fbpx
Wikipedia

Low birth weight

Low birth weight (LBW) is defined by the World Health Organization as a birth weight of an infant of 2,499 g (5 lb 8.1 oz) or less, regardless of gestational age.[1] Infants born with LBW have added health risks which require close management, often in a neonatal intensive care unit (NICU). They are also at increased risk for long-term health conditions which require follow-up over time.[citation needed]

Low birth weight may be a result of preterm birth.

Classification edit

Birth weight may be classified as:[2]

  • High birth weight (macrosomia): greater than 4,200 g (9 lb 4 oz)
  • Normal weight (term delivery): 2,500–4,200 g (5 lb 8 oz – 9 lb 4 oz)
  • Low birth weight: less than 2,500 g (5 lb 8 oz)
    • Very low birth weight (VLBW): less than 1,500 g (3 lb 5 oz)
    • Extremely low birth weight: less than 1,000 g (2 lb 3 oz)

Causes edit

LBW is either caused by preterm birth (that is, a low gestational age at birth, commonly defined as younger than 37 weeks of gestation) or the infant being small for gestational age (that is, a slow prenatal growth rate), or a combination of both.[citation needed]

In general, risk factors in the mother that may contribute to low birth weight include young ages, multiple pregnancies, previous LBW infants, poor nutrition, heart disease or hypertension, untreated celiac disease, substance use disorder, excessive alcohol use, and insufficient prenatal care. It can also be caused by prelabor rupture of membranes.[3] Environmental risk factors include smoking, lead exposure, and other types of air pollution.[4][5][6]

Preterm birth edit

The mechanism of preterm birth is heterogeneous and poorly understood. It may be tied to one or more of the following processes: premature fetal endocrine activation, intrauterine inflammation, over-distension of the uterus, and endometrial bleeding. A prominent risk factor for preterm birth is prior history of preterm delivery. However, there is no reliable protocol for screening and prevention of preterm birth.[7]

Small for gestational age edit

Infants born small for gestational age may be constitutionally small, with no associated pathologic process. Others have intrauterine growth restriction (IUGR) due to any of various pathologic processes. Babies with chromosomal abnormalities or other congenital anomalies may manifest IUGR as part of their syndrome. Problems with the placenta can prevent it from providing adequate oxygen and nutrients to the fetus, resulting in growth restriction. Infections during pregnancy that affect the fetus, such as rubella, cytomegalovirus, toxoplasmosis, and syphilis, may also affect the baby's weight.[citation needed]

Environmental factors edit

Maternal tobacco smoking doubles risk of LBW for the infant.[8][9] More recently, passive maternal smoking has been examined for possible effects on birth weight, and has been shown to increase risk of LBW by 16%.[10]

Air pollutants edit

The combustion products of solid fuel in developing countries can cause many adverse health issues in people. Because a majority of pregnant women in developing countries, where rate of LBW is high, are heavily exposed to indoor air pollution, increased relative risk translates into substantial population attributable risk of 21% of LBW.[11]

Particulate matter, a component of ambient air pollution, is associated with increased risk of low birth weight.[12][13] Because particulate matter is composed of extremely small particles, even nonvisible levels can be inhaled and present harm to the fetus.[14] Particulate matter exposure can cause inflammation, oxidative stress, endocrine disruption, and impaired oxygen transport access to the placenta, all of which are mechanisms for heightening the risk of low birth weight.[15] To reduce exposure to particulate matter, pregnant women can monitor the US Environmental Protection Agency's air quality index and take personal precautionary measures such as reducing outdoor activity on low quality days, avoiding high-traffic roads/intersections, and/or wearing personal protective equipment (i.e., facial mask of industrial design). Indoor exposure to particulate matter can also be reduced through adequate ventilation, as well as use of clean heating and cooking methods.[16][17]

A correlation between maternal exposure to carbon monoxide (CO) and low birth weight has been reported that the effect on birth weight of increased ambient CO was as large as the effect of the mother smoking a pack of cigarettes per day during pregnancy.[18] It has been revealed that adverse reproductive effects (e.g., risk for LBW) were correlated with maternal exposure to CO emissions in Eastern Europe and North America.[19] Mercury is a known toxic heavy metal that can harm fetal growth and health, and there has been evidence showing that exposure to mercury (via consumption of large oily fish) during pregnancy may be related to higher risks of LBW in the offspring.[20]

Other exposures edit

Elevated blood lead levels in pregnant women, even those well below the US Centers for Disease Control and Prevention's 10 ug/dL "level of concern", can cause miscarriage, premature birth, and LBW in the offspring.[21] Exposure of pregnant women to airplane noise was found to be associated with low birth weight via adverse effects on fetal growth.[22] Prevalence of low birth weight in Japan is associated with radiation doses from the Fukushima accidents of March 2011.[23]

Periodontal health edit

Low birth weight, preterm birth and preeclampsia have been associated with maternal periodontal disease, though the strength of the observed associations is inconsistent and varies according to the population studied, the means of periodontal assessment and the periodontal disease classification employed.[24] The risk of low birth weight can be reduced with treatment of the periodontal disease. This therapy is safe during pregnancy and reduces the inflammatory burden, thus decreasing risk for preterm birth and low birth weight.[25]

Management edit

Temperature regulation edit

 
Skin-to-skin contact with the mother can help with thermoregulation.
 
Low birth weight babies often spend time in a temperature-controlled incubator due to their inability to maintain core body temperature.

