MODULE 4: LOW BIRTH WEIGHT BABY

Scenario 2

GROUP 10

Scenario 2
A girl baby, 3 days old, referred from
midwife to hospital with face and
body looked yellow. From
alloanamnesis the baby was born 3
days ago by midwife with birth eight
1500 gr and gestational age 8
months when she was born. Her
mother smokes tobacco regularly.

Keywords
A girl baby, 3 days old
Jaundice
Birth weight 1500 gr
Gestional age 8 months
Mother smokes tobacco regularly

Clarification of words

Low birth weight babies:

an infant whose birth weight is less than
2500g regardless of gestational age.
Premature (preterm) babies:
an infant born before completion of 37th
week of gestation regardless of birth weight.

Questions
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.

What is the normal physiology of fetal development?

What are the causes of low birth weight baby?
What are the causes of premature baby?
What is the epidemiology of low birth weight baby?
What is the classification of gestational age?
Does the baby weight suits her gestational age?
What are the pathophysiology of jaundice?
What are the relationship between jaundice and low birth
weight baby?
What are the classification of jaundice?
What are the contents of cigarette that affect the fetal
development?
What are the relationship between smoking and low birth
weight baby?

Epidemiology Low Birth Weigth Baby

At least 17 million infants are born every
year with LBW, representing about 16% of
all newborns in developing countries.

Nearly 80% of all affected newborns with

LBW at termare born in Asia.

Factors of low birth weight infants

Genetics
Infants with a black mother
and father have the lowest
mean birth weights
infants born to two white
parents have the highest
weights.
Newborns with mixed-race
parents have intermediate
birth weight distributions
Age
- mothers under the age of
18 or over the age of 35

Nutrition

Non adequate supply of nutrients

Prenatal Care

higher for women who do not receive

prenatal care

Smoking

Smokers inhale nicotine and carbon

monoxide

which reach the baby through the

placenta

prevent the fetus from getting nutrients

and oxygen needed to grow

Causes for Premature Birth

Multiples pregnancy
Previous premature
birth
Short period between
pregnancies
Pre-eclampsia
HELLP Syndrome
Smoking
Uterine or cervical
abnormalities
Recurring infections

Chronic illnesses
Abortion
Mothers age
PPROM Preterm Premature Rupture of
Membranes
Placental risks & causes Placenta
Previa and Placental Abruption

Risks from smoking during pregnancy

Effects on
mother

Effects on babies

Difficulty getting pregnant

Baby born to small

Placenta separates from the womb too

early, causing bleeding

Baby born too early

Sudden infant death syndrome

Fetal death

Infant death

Certain birth defects,such as:

Placenta covers the cervix, causing

complications

Water breaks too early

Miscarriage

Cleft lip/palate
Clubfoot
Gastroschisis
Some heart defects

Crypyorchidism

Battaglia and Lubchenco Grafic

Clasification of Gestasional Age

Pure Prematurity : Gestasional Age Less than

37 weeks with appropriate weight
Small For Date : The weight is less than the
Gestasional Age
Large For Date : The Weight of the baby more
than the should gestasional age
Apropriate For Date : The Weight and the
Gestasional Age is Apropriate

Jaundice in Infant
Infant

jaundice is a yellow
discoloration in a newborn babies
skin and eyes
Common cause : immature liver of
the babies to get rid of bilirubin in
bloodstream

Classifications of jaundice in infants

Physiological
jaundice:

occurring in most
newborns
due to immaturity of
the baby's liver
slow processing of
bilirubin
2 to 4 days of age
disappears by 1 to 2
weeks of age

Pathological jaundice:

Criterias :

Jaundice appear <24

hours or >14 days of
life
Increases in the level of
total bilirubin by more
than 8.5umol/l
(0.5mg/dL) per hour or
(85umol/l) 5mg/dL per
24 hours
Total bilirubin more
than 331.5umol/l
(19.5mg/dL)
Direct bilirubin more
than 34umol/l
(2.0mg/dL)

Breastfeeding
jaundice:
not enough breast milk
- difficulty with
breastfeeding

Breast milk jaundice:

in 1% to 2%
ofbreastfedbabies
caused by substances
produced in the
mother's breast milk
that cause
hyperbilirubinemia
starts after the first 3
to 5 days
slowly improves over
3 to 12 weeks.

