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.     

Measuring New Born Foot Length to Identify Small Babies in Need of Extra Care: a Cross-Sectional Hospital Based Study

Objective

The neonatal mortality rate (NMR) continues to remain quite high, one important cause being preterm deliveries. The main obstacle in the pathway towards decreasing NMR is identification of babies in need of extra care. To analyze the utility of newborn foot length as a proxy measure for birth weight and gestational age.

Methods

A cross-sectional study done in a hospital of eastern India with 351 babies during 4 months. Right foot length of each recorded using a plastic, stiff ruler.

Findings

48.1% babies were preterm, 51.8% low birth weight (LBW) and 33.3% very low birth weight (VLBW). Foot length less than 7.75 cm has 92.3% sensitivity and 86.3% specificity for identification of preterm neonates. For identification of LBW babies (<2500 gm) a foot length less than 7.85cm has 100% sensitivity and 95.3% specificity. Foot length less than 6.85 cm has 100% sensitivity and 94.9% specifity for identification of VLBW babies (<1500 gm).

Conclusion

Foot length may be used in the identification of LBW and preterm babies who are in need of extra care.     

Physical status of newborns and neonatal outcome

Objective. To determine the extent to which physical status at birth is associated with neonatal mortality and the causes of mortality vis-a-vis size at birth and gestational age.Method : 11,223 consecutive live births completing 26 weeks of gestation and weighing ≥ 500 gm were included in the study. Birth weight and chest circumference were recorded as per WHO guidelines. Gestational age was calculated on the basis of L.M.P. and the new Ballard’s score. Deaths occurring in the hospital within 28 days were recorded. Percentile values of gestational age specific birth weights were calculated separately for singletons and multiple births. Percentage of SGA was calculated with reference to WHO recommended values. Birth weightgestational age-specific mortality rates were calculated at 2 wk and 500 gm intervals.Results : Low-birth-weight babies constituted 39.8% of the total, much in excess of WHO recommended figure of 15%. 76% deaths occurred among LBW babies and 56.2% among preterms. Mortality showed remarkable decline as the birth weight increased to 2000 gm. The lowest mortality was among singletons weighing 2500-3000 gm and of 38–40 weeks gestation. Prevalence of SGA at 40 and 42 weeks were 73.7% and 83.6% respectively. But, if SGA babies not categorised as LBW were excluded, the values came down to 32% and 36% respectively. 36% of all deaths occurred during the first 24 hrs of birth; asphyxia and related causes contributing to 50% of it.Conclusion : Cut-off value of 2000 gm instead of 2500 gm for birth weight may be preferable in countries where most LBW babies are SGAs. Simultaneously, deaths in non-LBW babies due to perinatal causes contribute significantly to total neonatal mortality and need due attention through sensitising obstetricians in essential newborn care and timely intervention.     

Thigh circumference at birth as the best predictor of low birth weight babies

The present study was undertaken to find out the best simple anthropometric parameter for identifying low birth weight babies (LBW). A total of 1000 newborn babies were subjected to anthropometry within 48 hours of life. Birth weight was significantly correlated (p less than 0.001) with thigh circumference (TC), mid-arm circumference (MAC), chest circumference (CC), length (L) and head circumference (HC). However, the correlation was maximum for TC (r = 0.9201). All anthropometric indicators had a statistically significant sensitivity, specificity and predictive value (p less than 0.001) for identifying less than or equal to 2500 g birth weight babies. However, thigh circumference of less than or equal to 14.5 cm and less than or equal to 13.5 cm had the best sensitivity, specificity and predictive value for identifying babies with birth weight of less than or equal to 2500 g and less than or equal to 2000 g, respectively. TC at birth is a cheap, simple, quick and reliable indicator for predicting LBW babies. It may be used whenever weighing at birth is not feasible.     

CDC Kerala 4: TDSC Items Based Developmental Therapy Package Among Low Birth Weight Babies – Outcome at 18 months Using DASII

Objective

To assess the effectiveness of Trivandrum Developmental Screening Chart (TDSC) items based intervention package developed at Child Development Centre, Kerala on the developmental outcome of children at 18 mo of age using Developmental Assessment Scale for Indian Infants (DASII) and compare the same in different birth weight groups.

Methods

Five hundred consecutive discharges from the Neonatal Intensive Care Unit (NICU), Sree Avittam Thirunal hospital, were recruited and followed up till 18 mo of age including 240 low birth weight (LBW;<2,500 g) babies and 260 normal birth weight babies. All 240 LBW babies were offered early intervention at monthly intervals till 12 mo of age, whereas the normal birth weight (NBW) group received only immunization service as per the routine of the hospital. The early intervention package for the low birth weight group was designed based on Trivandrum Developmental Screening Chart (TDSC 0–2 y) items delay. At 18 mo of age both the groups were offered developmental assessment using DASII by specially trained and experienced developmental therapists who were blind to the intervention status of the babies.