LBW newborns are at increased risk of hypothermia due to decreased brown fat stores. Plastic wraps, heated pads, and skin-to-skin contact decrease risk of hypothermia immediately after delivery. One or more of these interventions may be employed, though combinations incur risk of hyperthermia.[26] Warmed incubators in the NICU aid in thermoregulation for LBW infants.[citation needed]

Fluid and electrolyte balance edit

Frequent clinical monitoring of volume status and checking of serum electrolytes (up to three times daily) is appropriate to prevent dehydration, fluid overload, and electrolyte imbalance.[27] VLBW newborns have an increased body surface to weight ratio, increasing risk for insensible fluid losses and dehydration.[28] Humidified incubators and skin emollients can lessen insensible fluid loss in VLBW newborns.[27] However, fluid overloading is not benign; it is associated with increased risk of congestive heart failure, necrotizing enterocolitis, and mortality. A degree of fluid restriction mitigates these risks.[27]

VLBW newborns are at risk for electrolyte imbalances due to the relative immaturity of the nephrons in their kidneys. The kidneys are not equipped to handle large sodium loads. Therefore, if normal saline is given, the sodium level may become elevated, which may prompt the clinician to give more fluids. Sodium restriction has been shown to prevent fluid overload.[27] Potassium must also be monitored carefully, as immature aldosterone sensitivity and sodium-potassium pumping increases risk for hyperkalemia and cardiac arrhythmias.[27]

VLBW newborns are frequently found to have a persistently patent ductus arteriosus (PDA). If present, it is important to evaluate whether the PDA is causing increased circulatory volume, thus posing risk for heart failure. Signs of clinically significant PDA include widened pulse pressure and bounding pulses. In newborns with significant PDA, fluid restriction may avoid the need for surgical or medical therapy to close it.[27]

Approach to nutrition edit

As their gastrointestinal systems are typically unready for enteral feeds at the time of birth, VLBW infants require initial parenteral infusion of fluids, macronutrients, vitamins, and micronutrients.[28]

Energy needs edit

Decreased activity compared to normal weight newborns may decrease energy requirements, while comorbidities such as bronchopulmonary dysplasia may increase them. Daily weight gain can reveal whether a VLBW newborn is receiving adequate calories. Growth of 21 g/kg/day, mirroring in utero growth, is a target for VLBW and ELBW neonates.[28]

Enteral sources edit

Upon transitioning to enteral nutrition, human milk is preferable to formula initially in VLBW newborns because it speeds up development of the intestinal barrier and thereby reduces risk of necrotizing enterocolitis,[28] with an absolute risk reduction of 4%.[29] Donor human milk and maternal expressed breast milk are both associated with this benefit.[30] One drawback of human milk is the imprecision in its calorie content. The fat content in human milk varies greatly among women; therefore, the energy content of human milk cannot be known as precisely as formula.[28] Each time human milk is transferred between containers, some of the fat content may stick to the container, decreasing the energy content. Minimizing transfers of human milk between containers decreases the amount of energy loss.[28] Formula is associated with greater linear growth and weight gain than donor breast milk in LBW infants.[30]

Individual nutrient considerations edit

VLBW newborns are at increased risk for hypoglycemia due to decreased energy reserves and large brain mass to body mass ratio. Hypoglycemia may be prevented by intravenous infusion of glucose, amino acids, and lipids.[28] These patients are also at risk of hyperglycemia due to immature insulin secretion and sensitivity. However, insulin supplementation is not recommended due to the possible adverse effect of hypoglycemia, which is more dangerous.[28]

VLBW newborns have increased need for amino acids to mirror in utero nutrition. Daily protein intake above 3.0 g/kg is associated with improved weight gain for LBW infants.[31] ELBW newborns may require as much as 4 g/kg/day of protein.[28]

Due to the limited solubility of calcium and phosphorus in parenteral infusions, VLBW infants receiving parenteral nutrition will be somewhat deficient of these elements and will require clinical monitoring for osteopenia.[28]

Hematology edit

One Cochrane review showed administration of erythropoietin (EPO) decreases later need for blood transfusions, and also is associated with protection against necrotizing enterocolitis and intraventricular hemorrhage. EPO is safe and does not increase risk of mortality or retinopathy of prematurity.[32]

Prognosis edit

Perinatal outcomes edit

 
Low birth weight infants may require respiratory support such as intubation and mechanical ventilation due to lung immaturity.

LBW is closely associated with fetal and perinatal mortality and morbidity, inhibited growth and cognitive development, and chronic diseases later in life. At the population level, the proportion of babies with a LBW is an indicator of a multifaceted public-health problem that includes long-term maternal malnutrition, ill health, hard work and poor health care in pregnancy. On an individual basis, LBW is an important predictor of newborn health and survival and is associated with higher risk of infant and childhood mortality.[33]

Low birth weight constitutes as sixty to eighty percent of the infant mortality rate in developing countries. Infant mortality due to low birth weight is usually directly causal, stemming from other medical complications such as preterm birth, PPROM,[34] poor maternal nutritional status, lack of prenatal care, maternal sickness during pregnancy, and an unhygienic home environment.[35]

Long-term outcomes edit

Hyponatremia in the newborn period is associated with neurodevelopmental conditions such as spastic cerebral palsy and sensorineural hearing loss. Rapid correction of hyponatremia (faster than 0.4 mEq/L/hour) perinatally is also associated with neurodevelopmental adverse effects.[27] Among VLBW children, risk for cognitive impairment is increased with lower birth weight, male sex, nonwhite ethnicity, and lower parental education level. There is no clear association between brain injury in the neonatal period and later cognitive impairment.[36] Additionally, low birth weight has associations with cardiovascular diseases later in life, especially in cases of large increases in weight during childhood.[37][38][39][40]

Low birth weight is associated with schizoid personality disorder.[41]

Epidemiology edit

The World Health Organization (WHO) estimates the worldwide prevalence of low birth weight at 15% as of 2014, and varies by region: Sub-Saharan Africa, 13%; South Asia, 28%; East Asia and the Pacific, 6%; Latin America and the Caribbean, 9%.[42] Aggregate prevalence of LBW in United Nations-designated Least Developed Countries[43] is 13%.[42] The WHO has set a goal of reducing worldwide prevalence of LBW by 30% through public health interventions including improved prenatal care and women's education.[42]

In the United States, the Centers for Disease Control and Prevention (CDC) reports 313,752 LBW infants in 2018, for a prevalence of 8.28%.[44] This is increased from an estimated 6.1% prevalence in 2011 by the Agency for Healthcare Research and Quality (AHRQ).[45] The CDC reported prevalence of VLBW at 1.38% in 2018, similar to the 2011 AHRQ estimate.[45]

