Immune status of low birth weight babies

An attempt was made to evaluate the humoral and cellular immune status of preterm and small for dates babies born at All India Institute of Medical Sciences Hospital. The study sample included 24 term small-for-dates babies and 12 preterm babies (gestation of less than 37 weeks) and 20 term appropriate-for-dates babies who served as controls. The small-for-dates babies were subdivided into the following 2 subgroups on the basis of severity of intrauterine growth retardation (IUGR): mild IUGR -- babies weighing between 3rd and 10th percentile for their gestation; and severe IUGR -- babies weighing less than 2 S.D. or 3rd percentile for their gestation. The levels of immunoglobulin G (IgG), M (IgM), and A (IgA) were determined in the cord blood using the single radical diffusion technique. The B-lymphocytes were identified and counted by the surface membrane immunoglobulin (SmIg) using immunofluorescence technique. The cellular immune response was assessed by counting T-lymphocytes by E-rosette technique employing sheep red blood cells. The neonates with severe IUGR and preterm babies had significantly lower levels of IgG. The levels of IgM and IgA did not differ significantly in the 4 groups. The preterm babies had significantly higher percentage of B-lymphocytes though the absolute count was not significantly different from normal newborn babies. The absolute count B cells was significantly low in babies with severe IUGR. The babies with severe IUGR had significantly low absolute and percentage count of E-rosette forming cells as compared to normal newborn babies. The findings suggest that low birth weight babies with severe IUGR are at a greater risk to develop bacterial infection due to deficiency of both humoral and cellular immune host defenses. In contrast, preterm babies are immunologically competent though passively transferred maternal IgG levels are low. It is desirable to study the duration of immunodeficiency caused by severe IUGR and its reversibility on nutritional rehabilitation. In view of the wide prevalence of IUGR in India it is possible that inadequacy of cell mediated immune response in these infants may be associated with poor "takes" following at birth BCG and small pox vaccinations. The vaccination schedule may have to be modified depending upon the duration of immunodeficiency in babies with IUGR.     

Pulmonary lesions in low birth weight babies

Summary A clinicopathological study was carried out on 50 low birth weight neonates. Pulmonary pathology accounted for 21 deaths. The pathological lesions consisted of pneumonia (congenital and bronchopneumonial), massive pulmonary haemorrhage and hyaline membrane disease. From the Department of Pathology, Lady Hardinge Medical College, and the Kalavati Saran Children’s Hospital, New Delhi, I.     

Breast milk in low birth weight babies

Two hundred low birth weight babies weighing less than 1.8 kg. were studied to evaluate the impact of breast feeding versus top feeding. There was significantly less mortality in the breast fed group as compared with the top fed group (23% vs 47%, P<007). This was true whether the data was analysed for gestational age. or birth weight, although statistical significance was not achieved in some groups, due to small numbers. The rate of infection was lower in the breast fed as compared with the top fed group (35% vs 54%, P<0.001). The cure rate from infection was also higher in the breast fed group (P<001). In the breast fed group the weight gain occurred earlier, although by the 3rd week it was marginally greater in the top fed group.     

Predictor of low birth weight babies by anthropometry

OBJECTIVE: The present study was undertaken to find out the best simple anthropometric parameter for identifying low birth weight (LBW) babies. STUDY DESIGN: Hospital-based cross-sectional study. PARTICIPANTS: Newborn babies born in KHS hospital, Sevagram. RESULTS: In the present study, out of 868 newborn babies studied, 52.2% were male. Total 12.6% of them were birth weight < 2000 g and 44.6% were birth weight < 2500 g. Birth weight was significantly correlated (p < 0.001) with thigh circumference (TC), mid-arm circumference (MAC), calf circumference (CFC) and head circumference (HC). All anthropometric indicators had a statistically significant sensitivity, specificity and predictive value (p < 0.001) for identifying < or =2500 g birth weight babies. Receiver operating curve (ROC) analysis was done to identify the optimal cut-off points of these anthropometric measures separately for LBW babies and <2000 g birth weight babies. CONCLUSION: HC and TC appears to be better indicators for picking up LBW babies and MAC and CFC appears to be better in picking up very LBW babies.     

A longitudinal study of low birth weight babies

A longitudinal study of the growth and developmental parameters of 121 low birth weight babies along with 50 full term babies as control was carried out. 24.16 percent of low birth weight babies died during the neonatal period. Fifty five low birth weight babies who attended the well body clinic regularly and all the controls were followed up for a period of one year. Their growth and development parameters have been discussed.     

Care of low birth weight babies in slums

We studied 289 newborn infants from birth till one year of age. Low birth weight babies (< 2.5 kg) were 52.9%. Boys suffered 9.7 episodes of sickness, and girls 8.6 episodes of sickness. The mean episodes of various sicknesses, and their impact on weight gain, feeding pattern and growth pattern are discussed. Six deaths were observed, of which 4 were among the low birth weight babies. Mortality in babies born less than 2 kg was 44.4% and above 2 kg was less than 1%.     

Neonatal jaundice in very low birth weight babies

Very low birth weight (VLBW) neonates born between January 1995 to December 1998, who survived for >2 days, were studied for the incidence, causes and interventions required for neonatal jaundice. Significant neonatal jaundice was defined as the total serum bilirubin (TSB) level beyond which baby required intervention (phototherapy and/or exchange transfusion) for neonatal jaundice. The incidence of significant neonatal jaundice (NNJ) was 76.6% and 37.3% required exchange transfusion. It was 82.9% at gestational age ≤28 weeks reduced whereas to 56.9% at gestational age of 35—36 weeks. The incidence was 75.3%, 78.5% and 76.7% in the birth weight group of 750—799 grams, 1000—1249 grams and 1250—1499 grams respectively. Glucose 6 phosphatase dehydrogenase (G-6-PD) deficiency (12.1%) was the commonest cause of jaundice. There is a need for evaluation of prophylactic therapies that enhances liver function or decreases production of bilirubin, which would prevent the rise of TSB to dangerous levels and thus would decrease the need for exchange transfusions.