Results

It was observed that the LBW (<2,500 g) group, who received intervention had a DASII mental age of 18.31 as against 18.16 in the NBW (≥2,500 g) group and mental DQ 101.84 (LBW group) and 98.65 (NBW group) and the observed differences were not statistically significant. Similarly, the LBW, who received intervention group had a DASII motor age of 18.68 as against 18.47 in the NBW group and motor DQ 139.40 (LBW group) and 135.39 (NBW group) and the observed differences were not statistically significant.

Conclusions

The results of this TDSC based intervention package among low birth weight babies showed that at 18 mo of age there was no statistically significant difference in the developmental outcome using DASII, between low birth weight babies on intervention and the normal birth weight babies without any intervention.

     

Physical status of newborns and neonatal outcome

OBJECTIVE: To determine the extent to which physical status at birth is associated with neonatal mortality and the causes of mortality vis-a-vis size at birth and gestational age. METHOD: 11,223 consecutive live births completing 26 weeks of gestation and weighing > or = 500 gm were included in the study. Birth weight and chest circumference were recorded as per WHO guidelines. Gestational age was calculated on the basis of L.M.P. and the new Ballard's score. Deaths occurring in the hospital within 28 days were recorded. Percentile values of gestational age specific birth weights were calculated separately for singletons and multiple births. Percentage of SGA was calculated with reference to WHO recommended values. Birth weight-gestational age-specific mortality rates were calculated at 2 wk and 500 gm intervals. RESULT: Low-birth-weight babies constituted 39.8% of the total, much in excess of WHO recommended figure of 15%. 76% deaths occurred among LBW babies and 56.2% among preterms. Mortality showed remarkable decline as the birth weight increased to 2,000 gm. The lowest mortality was among singletons weighing 2,500-3,000 gm and of 38-40 weeks gestation. Prevalence of SGA at 40 and 42 weeks were 73.7% and 83.6% respectively. But, if SGA babies not categorised as LBW were excluded, the values came down to 32% and 36% respectively. 36% of all deaths occurred during the first 24 hrs of birth; asphyxia and related causes contributing to 50% of it. CONCLUSION: Cut-off value of 2,000 gm instead of 2,500 gm for birth weight may be preferable in countries where most LBW babies are SGAs. Simultaneously, deaths in non-LBW babies due to perinatal causes contribute sgnificantly to total neonatal mortality and need due attention through sensitising obstetricians in essential newbom care and timely Intervention.     

Cause-specific neonatal mortality in a neonatal care unit in Northern Tanzania: a registry based cohort study

ABSTRACT: BACKGROUND: The current decline in under-five mortality shows an increase in share of neonatal deaths. In order to address neonatal mortality and possibly identify areas of prevention and intervention, we studied causes of admission and cause-specific neonatal mortality in a neonatal care unit at Kilimanjaro Christian Medical Centre (KCMC) in Tanzania. METHODS: A total of 5033 inborn neonates admitted to a neonatal care unit (NCU) from 2000 to 2010 registered at the KCMC Medical Birth Registry and neonatal registry were studied. Clinical diagnosis, gestational age, birth weight, Apgar score and date at admission and discharge were registered. Cause-specific of neonatal deaths were classified by modified Wigglesworth classification. Statistical analysis was performed in SPSS 18.0. RESULTS: Leading causes of admission were birth asphyxia (26.8%), prematurity (18.4%), risk of infection (16.9%), neonatal infection (15.4%), and birth weight above 4000 g (10.7%). Overall mortality was 10.7% (536 deaths). Leading single causes of death were birth asphyxia (n = 245, 45.7%), prematurity (n = 188, 35.1%), congenital malformations (n = 49, 9.1%), and infections (n = 46, 8.6%). Babies with birth weight below 2500 g constituted 29% of all admissions and 52.1% of all deaths. Except for congenital malformations, case fatality declined with increasing birth weight. Birth asphyxia was the most frequent cause of death in normal birth weight babies (n = 179/246, 73.1%) and prematurity in low birth weight babies (n = 178/188, 94.7%). The majority of deaths (n = 304, 56.7%) occurred within 24 hours, and 490 (91.4%) within the first week. CONCLUSIONS: Birth asphyxia in normal birth weight babies and prematurity in low birth weight babies each accounted for one third of all deaths in this population. The high number of deaths attributable to birth asphyxia in normal birth weight babies suggests further studies to identify causal mechanisms. Strategies directed towards making obstetric and newborn care timely available with proper antenatal, maternal and newborn care support with regular training on resuscitation skills would improve child survival.     

