Prenatal care and the low birth weight infant

In this study the authors assessed human and economic consequences of low birth weight linked to the lack of prenatal care for indigent women. Low birth weight infants were defined as those who weighed between 860 and 2220 g, corresponding to the 50th percentiles at 26 and 34 weeks' gestation. Women seeking prenatal care had a significantly decreased incidence of low birth weight infants compared with those without such care. Concomitantly, low birth weight infants born to women with prenatal care had significantly better perinatal survival as well as less frequent respiratory distress and intraventricular hemorrhage. Because of these factors, infants born to clinic mothers used fewer neonatal intensive care days and had shorter hospitalizations. Hospital costs were reviewed for 175 surviving infants and failure to obtain prenatal care was associated with a 50% increase in costs for each infant. The frequencies of the most common pregnancy complications in women with and without prenatal care, coupled with corresponding obstetric interventions, suggest that such care facilitates identification and management of women at risk for delivery of low birth weight infants. The authors conclude that there are important human and economic advantages of antenatal care for indigent women.     

Evidence-based delivery room care of the very low birth weight infant

The first hour of a newborn's life is fraught with difficulty. Recommendations regarding the fundamental issues of resuscitation of these infants are developed and disseminated by the International Liaison Committee on Resuscitation and other organizations. However, these recommendations frequently do not address the needs of the very low birth weight infant and do not address some of the nuances that might lead to improved outcome. Improved organization and teamwork as well as improved monitoring and respiratory support can potentially improve the outcome of these infants.     

Special considerations in the nursing care of the very low birth weight infant

Improvement in obstetric and neonatal care has resulted in an increase in the number of very low birth weight infants (less than 1000 grams) being cared for in neonatal intensive care units. This article addresses issues related to the special nursing implications required in the care of these infants.     

Perinatal care regionalization and low birth weight infant mortality rates in Alaska

OBJECTIVE: The purpose of this study was to determine the extent to which the failure of non-tertiary care hospitals to appropriately triage and refer pregnant women and newborns contributes to low birth weight infant death in Alaska. STUDY DESIGN: Birth certificates from 1993 to 1997 were reviewed for all 2809 infants who were born at less than 2500 g. Death certificates and maternal and infant medical charts were reviewed for all 168 infant deaths that occurred during this time. RESULTS: Mother-infant pairs who received all care at Alaska's single tertiary care center had a lower mortality rate than those who received some care at a non-tertiary care center (risk ratio, 1.5; 95% confidence interval, 0.86-2.6). Despite this, only 4% of deaths among low birth weight infants (all <1500 g) were associated with care decisions at non-tertiary centers; none of these deaths involved intentional inappropriate retention of infants or mothers. CONCLUSION: Further emphasizing perinatal care regionalization (including for infants 1500-2499 g birth weight) is unlikely to substantially decrease low birth weight infant mortality rates.     

Breastfeeding the low birth weight preterm infant

The recent increase in the use of human milk in feeding low birth weight (LBW) preterm infants has stimulated new research questions in infant nutrition, especially in regards to the nutritional adequacy and nutrient composition of milk from mothers of mature and preterm infants. The current state of knowledge on the effect of feeding human milk with or without nutritional supplements on growth of the low birth weight infant is summarized. Recommendations and guidelines for feeding human milk and/or supplementing human milk in LBW infants are discussed and appropriate handling of human milk and feeding schedules are outlined.     

Urinary bladder perforation in a very low birth weight infant. A case report

Perforation of the urinary bladder is a rare complication with a considerable degree of morbidity and mortality in modern neonatal intensive care units. We report a case of urinary bladder perforation, which probably was triggered by prolonged urinary retention secondary to morphine infusion, using credé maneuver on an already over-distended bladder, and inserting an umbilical catheter as urethral catheterization in an extremely low birth weight infant.     

Haemophilus parainfluenzae sepsis in a very low birth weight premature infant: a case report and review of the literature.

Haemophilus parainfluenzae is an unusual cause of invasive bacterial disease and is particularly uncommon as a reported etiology of neonatal sepsis in current large published series. We describe a seriously ill, very low birth weight (VLBW) infant with documented early onset sepsis caused by H. parainfluenzae. We compare our case with those published previously and contrast the clinical presentation of infection in our patient to that of common bacterial pathogens causing neonatal sepsis. Our review suggests many common factors in the pathogenesis of early onset infection by H. parainfluenzae.     

Effect of maternal weight gain on infant birth weight

OBJECTIVE: To ascertain whether increased weight gain during pregnancy resulted in higher birth weight infants. METHODS: A database was constructed from valid data of a sample of 159 healthy women between 19 to 37 years of age. The inclusion criteria were: maternal age of 19-37 years, term gestations (37-42 weeks), a baseline weight obtained at 0-15 weeks gestation, and a final weight obtained within 2 weeks of delivery. Weight gain was calculated by subtracting baseline weight from the final weight. A documented height enabled calculation of BMI. A negative screen for gestational diabetes was required. RESULTS: Women with lower first trimester BMI (< 25) had infants of lower birth weight than women of higher BMI (> 25). Women with lower gain (< 35 lbs) delivered smaller infants than women with higher gain (> 35 lbs). Women of higher BMI and higher gain delivered the largest infants (F = 5.37; p = 0.0015). Underweight women (BMI < 19) gained less weight than women of normal weight (BMI 19-25), who gained the most weight. Obese women (BMI > 29) gained the least weight (F = 6.26; p = 0.0005). CONCLUSION: The results confirmed that excessive maternal weight gain in pregnancy (> 35 lbs), does result in higher birth weight infants.     