PHYSIOLOGY OF BILIRUBIN METABOLISM

PATHOPHYSIOLOGY OF JAUNDICE
1. During stage 1 ( production of bilirubinI)
i)preterm babies
ii)infection
iii)blood incompatibility
2. During stage 2 (transport of bilirubin I)
i) hypoalbuminemia
3. During stage 3 (conjugation of bilirubin I)
i) hypoglikemia

JAUNDICE IN PRETERM BABIES

IU : immature liver & RBC system

Postnatal : slow development of liver & RBC
system
Lifespan RBC preterm babies (50-60 days)

bilirubin load in liver

enterohepatic circulation of bilirubin

Long, persistent jaundice in preterm babies

Tobacco and LBWB

The smoke from a cigarette contains more than
4000 chemicals
Have various toxic, mutagenic and carcinogenic
effects
Major content:
1. Nicotine= decrease arteries size>>hypoxia
2. Carbon monoxide = bind with hemoglobn
>>oxyhemoglobin reduces>> hypoxia
3. Tar = carcinogenic >> compete for nutrition >>
hypoxia

Low birth weight baby

What induced preterm labour?
-Hypoxia
-Placenta previa
-Ketuban pecah dini

Smokes tobacco
Hypoxia
Placenta previa
Ketuban pecah dini
Preterm labour

Nicotine

Low birth
weight

Release of
catelcolamine

Decrease
fetal
development

Vasoconstricti
on

Less nutrition
and blood
supply

Produce
protease
Inflammator
y mediator
release
Collagen
degradatio
n
Irritant
from
cigarret
e
ruptured
membra
ne

Initiate
cervical
change

Hypoxia

Increase
placenta
area ( find
the area
with high
oxygen)

Close cervix
surface
(high
oxygen
area)

Preterm
labour

Sign & symptoms of pretem labour

four or more uterine contractions in one hour

cervical dilatation
vaginal bleeding in the third trimester
heavy pressure in the pelvis
abdominal or back pain
watery discharge from the vagina

Diagnosis

Bilirubin measurement
Blood type & Rh determination
Peripheral blood smear
Complete blood & Reticulocytes count
Direct Coombs test (DCT)

Anamnesis tambahan

When did the jaundice start?

Parents blood group
Smoking history of father and mother
Type of delivery and what induce the delivery

Treatment
Jaundice

Fototherapy

Transfusion therapy

Drugs (examples: phenobarbital or

luminal)

Breastfeeding baby

Source : Makalah ikterus

neonatorum,universitas
pembangunan negara

Low Birth Weight Baby

Regulation of environmental
temperature in an incubator with
temperature set :

Baby with weight < 2 kg 35 celcius of

degree

Baby with weight 2-2,5 kg 34 celcius of

degree
Incubator temperature is lowered 1
degree Celsius every week until the
baby can be placed on the ambient
temperature around 24-27 celcius of
degree.

Feeding with a pipette a little but

more often

Preterm
Feeding and Fluid Management of Preterm Babies
Babies without major illness:
1,75

2,5 kg

Allow the baby to begin breastfeeding

1,5-

1,749 kg

Give expressed breast milk using an alternative feeding

method every 3 hours until the baby is able to breastfeed.
1,25

1,49 kg

Give expressed breast milk by gastric tube every 3 hours

Progress to feeding by cup/ spoon as soon as the baby can

swallow without coughing or spitting

If the baby weighs 1,25 1,5 kg at least 8 times /day

If the baby weighs less than 1,25 kg at least 12

times/day

COMPLICATION OF LBW
inability

to maintain body temperature

difficulty feeding and gaining weight
infection
breathing
problems such asrespiratory
distress syndrome(a respiratory disease of
prematurity caused by immature lungs).
neurologic problems such as intraventricular
hemorrhage (bleeding inside the brain)
gastrointestinal
problems
such
as
necrotizing enterocolitis

PREVENTION OF LOW BIRTH WEIGHT

Prenatal care is a key factor. Health of both

mother and fetus can be checked.
Eating a healthy diet and gaining the proper
amount of weight.
Avoid alcohol, cigarettes, and illicit drugs.

COMPLICATIONS OF PRETERM BABY

Short term:
1. Breathing. Trouble breathing due to an
immature respiratory system
2. Heart and brain problem.
3. Temperature control problem. Lose body
heat rapidly; they don't have the stored
body fat of a full-term infant.
4. Blood problems.are at risk as anemia and
infant jaundice

Long-term complications:
1. Cerebral
palsy.disorder of movement,
muscle tone or posture that is caused by
injury to a preterm's developing brain.
2. Impaired
cognitive
skills.Learning
disability.
3. Vision problems.Preterm born before 30
weeks
may
develop
retinopathy
of
prematurity (ROP).
4. Chronic health issues. Such as infection.
5. Dental
problems.Increased
risk
of
developing dental problems, eg delayed
tooth eruption, tooth discoloration and

PREVENTION OF PRETERM LABOUR

Weekly shots of the hormone progesterone.

Seek regular prenatal care.
Eat healthy food.
Manage chronic condition eg DM
Avoid risky substance. Quit smoking.
Manage stress.

COMPLICATION OF JAUNDICE

Sick or difficult to wake

High-pitched crying
Poor sucking or feeding
Backward arching of the neck and body
Fever
Vomiting

PREVENTION OF JAUNDICE
1. Antenatal
2. Avoid

care

using drugs in pregnancy & intrapartum period :

Sulfa furazole

Novobiocin

Oxytocin, etc

3. Prevent
4. R/

hypoxia in fetus & neonatus

luminal for pregnant mother 1 2 day before labor

5. Good

Ilumination

6. Early

feeding

7. Prevent

infection.

THANK YOU!