Fetal and maternal factors associated with neonatal adiposity as measured by air displacement plethysmography: A large cross-sectional study

Background

There is evidence that the fetal and early postnatal environments play a role in determining the risk of lifetime obesity, diabetes and cardiovascular disease. Neonatal body composition, as a surrogate marker of the in-utero environment, can be reliably and accurately measured by air displacement plethysmography (ADP). Our primary objective was to identify preconception, fetal and maternal factors affecting neonatal body composition.

Methods

This cross-sectional study included 599 term babies born between September and October 2010 at Royal Prince Alfred Hospital, Sydney, Australia. Neonatal body fat percentage (BF%) was measured within 48 h of birth using ADP. Maternal demographic, anthropometric and medical data as well as neonatal gestational age and sex were used to develop a regression model that predicted body composition and birthweight.

Results

The mean (SD) neonatal BF% in our whole population was 9.2(4.4)%. Significant variables in the model for neonatal BF% were neonatal sex, gestational age, maternal ethnicity, gestational weight gain (GWG), pre-pregnancy BMI, parity and maternal hypertension (p < 0.05); together, these explained 19% of the variation in BF%. GDM status was not a significant variable. Neonatal female sex, maternal Caucasian ethnicity and increased gestational weight gain explained the most variation and were most strongly associated with increased BF%.

Conclusions

This study highlights maternal obesity and increased gestational weight gain as two factors that are amenable to intervention as risk factors for newborn adiposity, which is important in the future study of the “developmental origins of health and disease” hypothesis.     

Mid arm circumference (MAC) and body mass index (BMI)--the two important auxologic parameters in neonates

Even though birth weight is the most sensitive predictor of health and outcome, accurate weighing and proper recording are not done in most developing countries. Most neonates lose 10% of body weight soon after birth and when such babies subsequently come for medical care, it becomes difficult to know whether the baby was low birth weight (LBW) at birth or not, to predict the outcome. Among the many surrogate auxologic parameters to identify LBW babies, mid arm circumference (MAC) was found to be the most useful and simplest. At a cut off of 9 cm, with a sensitivity of 92% and a specificity of 90.5% to identify LBW, MAC is recommended as an alternative measurement. Ponderal index is measured in neonatal period to identify growth retardation. Body mass index (BMI) is a very useful index in children and adults to identify obesity/chronic energy deficiency (CED). Tracking of BMI from neonatal period to adulthood is recommended to plan intervention and predict outcome. The mean BMI observed in the present study was 12.86 kg/m2 close to the expected of 13.     

Determinants of survival in very low birth weight neonates in a public sector hospital in Johannesburg

Background  

Audit of disease and mortality patterns provides essential information for health budgeting and planning, as well as a benchmark for comparison. Neonatal mortality accounts for about 1/3 of deaths < 5 years of age and very low birth weight (VLBW) mortality for approximately 1/3 of neonatal mortality. Intervention programs must be based on reliable statistics applicable to the local setting; First World data cannot be used in a Third World setting. Many neonatal units participate in the Vermont Oxford Network (VON); limited resources prevent a significant number of large neonatal units from developing countries taking part, hence data from such units is lacking. The purpose of this study was to provide reliable, recent statistics relevant to a developing African country, useful for guiding neonatal interventions in that setting.     

Epidemiology of low birth weight in Ahmedabad

The study to elucidate epidemiological features of LBW (low birth weight) babies shows incidence of LBW to be 20·37%, out of 481 single births studied in 1982. 6·03% were small for gestational age (SGA). Of LBW babies 61·22% were born preterm (<37 weeks) as compared to 31·85% of normal babies. Of preterm babies 3·3% were SGA, while 7·69% of fullterm babies were SGA. SGA babies were found to be significantly related to parity, being most common in primi, and without antenatal care (ANC). Younger (15–25 years), shorter and primipara mothers were more likely to give birth to LBW babies. Of mothers giving birth to normal babies 85·52% had taken ANC, as compared to 67·34% giving birth to LBW babies. SGA was more common in mothers who had not taken ANC. Young, short and primipara mothers, who are prone to give birth to LBW babies should be detected early and brought under qualitative ANC.     

can the special care neonatal unit admission cut-off be lowered down to 1500g babies?

Objective  

The study was conducted to find out whether there is any significant difference in outcome if low birth weight babies weighing between 1500g and 1800g are managed by keeping them with their mothers, i.e., without special care neonatal unit (SCNU) admission.     

Meta-Analysis to Estimate the Correlation Coefficients Between Birthweight and Other Anthropometric Measurements at Birth

Objective  

To pool the correlation coefficients between birthweight (BW) and other newborn anthropometric measurements at birth.     