References edit

  1. ^ P07 - Disorders related to short gestation and low birth weight in ICD-10
  2. ^ "eMedicine - Extremely Low Birth Weight Infant: Article by KN Siva Subramanian, MD". Retrieved 2007-11-28.
  3. ^ Rizzo, Nicola; Simonazzi, Giuliana; Curti, Alessandra (2015-09-24). "Obstetrical risk factors of ELBW". Italian Journal of Pediatrics. 41 (Suppl 1): A35. doi:10.1186/1824-7288-41-S1-A35. ISSN 1824-7288. PMC 4595176.
  4. ^ . Umm.edu. 2008-10-22. Archived from the original on 2011-08-20. Retrieved 2011-01-05.
  5. ^ Tersigni, C.; Castellani, R.; de Waure, C.; Fattorossi, A.; De Spirito, M.; Gasbarrini, A.; Scambia, G.; Di Simone, N. (2014). "Celiac disease and reproductive disorders: meta-analysis of epidemiologic associations and potential pathogenic mechanisms". Human Reproduction Update. 20 (4): 582–593. doi:10.1093/humupd/dmu007. hdl:10807/56796. ISSN 1355-4786. PMID 24619876.
  6. ^ Saccone G, Berghella V, Sarno L, Maruotti GM, Cetin I, Greco L, Khashan AS, McCarthy F, Martinelli D, Fortunato F, Martinelli P (Oct 9, 2015). "Celiac disease and obstetric complications: a systematic review and metaanalysis". Am J Obstet Gynecol. 214 (2): 225–34. doi:10.1016/j.ajog.2015.09.080. hdl:11369/330101. PMID 26432464.
  7. ^ Simhan HN, Caritis SN (2007). "Prevention of Preterm Delivery". New England Journal of Medicine. 357 (5): 477–487. doi:10.1056/NEJMra050435. PMID 17671256.
  8. ^ Saygin Avsar, Tuba (2021). "Health outcomes of smoking during pregnancy and the postpartum period: an umbrella review". BMC Pregnancy and Childbirth. 21 (1): 43–49. doi:10.1186/s12884-021-03729-1. hdl:1983/edef2022-ce4c-43b9-8104-0115f317861f. PMID 7995767. S2CID 232360282.
  9. ^ Knopik, Valerie S. (2009). "Maternal smoking during pregnancy and child outcomes: real or spurious effect?". Developmental Neuropsychology. 34 (1): 1–36. doi:10.1080/87565640802564366. ISSN 1532-6942. PMC 3581055. PMID 19142764.
  10. ^ Salmasi, Giselle; Grady, Rosheen; Jones, Jennifer; McDonald, Sarah D.; Knowledge Synthesis Group (2010). "Environmental tobacco smoke exposure and perinatal outcomes: a systematic review and meta-analyses". Acta Obstetricia et Gynecologica Scandinavica. 89 (4): 423–441. doi:10.3109/00016340903505748. ISSN 1600-0412. PMID 20085532. S2CID 9206564.
  11. ^ Pope, Daniel P.; Mishra, Vinod; Thompson, Lisa; Siddiqui, Amna Rehana; Rehfuess, Eva A.; Weber, Martin; Bruce, Nigel G. (2010). "Risk of low birth weight and stillbirth associated with indoor air pollution from solid fuel use in developing countries". Epidemiologic Reviews. 32: 70–81. doi:10.1093/epirev/mxq005. ISSN 1478-6729. PMID 20378629.
  12. ^ EPA, OAR, US (2014-04-09). "Criteria Air Pollutants". www.epa.gov. Retrieved 2017-03-31.
  13. ^ Li, Xiangyu; Huang, Shuqiong; Jiao, Anqi; Yang, Xuhao; Yun, Junfeng; Wang, Yuxin; Xue, Xiaowei; Chu, Yuanyuan; Liu, Feifei; Liu, Yisi; Ren, Meng (Aug 2017). "Association between ambient fine particulate matter and preterm birth or term low birth weight: An updated systematic review and meta-analysis". Environmental Pollution. 227: 596–605. doi:10.1016/j.envpol.2017.03.055. ISSN 1873-6424. PMID 28457735.
  14. ^ "CDC - Air Quality - Particle Pollution". www.cdc.gov. Retrieved 2017-03-31.
  15. ^ Erickson, Anders C.; Arbour, Laura (2014-11-26). "The Shared Pathoetiological Effects of Particulate Air Pollution and the Social Environment on Fetal-Placental Development". Journal of Environmental and Public Health. 2014: 901017. doi:10.1155/2014/901017. ISSN 1687-9805. PMC 4276595. PMID 25574176.
  16. ^ . EPA. 2009-05-19. Archived from the original on 2009-06-04.
  17. ^ US EPA National Center for Environmental Assessment, Research Triangle Park NC, Environmental Media Assessment Group; Sacks, Jason. "2009 Final Report: Integrated Science Assessment for Particulate Matter". cfpub.epa.gov. Retrieved 2017-03-31.{{cite web}}: CS1 maint: multiple names: authors list (link)
  18. ^ Lewtas, Joellen (Nov 2007). "Air pollution combustion emissions: characterization of causative agents and mechanisms associated with cancer, reproductive, and cardiovascular effects". Mutation Research. 636 (1–3): 95–133. doi:10.1016/j.mrrev.2007.08.003. ISSN 0027-5107. PMID 17951105.
  19. ^ Townsend CL, Maynard RL (Oct 2002). "Effects on health of prolonged exposure to low concentrations of carbon monoxide". Occup Environ Med. 59 (10): 708–11. doi:10.1136/oem.59.10.708. PMC 1740215. PMID 12356933.
  20. ^ Gochfeld M, Burger J (Aug 2005). "Good fish/bad fish: a composite benefit-risk by dose curve". Neurotoxicology. 26 (4): 511–20. doi:10.1016/j.neuro.2004.12.010. PMID 15979722.
  21. ^ Cleveland, Lisa M.; Minter, Monica L.; Cobb, Kathleen A.; Scott, Anthony A.; German, Victor F. (Oct 2008). "Lead hazards for pregnant women and children: part 1: immigrants and the poor shoulder most of the burden of lead exposure in this country. Part 1 of a two-part article details how exposure happens, whom it affects, and the harm it can do". The American Journal of Nursing. 108 (10): 40–49, quiz 50. doi:10.1097/01.NAJ.0000337736.76730.66. ISSN 1538-7488. PMID 18827541.
  22. ^ Kawada T (Feb 2004). "The effect of noise on the health of children". Journal of Nippon Medical School. 71 (1): 5–10. doi:10.1272/jnms.71.5. PMID 15129589.
