period but during
their infancy, thus significantly raising the
rate of infant and prenatal mortality.
Most of them become victims of protein
energy mal nutrition and infection.
Importance:
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LBW is one of the most serious challenges
in maternal and child health indevelped and
developing countries.
Its public health significance may be
ascribed, to numerous factors:
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Its high incidence.
Its association with mental retardation.
A high risk of prenatal and infant mortality
and morbidity.
Its public health significance may be
ascribed, to numerous factors:
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LBW is the single most important factor
determining the survival chances of the
child (the infant mortality rate is about 20
times greater for all breast fed babies.
.
Its public health significance may be
ascribed, to numerous factors:
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Many of them become victims of protein –
energy – malnutrition and infection.
There is a strong and significant positive
status and the length of pregnancy and
birth weight
Prevention:
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The rates of LBW could not be reduced to
more than 10 percent in all parts of the
world. There is no universal solution,
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interventions have to be case specific.
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In recent years good attention has been
given to ways and means of preventing
LBW through good prenatal care and
interventions programmes rather than
treatment of low birth weigh babies born
later.
Direct intervention measures: (mothers )
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Increasing food intake
Controlling infection
Early detection and treatment of medical
disorders
Prevention:
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Indirect intervention:
Family planning
Improved sanitation
Improving health and nutrition of young
girls
Improvement of socio-economic
conditions
Government support (maternity leave)
Treatment:
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From the point of view of treatment. LBW
babies can be divided into 2 groups.
Those under 2 kg.
Those between 2 – 2.5 kg.
The first group require first class modern
neonatal care which is hardly available
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globally in an intensive care unit their
weight reaches the weight of the second
group.
The second group may need an intensive
care unit for a day or two.
The intensive care comprises of:
 Incubatory care, that adjust temp, humility
oxegen supply (low levels of oxygen in the
blood steam can produce cerebral palsy. If
it is excessive leads to retrolenta fit
roplasia).
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Feeding: Nasal catheter.
Prevention of infection: Infection can cause
death in the first few hours (respiratory
infection so prevention of infection is there
fore one of the most important functions of
an intensive care unit.
The leading causes of death in low
birth
weight babies:
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Atelectasia.
Malformation.
Pulmonary haemorrhage.
Intracranial bleeding.
Pneumonia and other infections.
The development of perinatal intensive
care units has been associated with a
decline in neonatal mortality.
Feeding of infants:
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Breast feeding:
Ideal
Protect from infection and malnutrition
Reduces infant mortality
Advantages:
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Safe, clean ,cheap, and available in correct temp.
Meets nutritional requirement of infant in first
months of life
Antimicrobial factors
Easily digested ,has biochemical advantages.
Promotes bonding
Protects against obesity
Sucking is good for development of jaws & teeth
Prevents malnutrition
Child spacing
Artificial feeding:
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Dried milk,cow`s milk
Indications:
Failure of breast milk
Prolonged illness
Death of mother
Comparison between breast milk and
cow's milk
constituent
Breast milk
Cow's milk
proteins
↓
↑
fats
=
=
carbohydrates
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Minerals
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↑
vitamins
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↓
Weaning:
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Gradual process starts around 4-5 months
Supplementary foods
If not done properly ,diarrhoea and growth
failure
Solid foods introduced at age of one year
Nutrition education
Promoting home-made weaning foods.
Thank you
Nutritional
surveillance
Nutritional surveillance
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first came into prominence at the World
Food Conference in 1974, since then the
concept has evolved and has been applied
in many developing countries.
Nutritional surveillance is defined as “to
watch over nutrition in order to make
decisions that lead to the improvement in
nutrition in populations”
Another Definition:
The continuous collection and analysis of
nutritional status data in order to give warning of
impending crisis or to make policy and
programmatic decisions that will lead to
improvement in the nutrition situation of the
population
 Objectives:
1- to aid long-term planning.
2- to provide input for management and evaluation.
3- to give timely warning and interventions.
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Growth Monitoring
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The practice of following a child’s physical
development, by regular measurement of certain
indicators (usually weight and sometimes length)
in order to maintain good health by detecting
growth faltering and intervening in a timely
manner
Nutrition Status – Is the balance between
nutrient intake and nutrient requirements and/or
the degree to which an individual’s physiological
needs for nutrients are being met from the food
they eat.
Growth monitoring & surveillance
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Preservation of normal
growth
Educational –
motivational
All infants
Starts before 6 month.
Small groups.
No trained worker
Simple card
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Detection of
malnutrition
Diagnosticinterventional
Sample
Representative ages
Any size.
Trained worker
Precise.
Growth monitoring & surveillance
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Maintaining good
nutrition
Early home
interventions.
Brief response time
PHC interventions.
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Detect malnutrition.
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Referral to health
system for check up
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Nutritional
rehabilitation
Long response time.
Community –wide
food supplements.
Referral to
rehabilitation centers.
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INDICATORS
Nutritional Status Indicators
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Socio-economic indicators
Quality of housing
Water supply
Sanitation
Diseases and Epidemics
Mortality
Literacy levels
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Food security indicators
Ecological zone
 Farm size
 Use of extension services
 Food prices
 Population response to food shortages
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Nutritional status indicators:
Phenomenon
 maternal nutrition
 Infant and preschool
 Child nutrition
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School child nutrition
Indicator
 birth weight
 % of breastfed babies.
 Mortality rates.
 Height for age
 Weight for height.
 Height for age
 Weight for height at school
admission
 Clinical signs.
Assessment of nutritional status;
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Clinical examination.
Anthropometry.
Biochemical evaluation.
Functional assessment.
Assessment of dietary intake.
Vital and health statistics.
Ecological studies.
Assessment of nutritional status;
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Clinical examination.
Anthropometry.
Biochemical evaluation.
Functional assessment.
Assessment of dietary intake.
Vital and health statistics.
Ecological studies.
1- Clinical examination:
WHO classification of clinical signs:
1- not related to nutrition e.g alopecia
2- that need further investigation e.g corneal
vascularisation.
3- known to be of value e.g angular stomatitis
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Drawbacks of clinical signs
1- malnutrition cannot be quantified.
2- many deficiencies lack clinical signs.
3- lack of specificity.
2- anthropometry
1- height
2- weight.
3- skinfold thickness.
4- arm circumference
Additional in children
5- head circumference
6- Chest circumference.
3- laboratory and biochemical
assessment:
Lab.
Hb%,stools and urine
 Biochemical applied to measure:
1- nutrient concentration e.g serum iron.
2- metabolites in urine e.g urinary iodine.
3- enzymes e.g ribofavin deficiency.
Disadvantages:
Time-consuming, expensive ,cannot be applied on
large scale ,and reveal only current status.
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4- Functional indicators
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Structural integrity.
Host defense.
Homeostasis.
Reproduction.
Nerve function
Work capacity.
5- Assessment of dietary intake
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Weighment of raw foods
Weighment of cooked foods.
Oral questionnaire method.
6- Vital statistics
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Morbidity data
Mortality data
7- Assessment of ecological factors
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food balance sheet.
Socioeconomic factors.
Health and educational services.
Conditioning influences.