1. By: Quang Pham, Emily Spencer, Melissa Warren, and Sherita Green

2. Low Birth Weight: less than 5lb 8oz Full-term infantLBW Infant

3. Why? Premature Birth (birth before 37 weeks) Pregnancy with twins, triplets or more Birth Defects Fetal Growth Restriction/Intrauterine Growth Restriction Drug/alcohol use Smoking

4.  Inadequate maternal weight gain  Age (under 17 or over 35)  Placental problems  Low income  Lack of education  Race (African-Americans are at highest risk) Infections in the mother/fetus

5.  Why relevant?  Increases risk for serious health problems in newborns  Increases risk of death in newborns  World Health Organization: 23.8% of all births

6. Pathophysiology  Birth weight governed by two major processes: duration of gestation, and intrauterine growth rate  Therefore low birth weight is caused by either short gestation or retarded intrauterine growth (or a combo)

7. Pathophysiology (Con’t)  Premature infants- at far greater risk for developing hyaline membrane disease, apnea, intracranial hemorrhage, sepsis and other conditions related to physiological immaturity  IUGR- more likely to exhibit permanent growth deficiencies as well as subtle cognitive deficiencies

8. Contributing Factors To LBW  M aternal Factors  Maternal Disease  Environmental Factors  Placental Factors  Fetal Factors  Important to remember that LBW is multifactorial

9. Cultural Factors  Income  Education  Asian and Indian- have some of the highest rates of LBW possibly due to short stature and low pre-gestational weight of mothers  African –Americans have highest rate of LBW in the United States

10. How Low Birth Weight Impacts Women’s Heath/Neonatal Health  $10,000 per day in Colorado  Assisted reproductive technology often results in multiple births (causing low birth weight) and there is also a higher risk for low birth weight when using this technology

11. Medical problems of low birth weight babies:  Respiratory Distress Syndrome  Due to low surfactant production; can be treated with oxygen. In severe cases, intubation and and administration of surfactant.  Bleeding in the brain  Patent ductus arteriosus  Heart condition caused by the non-closure of the PDA. Can be treated with indomethacin or ibuprofen. If the medication doesn’t work, surgery is the next step.  Necrotizing Enterocolitis  Infection of the intestines that usually appear 2-3 weeks after birth. Can cause abdominal swelling and difficulty feeding. Treatment involves antibiotics and the use of IV nutrition until the intestines can heal.  Retinopathy of prematurity  Eye disease that is caused by the overgrowth of veins in the retina. Most cases heal by themselves, and in severe cases will need cryosurgery. In some infants, it can lead to blindness.

12. Medical problems (Con’t) Medical problems of low birth weight babies:  Asphyxia  Aspiration syndrome  Hypothermia  Hypoglycemia  Polycythemia  May be at risk for certain chronic conditions in adulthood (ex: high BP, diabetes, heart disease)

13. Preventions  Avoid smoking, drugs, and alcohol during pregnancy  Follow regular prenatal check ups:  Every 4 weeks for the first 28 to 32 weeks  Every 2 weeks from 32 to 36 weeks  Every week from 36 to 40 weeks

14. Preventions (Con’t)  Monitor pre-pregnancy weight  Monitor maternal nutrition  Ultrasound  Education about all risk factors is key!!!

15. Treatments  Baby gestational age, overall health, medical history  Care in the NICU  Check blood sugar constantly because glucose is the main source to keep baby warm  Check temperature constantly: If baby is loosing heat, glucose level decreases

16. Treatment (Con’t)  Weight 2 times per day:  If baby weights > 4lbs, keep in the crips  baby weights < 4lbs, keep in the warmer  Breast milk is the only option for babies because breast milk contains growth nutrition for LBW baby

17. Treatments (Con’t)  IV feeding tube might be required: when baby can eat without IV tube, start feeding slowly to see if baby can tolerate it, if so, then can start increasing milk’s volume gradually.

18. VitaminsLess than 18 years19-30 yearsSources Vitamin A (mcg/d)750770Fruits, cream, butter, green vegetable Vitamin D (mcg/d)55Fortified milk, margarine, butter, liver Vitamin E (mcg/d)15 Vegetable fats and oils, whole grains, greens, eggs Vitamin K (mcg/d)7590Green leafy vegetable, liver Vitamin C (mg/d)8085Citrus fruit, tomatoes, strawberries, potatoes. Thiamine (mg/d)1.4 Pork, liver, milk, potatoes Riboflavin (mg/d)1.4 Milk, liver, eggs, breads, cereals Niacin (mg/d)18 Meat, fish, poultry, liver, whole grains Vitamin B6 (mg/d)1.9 Wheat germ, yeast, fish, liver, pork, tomatoes Folate (mcg/d)600 Green leafy vegetables, liver, peanut Vitamin B122.62.8Animal sources Calcium (mg/d)1300 Nuts, dried fruits, dark green leafy vegetables Phosphorus (mg/d)1250 Milk, eggs, meat Magnesium (mg/d)400350Milk, whole grains, dark green vegetables, nuts Iron (mg/d)27 Meat, eggs, whole grains Zinc (mg/d)1211Meat, shellfish, poultry Iodine (mcg/d)220 Seafood, iodine salt Selenium (mcg/d)60 Dietary Reference Intakes for Pregnant Females: (Text book)

19. Implications on Nursing Practice  Have to play the role of an educator  In the Community- provide follow up care  In hospital- monitor infants closely and pay meticulous attention to physiologic parameters  Try to prevent long-term disorders

20. References  March of Dimes Website www.marchofdimes.com  World Health Organization Website www.who.int/en  Davidson, M. London, M., & Ladewig, P. (2008). Old’s Maternal-Newborn Nursing & Women’s Health Across the Lifespan (8 th ed.) Upper Saddie River: Pearson Prentice Hall. (p. 930-932)  Gundersan-Lutheran, NICU http://www.gundluth.org/?id=417&sid=1  Dahlia Drulia Photography http://www.flickr.com/photos/drulia/3471051582/  http://www.nice.org.uk/niceMedia/documents/low_birth_weight_evidence_briefing.pdf http://www.nice.org.uk/niceMedia/documents/low_birth_weight_evidence_briefing.pdf