  23. ^ Scherb H, Hayashi K (July 2020). "Spatiotemporal association of low birth weight with Cs-137 deposition at the prefecture level in Japan after the Fukushima nuclear power plant accidents: an analytical-ecologic epidemiological study". Environmental Health. 19 (1): 82. Bibcode:2020EnvHe..19...82S. doi:10.1186/s12940-020-00630-w. PMC 7346451. PMID 32646457.
  24. ^ Sanz, M (April 2013). "Periodontitis and adverse pregnancy outcomes: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases". J Periodontol. 84 (4 suppl): S164–9. doi:10.1902/jop.2013.1340016. PMID 23631576.
  25. ^ Shah, Monali (November 2013). "Effect of nonsurgical periodontal therapy during gestation period on adverse pregnancy outcome: a systematic review". J Matern Fetal Neonatal Med. 26 (17): 1691–5. doi:10.3109/14767058.2013.799662. PMID 23617740. S2CID 23564952.
  26. ^ McCall, Emma M.; Alderdice, Fiona; Halliday, Henry L.; Vohra, Sunita; Johnston, Linda (12 Feb 2018). "Interventions to prevent hypothermia at birth in preterm and/or low birth weight infants". The Cochrane Database of Systematic Reviews. 2018 (2): CD004210. doi:10.1002/14651858.CD004210.pub5. ISSN 1469-493X. PMC 6491068. PMID 29431872.
  27. ^ a b c d e f g Evidence-based handbook of neonatology. Oh, William. New Jersey: World Scientific. 2011. pp. 267–290. ISBN 978-981-4313-46-9. OCLC 775591575.{{cite book}}: CS1 maint: others (link)
  28. ^ a b c d e f g h i j Evidence-based handbook of neonatology. Oh, William. New Jersey: World Scientific. 2011. pp. 291–315. ISBN 978-981-4313-46-9. OCLC 775591575.{{cite book}}: CS1 maint: others (link)
  29. ^ Miller, Jacqueline; Tonkin, Emma; Damarell, Raechel A.; McPhee, Andrew J.; Suganuma, Machiko; Suganuma, Hiroki; Middleton, Philippa F.; Makrides, Maria; Collins, Carmel T. (2018-05-31). "A Systematic Review and Meta-Analysis of Human Milk Feeding and Morbidity in Very Low Birth Weight Infants". Nutrients. 10 (6): 707. doi:10.3390/nu10060707. ISSN 2072-6643. PMC 6024377. PMID 29857555.
  30. ^ a b Quigley, Maria; Embleton, Nicholas D.; McGuire, William (July 19, 2019). "Formula versus donor breast milk for feeding preterm or low birth weight infants". The Cochrane Database of Systematic Reviews. 7 (7): CD002971. doi:10.1002/14651858.CD002971.pub5. ISSN 1469-493X. PMC 6640412. PMID 31322731.
  31. ^ Fenton, Tanis R.; Premji, Shahirose S.; Al-Wassia, Heidi; Sauve, Reg S. (2014-04-21). "Higher versus lower protein intake in formula-fed low birth weight infants". The Cochrane Database of Systematic Reviews. 2014 (4): CD003959. doi:10.1002/14651858.CD003959.pub3. ISSN 1469-493X. PMC 7104240. PMID 24752987.
  32. ^ Ohlsson, Arne; Aher, Sanjay M. (2020-02-11). "Early erythropoiesis-stimulating agents in preterm or low birth weight infants". The Cochrane Database of Systematic Reviews. 2 (2): CD004863. doi:10.1002/14651858.CD004863.pub6. ISSN 1469-493X. PMC 7014351. PMID 32048730.
  33. ^ Stevens-Simon C, Orleans M (Sep 1999). "Low-birthweight prevention programs: the enigma of failure". Birth. 26 (3): 184–91. doi:10.1046/j.1523-536x.1999.00184.x. PMID 10655819.
  34. ^ Kalikkot Thekkeveedu, Renjithkumar; Guaman, Milenka Cuevas; Shivanna, Binoy (November 2017). "Bronchopulmonary dysplasia: A review of pathogenesis and pathophysiology". Respiratory Medicine. 132: 170–177. doi:10.1016/j.rmed.2017.10.014. ISSN 1532-3064. PMC 5729938. PMID 29229093.
  35. ^ Andrews, K.M.; Brouillette, D.B; Brouillette, R.T. (2008). "Mortality, Infant". Encyclopedia of Infant and Early Childhood Development. pp. 343–359. doi:10.1016/B978-012370877-9.00084-0. ISBN 9780123708779.
  36. ^ Linsell, Louise; Malouf, Reem; Morris, Joan; Kurinczuk, Jennifer J.; Marlow, Neil (Dec 2015). "Prognostic Factors for Poor Cognitive Development in Children Born Very Preterm or With Very Low Birth Weight: A Systematic Review". JAMA Pediatrics. 169 (12): 1162–1172. doi:10.1001/jamapediatrics.2015.2175. ISSN 2168-6211. PMC 5122448. PMID 26457641.
  37. ^ Toemen L., De Jonge L.L., Gishti O., et al Longitudinal growth during fetal life and infancy and cardiovascular outcomes at school-age. J. Hypertens.. 2016;34(7):1396-1406. doi:10.1097/HJH.0000000000000947
  38. ^ Barker DJ, Osmond C, Forsen TJ, Kajantie E, Eriksson JG. Trajectoriesof growth among children who have coronary events as adults.N Engl JMed2005; 353:1802–1809.
  39. ^ Curhan GC, Willett WC, Rimm EB, Spiegelman D, Ascherio AL, Stamp-fer MJ. Birth weight and adult hypertension, diabetes mellitus, andobesity in US men.Circulation1996; 94:3246–3250
  40. ^ Osmond C, Barker DJ, Winter PD, Fall CH, Simmonds SJ. Early growthand death from cardiovascular disease in women.BMJ1993; 307:1519–1524.
  41. ^ Abel, Kathryn M.; Wicks, Susanne; Susser, Ezra S.; Dalman, Christina; Pedersen, Marianne G.; Mortensen, Preben Bo; Webb, Roger T. (2010). "Birth Weight, Schizophrenia, and Adult Mental Disorder". Archives of General Psychiatry. 67 (9): 923–930. doi:10.1001/archgenpsychiatry.2010.100. PMID 20819986. Retrieved 2023-05-03.
  42. ^ a b c "Global nutrition targets 2025: low birth weight policy brief". www.who.int. Retrieved 2020-11-04.
  43. ^ "UNSD — Methodology: Standard country or area codes for statistical use (M49)". unstats.un.org. Retrieved 2020-11-04.
  44. ^ "FastStats - Birthweight and Gestation". www.cdc.gov. 2020-08-04. Retrieved 2020-11-04.
  45. ^ a b Kowlessar N.M., Jiang H.J., and Steiner C. Hospital Stays for Newborns, 2011. HCUP Statistical Brief #163. October 2013. Agency for Healthcare Research and Quality, Rockville, MD. [1] 2022-08-18 at the Wayback Machine

