OBJECTIVES When you have completed this unit you should be able to: Identify and manage low birth weight infants. Define preterm and underweight for gestational age infants. List the complications of low birth weight infants. Prevent hypothermia and hypoglycaemia. Prevent recurrent apnoea. Manage anaemia of prematurity. Provide kangaroo mother care (KMC). Keep good patient notes. Assess patient care.

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38-1 WHAT IS A LOW BIRTH WEIGHT INFANT?

A low birth weight (LBW) infant is an infant that weighs less than 2500g at birth. The weight of all infants must be measured at birth so that low birth weight infants can be identified.

IT IS IMPORTANT TO WEIGH ALL INFANTS AFTER DELIVERY

38-2 WHY IS IT IMPORTANT TO IDENTIFY ALL LOW BIRTH WEIGHT INFANTS?

Because these infants are at an increased risk of problems and may need more than primary care. All low birth weight infants must be carefully assessed after birth.

LOW BIRTH WEIGHT INFANTS ARE AT AN INCREASED RISK OF PROBLEMS AND MAY NEED SPECIAL CARE

38-3 WHY ARE SOME INFANTS BORN WITH A LOW BIRTH WEIGHT?

Most infants weigh between 2500 and 4000g at birth. However, some infants have a low birth weight (less than 2500g) as a result of one or both of the following 2 important problems during pregnancy:

1. They may be born too soon.
2. They weigh less than expected for the duration of pregnancy (i.e. they are underweight for their gestational age).

38-4 WHICH INFANTS ARE BORN TOO SOON?

The gestational age of an infant is measured from the first day of the mother's last normal menstrual period to the day of delivery. The average gestational age is 40 weeks (280 days) with a range of 37 weeks (259 days) to 42 weeks (293 days). Infants with a gestational age between 37 and 42 weeks are called TERM infants. PRETERM infants are born before 37 weeks while POST TERM infants are born after 42 weeks.

Any infant born before 37 weeks (i.e. preterm) is regarded as being born too soon. About 5% of all infants are born preterm in a wealthy community and often more than 20% in a poor community.

PRETERM INFANTS ARE BORN BEFORE 37 WEEKS

38-5 WHAT IS AN UNDERWEIGHT FOR GESTATIONAL AGE INFANT?

Any infant with a birth weight which is less than expected for its gestational age is called an UNDERWEIGHT FOR GESTATIONAL AGE infant. When plotted on a birth weight for gestational age chart (a "fetal growth chart"), underweight for gestational age infants have a birth weight which falls below the 10th centile. Normally grown infants (appropriate for their gestational age) have a birth weight and head circumference between the 10th and 90th centiles.

UNDERWEIGHT FOR GESTATIONAL AGE INFANTS HAVE A BIRTH WEIGHT BELOW THE 10TH CENTILE

Infants may be underweight for gestational age because of one or both of the following:

1. They have grown too slowly during pregnancy.
2. They have lost weight during the last weeks of pregnancy.

The method of plotting a newborn infant's weight and head circumference on a "growth chart" is described in skills workshop 17 in the Newborn Care manual of PEP.

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