Neonatal and infant problems of low birth weight

New therapies are being developed to improve survival of low-birth-weight infants, especially those weighing less than 1000 g. The most exciting new development is the use of surfactant replacement therapy for treatment of respiratory distress syndrome. This therapy results in less severe acute lung disease and has decreased mortality from respiratory distress syndrome. As more infants survive, consideration of long-term sequelae including chronic lung disease and neurologic outcome are of paramount importance. This review covers strategies for prevention and treatment of respiratory distress syndrome (including surfactant replacement). New and evolving treatments for amelioration of chronic lung disease and issues in neurologic outcome for the low-birth-weight infant (including prevention of intraventricular hemorrhage) are addressed.     

Racial differences in prenatal care of mothers delivering very low birth weight infants.

OBJECTIVES: To determine whether there are any racial differences in the prenatal care of mothers delivering very low birth weight infants (VLBW). STUDY DESIGN: Retrospective cohort study of infants cared for at a single regional level III neonatal intensive care unit over a 9-year period, July 1993-June 2002, N = 1234. The main outcome variables investigated included antenatal administration of steroids, delivery by cesarean section, and use of tocolytic medications. Both univariate and multivariate analyses were performed. RESULTS: After controlling for potential confounding variables, white mothers delivering VLBWs had an increased odds of cesarean delivery (odds ratio 1.5, 95% confidence intervals (CI) 1.1-2.0), receiving antenatal steroids (1.3, CI 1.01-1.8), and tocolysis (1.4, CI 1.1-2.0) compared to black mothers. The models controlled for gestational age, multiple gestation, premature labor, clinical chorioamnionitis, maternal age, income, year of birth, and presentation. CONCLUSIONS: In our population of VLBWs, white mothers are more likely to receive antenatal steroids, tocolytic medications, and deliver by cesarean section when compared to black mothers. From our data we cannot determine the reasons behind these racial differences in care of mothers delivering VLBWs.     

Effect of prenatal smoking cessation interventions on birth weight: meta-analysis

Background: Smoking is preventable factor for pregnancy outcomes such as low birth weight (LBW). In this study, we assessed the effects of smoking cessation in pregnancy period on the birth weight in Randomized Controlled Trial studies (RCTs).

Methods: International databases of Pub Med, Scopus, and Web of Science, by the MeSH heading and/or additional terms, were searched to assess relevant studies in systematic possess. I² statistics was used to assess of heterogeneity. Pooled effects size was obtained by random effects model. Meta-regression was used to explore of heterogeneity using Stata software version 12 (Stata Corp, College Station, TX).

Results: A total 16 RCTs, 6192 women were enrolled to assess of smoking cessation in pregnancy period on the birth weight. Relative risk (RR) of not smoking at the end of pregnancy in intervention group was 2.47 (95% CI: 1.73–3.20). The odds ratio (OR) for effect of smoking cessation on LBW was 0.65 (95% CI: 0.42–0.88) and standardized mean difference (SMD) was significantly increased in the intervention group, 0.28 (95% CI: 0.05–0.50).

Conclusions: Results of this study approve results of previous RCTs that smoking cessation in pregnancy is a good practical action to prevention of LBW in infants.     

Low birth weight and early weight gain in the metabolic syndrome: Consequences for infant nutrition

Emerging data indicate that being born small for gestational age (SGA) and rapid infant catch-up growth may play a significant role in the risk of developing type 2 diabetes (T2DM) and the metabolic syndrome (MS) many years later in life. The impact of these perinatal T2DM and MS risk factors may be more important than genetics in some parts of the world, including low-income countries. Breastfeeding for 3–6 months is associated with reduced risk of developing insulin resistance and the metabolic syndrome. Promotion of fast growth in SGA infants by nutrient-enriched formula increases risk of hypertension and the metabolic syndrome. While waiting for better knowledge of how to combat T2DM and MS with early-life interventions, breastfeeding should be recommended and enforced whenever possible, keeping in mind the health and nutritional status of the mother. Furthermore, promotion of fast weight gain in SGA infants by nutrient-enriched formula feeding should be used with caution. However, growth limitation by restriction of nutrition in SGA infants below general recommendations should not be recommended.     

Quality of prenatal care; selected social, behavioral, and biomedical factors; and birth weight

Two hundred two poor, mainly black women were studied to assess the effects of selected social, behavioral, and biologic factors on birth weight. A path analysis was used to model hypotheses about the interrelationships among these variables. Six sociocultural factors had direct paths to quality of prenatal care: amount of insurance, delay in telling others about the pregnancy, attitudes toward health professionals, month of gestation in which the pregnancy was suspected, perception of the importance of prenatal care, and initial attitude toward the pregnancy. Together, these factors accounted for 64% of the variance in the quality of prenatal care received. Four variables had direct paths to birth weight: month in which the pregnancy was suspected, quality of prenatal care, hypertension, and substance abuse, which together accounted for 13% of the variance in birth weight. The key findings were the relative impact that the quality of prenatal care, especially the source of care, had on birth weight, and the potential for improving birth outcomes by addressing the negative effects of underlying social factors.