birth, weight, this, article, lead, section, short, adequately, summarize, points, please, consider, expanding, lead, provide, accessible, overview, important, aspects, article, october, 2021, defined, world, health, organization, birth, weight, infant, less, . This article s lead section may be too short to adequately summarize the key points Please consider expanding the lead to provide an accessible overview of all important aspects of the article October 2021 Low birth weight LBW is defined by the World Health Organization as a birth weight of an infant of 2 499 g 5 lb 8 1 oz or less regardless of gestational age 1 Infants born with LBW have added health risks which require close management often in a neonatal intensive care unit NICU They are also at increased risk for long term health conditions which require follow up over time citation needed Low birth weight may be a result of preterm birth Contents 1 Classification 2 Causes 2 1 Preterm birth 2 2 Small for gestational age 2 3 Environmental factors 2 3 1 Air pollutants 2 3 2 Other exposures 2 4 Periodontal health 3 Management 3 1 Temperature regulation 3 2 Fluid and electrolyte balance 3 3 Approach to nutrition 3 3 1 Energy needs 3 3 2 Enteral sources 3 3 3 Individual nutrient considerations 3 4 Hematology 4 Prognosis 4 1 Perinatal outcomes 4 2 Long term outcomes 5 Epidemiology 6 ReferencesClassification editBirth weight may be classified as 2 High birth weight macrosomia greater than 4 200 g 9 lb 4 oz Normal weight term delivery 2 500 4 200 g 5 lb 8 oz 9 lb 4 oz Low birth weight less than 2 500 g 5 lb 8 oz Very low birth weight VLBW less than 1 500 g 3 lb 5 oz Extremely low birth weight less than 1 000 g 2 lb 3 oz Causes editLBW is either caused by preterm birth that is a low gestational age at birth commonly defined as younger than 37 weeks of gestation or the infant being small for gestational age that is a slow prenatal growth rate or a combination of both citation needed In general risk factors in the mother that may contribute to low birth weight include young ages multiple pregnancies previous LBW infants poor nutrition heart disease or hypertension untreated celiac disease substance use disorder excessive alcohol use and insufficient prenatal care It can also be caused by prelabor rupture of membranes 3 Environmental risk factors include smoking lead exposure and other types of air pollution 4 5 6 Preterm birth edit Further information Preterm birth The mechanism of preterm birth is heterogeneous and poorly understood It may be tied to one or more of the following processes premature fetal endocrine activation intrauterine inflammation over distension of the uterus and endometrial bleeding A prominent risk factor for preterm birth is prior history of preterm delivery However there is no reliable protocol for screening and prevention of preterm birth 7 Small for gestational age edit Further information Small for gestational age Infants born small for gestational age may be constitutionally small with no associated pathologic process Others have intrauterine growth restriction IUGR due to any of various pathologic processes Babies with chromosomal abnormalities or other congenital anomalies may manifest IUGR as part of their syndrome Problems with the placenta can prevent it from providing adequate oxygen and nutrients to the fetus resulting in growth restriction Infections during pregnancy that affect the fetus such as rubella cytomegalovirus toxoplasmosis and syphilis may also affect the baby s weight citation needed Environmental factors edit Maternal tobacco smoking doubles risk of LBW for the infant 8 9 More recently passive maternal smoking has been examined for possible effects on birth weight and has been shown to increase risk of LBW by 16 10 Air pollutants edit The combustion products of solid fuel in developing countries can cause many adverse health issues in people Because a majority of pregnant women in developing countries where rate of LBW is high are heavily exposed to indoor air pollution increased relative risk translates into substantial population attributable risk of 21 of LBW 11 Particulate matter a component of ambient air pollution is associated with increased risk of low birth weight 12 13 Because particulate matter is composed of extremely small particles even nonvisible levels can be inhaled and present harm to the fetus 14 Particulate matter exposure can cause inflammation oxidative stress endocrine disruption and impaired oxygen transport access to the placenta all of which are mechanisms for heightening the risk of low birth weight 15 To reduce exposure to particulate matter pregnant women can monitor the US Environmental Protection Agency s air quality index and take personal precautionary measures such as reducing outdoor activity on low quality days avoiding high traffic roads intersections and or wearing personal protective equipment i e facial mask of industrial design Indoor exposure to particulate matter can also be reduced through adequate ventilation as well as use of clean heating and cooking methods 16 17 A correlation between maternal exposure to carbon monoxide CO and low birth weight has been reported that the effect on birth weight of increased ambient CO was as large as the effect of the mother smoking a pack of cigarettes per day during pregnancy 18 It has been revealed that adverse reproductive effects e g risk for LBW were correlated with maternal exposure to CO emissions in Eastern Europe and North America 19 Mercury is a known toxic heavy metal that can harm fetal growth and health and there has been evidence showing that exposure to mercury via consumption of large oily fish during pregnancy may be related to higher risks of LBW in the offspring 20 Other exposures edit Elevated blood lead levels in pregnant women even those well below the US Centers for Disease Control and Prevention s 10 ug dL level of concern can cause miscarriage premature birth and LBW in the offspring 21 Exposure of pregnant women to airplane noise was found to be associated with low birth weight via adverse effects on fetal growth 22 Prevalence of low birth weight in Japan is