Comparison of Two Phototherapy Methods (Prophylactic vs Therapeutic) for Management of Hyperbilirubinemia in Very Low Birth Weight Newborns

Objective

Preterm and low birth weight (LBW) infants are at greater risk of developing bilirubin-associated brain damage compared with term infants. Certainly, phototherapy, if used appropriately, is capable of controlling the bilirubin levels in LBW infants; but there is not a unique phototherapy treatment strategy in LBW infants. This study was designed to compare the prophylactic phototherapy and late treatment of jaundiced newborns weighing 1000-1500 grams.

Methods

Sixty newborns with birth weight 1000–1500 g were studied. They were divided into two groups: the “Prophylactic” group, in which phototherapy started within six hours after birth and continued for at least 96 hours, and the "Treatment" group, which received phototherapy when indicated according to birth weight and suspended when bilirubin level fell below 50% of bilirubin level for blood exchange. Mean value of daily transcutaneous bilirubin (TCB), duration of phototherapy, the need for blood exchange, and the highest TCB value in both groups were analyzed.

Findings

In the prophylactic group, the highest daily mean rate of TCB was 7.71±1.84 mg/dl, which happened on the third day. In the treatment group, it was 8.74±1.72 mg/dl on the fourth day after birth. The TCB values in prophylactic group were significantly less than those of the treatment group only on the fourth and fifth days after birth (P<0.001). Although the median duration of phototherapy in the treatment group was shorter than that of the prophylactic group (137.60±57.39 vs 168.71±88.01 hours, respectively), this difference was not statistically significant. Only one neonate needed blood exchange in the treatment group.

Conclusion

The prophylactic phototherapy treatment for babies weighing 1000–1500 g significantly decreases bilirubin levels on the fourth and fifth days after birth but the clinical course of hyperbilirubinemia does not alter in LBW infant, as indicated by the non-significant change in the duration of phototherapy.     

Neonatal mortality rate: Relationship to birth weight and gestational age

A total of 2063 live births were studied during one year period from July 1994 to June 1995. Neonatal mortality rate (NMR) was 35.4 per thousand live births. The case fatality rate among low birth weight and preterms was 10.1% and 18.1% respectively. Though, low birth weight babies accounted for 27.8% of the live births but contributed for 79.5% of neonatal deaths [p<0.001]. Similarly, preterm babies accounted for 13.2% of the live births but contributed for 69.9% of neonatal deaths [p<0.001]. The causes of neonatal deaths found were birth asphyxia (31.1%), infections (23.3%), immaturity (17.8%), hypothermia (9.6%), hyaline membrane disease (2.7%) and cogenital malformation (1.4%). There is need to identify strategies to reduce the incidence of prematurity and low birth weight babies. Comprehensive antenatal coverage and adequate care followed by optimal management of newborns at birth is likely to reduce NMR and improve quality of life among survivors.     

Kangaroo Mother Care (KMC) in LBW infants—a Western Rajasthan experience

Objective This study was taken to study the various beneficial effects of KMC in LBW babies. Methods 50 LBW babies (birth weight >2 kg) two who delivered at Umaid Hospital, RIMCH Jodhpur included in this study and they have given KMC 4–6 hours/day in 3–4 settings. Maternal & Neonatal characteristics and complications prospectively recorded. Results Of 50 LBW babies enrolled, M:F ratio was 1.5:1 and mean birth weight was 1.487 ± 0.175kg. The mean age at which KMC started was 4±1.738 days. The mean weight gain was 29 ± 3.52 gms, mean age of discharge 23.6 ± 3.52 days and mean duration of hospital stay was 15.5 ± 11.3 days. Conclusion KMC is effective and safe in stable preterm infants and as effective on traditional care with incubators. KMC because of its simplicity may have a place in home care of LBW babies.     

Maternal risk factors associated with term low birth weight neonates: <Emphasis Type="Italic">A matched-pair case control study</Emphasis>

Objective  

To study maternal risk factors associated with full term low birth weight (LBW) neonates.     

Effect of Zinc Supplementation on Growth of Low Birth Weight Infants Aged 1–6 Mo in Ardabil,Iran

Objective  

To assess the effect of zinc supplementation on growth of low birth weight (LBW) infants aged 1–6 mo.     

Experience with Kangaroo mother care in a neonatal intensive care unit (NICU) in Chandigarh,India

Objective  

To study the feasibility and acceptability of Kangaroo mother care (KMC) on the low birth weight infants (LBWI) in the neonatal intensive care unit (NICU) by the mothers, family members and health care workers (HCW) and to observe its effect on the vital parameters of the babies.