associated with radiation doses from the Fukushima accidents of March 2011 23 Periodontal health edit Low birth weight preterm birth and preeclampsia have been associated with maternal periodontal disease though the strength of the observed associations is inconsistent and varies according to the population studied the means of periodontal assessment and the periodontal disease classification employed 24 The risk of low birth weight can be reduced with treatment of the periodontal disease This therapy is safe during pregnancy and reduces the inflammatory burden thus decreasing risk for preterm birth and low birth weight 25 Management editTemperature regulation edit nbsp Skin to skin contact with the mother can help with thermoregulation nbsp Low birth weight babies often spend time in a temperature controlled incubator due to their inability to maintain core body temperature LBW newborns are at increased risk of hypothermia due to decreased brown fat stores Plastic wraps heated pads and skin to skin contact decrease risk of hypothermia immediately after delivery One or more of these interventions may be employed though combinations incur risk of hyperthermia 26 Warmed incubators in the NICU aid in thermoregulation for LBW infants citation needed Fluid and electrolyte balance edit Frequent clinical monitoring of volume status and checking of serum electrolytes up to three times daily is appropriate to prevent dehydration fluid overload and electrolyte imbalance 27 VLBW newborns have an increased body surface to weight ratio increasing risk for insensible fluid losses and dehydration 28 Humidified incubators and skin emollients can lessen insensible fluid loss in VLBW newborns 27 However fluid overloading is not benign it is associated with increased risk of congestive heart failure necrotizing enterocolitis and mortality A degree of fluid restriction mitigates these risks 27 VLBW newborns are at risk for electrolyte imbalances due to the relative immaturity of the nephrons in their kidneys The kidneys are not equipped to handle large sodium loads Therefore if normal saline is given the sodium level may become elevated which may prompt the clinician to give more fluids Sodium restriction has been shown to prevent fluid overload 27 Potassium must also be monitored carefully as immature aldosterone sensitivity and sodium potassium pumping increases risk for hyperkalemia and cardiac arrhythmias 27 VLBW newborns are frequently found to have a persistently patent ductus arteriosus PDA If present it is important to evaluate whether the PDA is causing increased circulatory volume thus posing risk for heart failure Signs of clinically significant PDA include widened pulse pressure and bounding pulses In newborns with significant PDA fluid restriction may avoid the need for surgical or medical therapy to close it 27 Approach to nutrition edit As their gastrointestinal systems are typically unready for enteral feeds at the time of birth VLBW infants require initial parenteral infusion of fluids macronutrients vitamins and micronutrients 28 Energy needs edit Decreased activity compared to normal weight newborns may decrease energy requirements while comorbidities such as bronchopulmonary dysplasia may increase them Daily weight gain can reveal whether a VLBW newborn is receiving adequate calories Growth of 21 g kg day mirroring in utero growth is a target for VLBW and ELBW neonates 28 Enteral sources edit Upon transitioning to enteral nutrition human milk is preferable to formula initially in VLBW newborns because it speeds up development of the intestinal barrier and thereby reduces risk of necrotizing enterocolitis 28 with an absolute risk reduction of 4 29 Donor human milk and maternal expressed breast milk are both associated with this benefit 30 One drawback of human milk is the imprecision in its calorie content The fat content in human milk varies greatly among women therefore the energy content of human milk cannot be known as precisely as formula 28 Each time human milk is transferred between containers some of the fat content may stick to the container decreasing the energy content Minimizing transfers of human milk between containers decreases the amount of energy loss 28 Formula is associated with greater linear growth and weight gain than donor breast milk in LBW infants 30 Individual nutrient considerations edit VLBW newborns are at increased risk for hypoglycemia due to decreased energy reserves and large brain mass to body mass ratio Hypoglycemia may be prevented by intravenous infusion of glucose amino acids and lipids 28 These patients are also at risk of hyperglycemia due to immature insulin secretion and sensitivity However insulin supplementation is not recommended due to the possible adverse effect of hypoglycemia which is more dangerous 28 VLBW newborns have increased need for amino acids to mirror in utero nutrition Daily protein intake above 3 0 g kg is associated with improved weight gain for LBW infants 31 ELBW newborns may require as much as 4 g kg day of protein 28 Due to the limited solubility of calcium and phosphorus in parenteral infusions VLBW infants receiving parenteral nutrition will be somewhat deficient of these elements and will require clinical monitoring for osteopenia 28 Hematology edit One Cochrane review showed administration of erythropoietin EPO decreases later need for blood transfusions and also is associated with protection against necrotizing enterocolitis and intraventricular hemorrhage EPO is safe and does not increase risk of mortality or retinopathy of prematurity 32 Prognosis editPerinatal outcomes edit nbsp Low birth weight infants may require respiratory support such as intubation and mechanical ventilation due to lung immaturity LBW is closely associated with fetal and perinatal mortality and morbidity inhibited growth and cognitive development and chronic diseases later in life At the population level the proportion of babies with a LBW is an indicator of a multifaceted public health problem that includes long term maternal malnutrition ill health hard work and poor health care in pregnancy On an individual basis LBW is an important predictor of newborn health and survival and is associated with higher risk of infant and childhood mortality 33 Low birth weight constitutes as sixty to eighty percent of the infant mortality rate in developing countries Infant mortality due to low birth weight is usually directly causal stemming from other medical complications such as preterm birth PPROM 34 poor maternal nutritional status lack of prenatal care maternal sickness during pregnancy and an unhygienic home environment 35 Long term outcomes edit Hyponatremia in the newborn period is associated with neurodevelopmental conditions such as spastic cerebral palsy and sensorineural hearing loss Rapid correction of hyponatremia faster than 0 4 mEq L hour perinatally is also associated with neurodevelopmental adverse effects 27 Among VLBW children risk for cognitive impairment is increased with lower birth weight male sex nonwhite ethnicity and lower parental education level There is no clear association between brain injury in the neonatal period and later cognitive impairment 36 Additionally low birth weight has associations with cardiovascular diseases later in life especially in cases of large increases in weight during childhood 37 38 39 40 Low birth weight is associated with schizoid personality disorder 41 Epidemiology editThe World Health Organization WHO estimates the worldwide prevalence of low birth weight at 15 as of 2014 and varies by region Sub Saharan Africa 13 South Asia 28 East Asia and the Pacific 6 Latin America and the Caribbean 9 42 Aggregate prevalence of LBW in United Nations designated Least Developed Countries 43 is 13 42 The WHO has set a goal of reducing worldwide prevalence of LBW by 30 through public health interventions including improved prenatal care and women s education 42 In the United States the Centers for Disease Control and Prevention CDC reports 313 752 LBW infants in 2018 for a prevalence of 8 28 44 This is increased from an estimated 6 1 prevalence in 2011 by the Agency for Healthcare Research and Quality AHRQ 45 The CDC reported prevalence of VLBW at 1 38 in 2018 similar to the 2011 AHRQ estimate 45 References edit P07 Disorders related to short gestation and low birth weight in ICD 10 eMedicine Extremely Low Birth Weight Infant Article by KN Siva Subramanian MD Retrieved 2007 11 28 Rizzo Nicola Simonazzi Giuliana Curti Alessandra 2015 09 24 Obstetrical risk factors of ELBW Italian Journal of Pediatrics 41 Suppl 1 A35 doi 10 1186 1824 7288 41 S1 A35 ISSN 1824 7288 PMC 4595176 Labor and delivery Low Birth Weight Umm edu 2008 10 22 Archived from the original on 2011 08 20 Retrieved 2011 01 05 Tersigni C Castellani R de Waure C Fattorossi A De Spirito M Gasbarrini A Scambia G Di Simone N 2014 Celiac disease and reproductive disorders meta analysis of epidemiologic associations and potential pathogenic mechanisms Human Reproduction Update 20 4 582 593 doi 10 1093 humupd dmu007 hdl 10807 56796 ISSN 1355 4786 PMID 24619876 Saccone G Berghella V Sarno L Maruotti GM Cetin I Greco L Khashan AS McCarthy F Martinelli D Fortunato F Martinelli P Oct 9 2015 Celiac disease and obstetric complications a systematic review and metaanalysis Am J Obstet Gynecol 214 2 225 34 doi 10 1016 j ajog 2015 09 080 hdl 11369 330101 PMID 26432464 Simhan HN Caritis SN 2007 Prevention of Preterm Delivery New England Journal of Medicine 357 5 477 487 doi 10 1056 NEJMra050435 PMID 17671256 Saygin Avsar Tuba 2021 Health outcomes of smoking during pregnancy and the postpartum period an umbrella review BMC Pregnancy and Childbirth 21 1 43 49 doi 10 1186 s12884 021 03729 1 hdl 1983 edef2022 ce4c 43b9 8104 0115f317861f PMID 7995767 S2CID 232360282 Knopik Valerie S 2009 Maternal smoking during pregnancy and child outcomes real or spurious effect Developmental Neuropsychology 34 1 1 36 doi 10 1080 87565640802564366 ISSN 1532 6942 PMC 3581055 PMID 19142764 Salmasi Giselle Grady Rosheen Jones Jennifer McDonald Sarah D Knowledge Synthesis Group 2010 Environmental tobacco smoke exposure and perinatal outcomes a systematic review and meta analyses Acta Obstetricia et Gynecologica Scandinavica 89 4 423 441 doi 10 3109 00016340903505748 ISSN 1600 0412 PMID 20085532 S2CID 9206564 Pope Daniel P Mishra Vinod Thompson Lisa Siddiqui Amna Rehana Rehfuess Eva A Weber Martin Bruce Nigel G 2010 Risk of low birth weight and stillbirth associated with indoor air pollution from solid fuel use in developing countries Epidemiologic Reviews 32 70 81 doi 10 1093 epirev mxq005 ISSN 1478 6729 PMID 20378629 EPA OAR US 2014 04 09 Criteria Air Pollutants www epa gov Retrieved 2017 03 31 Li Xiangyu Huang Shuqiong Jiao Anqi Yang Xuhao Yun Junfeng Wang Yuxin Xue Xiaowei Chu Yuanyuan Liu Feifei Liu Yisi Ren Meng Aug 2017 Association between ambient fine particulate matter and preterm birth or term low birth weight An updated systematic review and meta analysis Environmental Pollution 227 596 605 doi 10 1016 j envpol 2017 03 055 ISSN 1873 6424 PMID 28457735 CDC Air Quality Particle Pollution www cdc gov Retrieved 2017 03 31 Erickson Anders C Arbour Laura 2014 11 26 The Shared Pathoetiological Effects of Particulate Air Pollution and the Social Environment on Fetal Placental Development Journal of Environmental and Public Health 2014 901017 doi 10 1155 2014 901017 ISSN 1687 9805 PMC 4276595 PMID 25574176 Particulate matter EPA 2009 05 19 Archived from the original on 2009 06 04 US EPA National Center for Environmental Assessment Research Triangle Park NC Environmental Media Assessment Group Sacks Jason 2009 Final Report Integrated Science Assessment for Particulate Matter cfpub epa gov Retrieved 2017 03 31 a href Template Cite web html title Template Cite web cite web a CS1 maint multiple names authors list link Lewtas Joellen Nov 2007 Air pollution combustion emissions characterization of causative agents and mechanisms associated with cancer reproductive and cardiovascular effects Mutation Research 636 1 3 95 133 doi 10 1016 j mrrev 2007 08 003 ISSN 0027 5107 PMID 17951105 Townsend CL Maynard RL Oct 2002 Effects on health of prolonged exposure to low concentrations of carbon monoxide Occup Environ Med 59 10 708 11 doi 10 1136 oem 59 10 708 PMC 1740215 PMID 12356933 Gochfeld M Burger J Aug 2005 Good fish bad fish a composite benefit risk by dose curve Neurotoxicology 26 4 511 20 doi 10 1016 j neuro 2004 12 010 PMID 15979722 Cleveland Lisa M Minter Monica L Cobb Kathleen A Scott Anthony A German Victor F Oct 2008 Lead hazards for pregnant women and children part 1 immigrants and the poor shoulder most of the burden of lead exposure in this country Part 1 of a two part article details how exposure happens whom it affects and the harm it can do The American Journal of Nursing 108 10 40 49 quiz 50 doi 10 1097 01 NAJ 0000337736 76730 66 ISSN 1538 7488 PMID 18827541 Kawada T Feb 2004 The effect of noise on the health of children Journal of Nippon Medical School 71 1 5 10 doi 10 1272 jnms 71 5 PMID 15129589 Scherb H Hayashi K July 2020 Spatiotemporal association of low birth weight with Cs 137 deposition at the prefecture level in Japan after the Fukushima nuclear power plant accidents an analytical ecologic epidemiological study Environmental Health 19 1 82 Bibcode 2020EnvHe 19 82S doi 10 1186 s12940 020 00630 w PMC 7346451 PMID 32646457 Sanz M April 2013 Periodontitis and adverse pregnancy outcomes consensus report of the Joint EFP AAP Workshop on Periodontitis and Systemic Diseases J Periodontol 84 4 suppl S164 9 doi 10 1902 jop 2013 1340016 PMID 23631576 Shah Monali November 2013 Effect of nonsurgical periodontal therapy during gestation period on adverse pregnancy outcome a systematic review J Matern Fetal Neonatal Med 26 17 1691 5 doi 10 3109 14767058 2013 799662 PMID 23617740 S2CID 23564952 McCall Emma M Alderdice Fiona Halliday Henry L Vohra Sunita Johnston Linda 12 Feb 2018 Interventions to prevent hypothermia at birth in preterm and or low birth weight infants The Cochrane Database of Systematic Reviews 2018 2 CD004210 doi 10 1002 14651858 CD004210 pub5 ISSN 1469 493X PMC 6491068 PMID 29431872 a b c d e f g Evidence based handbook of neonatology Oh William New Jersey World Scientific 2011 pp 267 290 ISBN 978 981 4313 46 9 OCLC 775591575 a href Template Cite book html title Template Cite book cite book a CS1 maint others link a b c d e f g h i j Evidence based handbook of neonatology Oh William New Jersey World Scientific 2011 pp 291 315 ISBN 978 981 4313 46 9 OCLC 775591575 a href Template Cite book html title Template Cite book cite book a CS1 maint others link Miller Jacqueline Tonkin Emma Damarell Raechel A McPhee Andrew J Suganuma Machiko Suganuma Hiroki Middleton Philippa F Makrides Maria Collins Carmel T 2018 05 31 A Systematic Review and Meta Analysis of Human Milk Feeding and Morbidity in Very Low Birth Weight Infants Nutrients 10 6 707 doi 10 3390 nu10060707 ISSN 2072 6643 PMC 6024377 PMID 29857555 a b Quigley Maria Embleton Nicholas D McGuire William July 19 2019 Formula versus donor breast milk for feeding preterm or low birth weight infants The Cochrane Database of Systematic Reviews 7 7 CD002971 doi 10 1002 14651858 CD002971 pub5 ISSN 1469 493X PMC 6640412 PMID 31322731 Fenton Tanis R Premji Shahirose S Al Wassia Heidi Sauve Reg S 2014 04 21 Higher versus lower protein intake in formula fed low birth weight infants The Cochrane Database of Systematic Reviews 2014 4 CD003959 doi 10 1002 14651858 CD003959 pub3 ISSN 1469 493X PMC 7104240 PMID 24752987 Ohlsson Arne Aher Sanjay M 2020 02 11 Early erythropoiesis stimulating agents in preterm or low birth weight infants The Cochrane Database of Systematic Reviews 2 2 CD004863 doi 10 1002 14651858 CD004863 pub6 ISSN 1469 493X PMC 7014351 PMID 32048730 Stevens Simon C Orleans M Sep 1999 Low birthweight prevention programs the enigma of failure Birth 26 3 184 91 doi 10 1046 j 1523 536x 1999 00184 x PMID 10655819 Kalikkot Thekkeveedu Renjithkumar Guaman Milenka Cuevas Shivanna Binoy November 2017 Bronchopulmonary dysplasia A review of pathogenesis and pathophysiology Respiratory Medicine 132 170 177 doi 10 1016 j rmed 2017 10 014 ISSN 1532 3064 PMC 5729938 PMID 29229093 Andrews K M Brouillette D B Brouillette R T 2008 Mortality Infant Encyclopedia of Infant and Early Childhood Development pp 343 359 doi 10 1016 B978 012370877 9 00084 0 ISBN 9780123708779 Linsell Louise Malouf Reem Morris Joan Kurinczuk Jennifer J Marlow Neil Dec 2015 Prognostic Factors for Poor Cognitive Development in Children Born Very Preterm or With Very Low Birth Weight A Systematic Review JAMA Pediatrics 169 12 1162 1172 doi 10 1001 jamapediatrics 2015 2175 ISSN 2168 6211 PMC 5122448 PMID 26457641 Toemen L De Jonge L L Gishti O et al Longitudinal growth during fetal life and infancy and cardiovascular outcomes at school age J Hypertens 2016 34 7 1396 1406 doi 10 1097 HJH 0000000000000947 Barker DJ Osmond C Forsen TJ Kajantie E Eriksson JG Trajectoriesof growth among children who have coronary events as adults N Engl JMed2005 353 1802 1809 Curhan GC Willett WC Rimm EB Spiegelman D Ascherio AL Stamp fer MJ Birth weight and adult hypertension diabetes mellitus andobesity in US men Circulation1996 94 3246 3250 Osmond C Barker DJ Winter PD Fall CH Simmonds SJ Early growthand death from cardiovascular disease in women BMJ1993 307 1519 1524 Abel Kathryn M Wicks Susanne Susser Ezra S Dalman Christina Pedersen Marianne G Mortensen Preben Bo Webb Roger T 2010 Birth Weight Schizophrenia and Adult Mental Disorder Archives of General Psychiatry 67 9 923 930 doi 10 1001 archgenpsychiatry 2010 100 PMID 20819986 Retrieved 2023 05 03 a b c Global nutrition targets 2025 low birth weight policy brief www who int Retrieved 2020 11 04 UNSD Methodology Standard country or area codes for statistical use M49 unstats un org Retrieved 2020 11 04 FastStats Birthweight and Gestation www cdc gov 2020 08 04 Retrieved 2020 11 04 a b Kowlessar N M Jiang H J and Steiner C Hospital Stays for Newborns 2011 HCUP Statistical Brief 163 October 2013 Agency for Healthcare Research and Quality Rockville MD 1 Archived 2022 08 18 at the Wayback Machine Retrieved from https en wikipedia org w index php title Low birth weight amp oldid 1220158995, wikipedia, wiki, book, books, library,

article

, read, download, free, free download, mp3, video, mp4, 3gp, jpg, jpeg, gif, png, picture, music, song, movie, book, game, games.