MATERNAL FACTORS CONTRIBUTING TO LOW BIRTH WEIGHT INFANTS

Low birth weight (LBW) infants are babies that are born weighing less than 2.5 kgs; whereas an average infant weight should ideally be about 8 pounds or more. Infant weight is a key determinant of survival, health and development of the child. It is also a dominant factor contributing towards infant morbidity and mortality, but if treated and cared for properly, low birth weight infants can develop normally with minimum complications. Though, it is important to understand what factors contribute towards low birth weight, so that the problem can be treated effectively.

Causes of Low Birth Weight

One of the prime causes of low birth weight is premature birth of the baby – implying that the baby was born before 37 weeks of pregnancy resulting in less time in mother’s womb for growth and gaining weight since most of the weight is gained by the baby during the last few weeks of pregnancy.

Another, significant cause of low birth weight is a problem called intrauterine growth restriction (IUGR), which implies improper growth of baby even during pregnancy. Infants that are affected by this condition could be born with low birth weight in spite of having completed the entire pregnancy term. However, IUGR can also result in premature birth. The condition may be caused due to fetal, placental or maternal factors or a combination of these.

Maternal Factors Contributing to Low Birth Weight

One of the prime causes of low birth weight in infants are maternal factors affecting the fetus in utero and the impact on fetus. Some maternal factors contributing to low birth weight are:

  • Age: Mothers of age 20 years or below are more likely to have babies that have low birth weights.
  • Interval between pregnancies: The lesser the gap between two consecutive pregnancies, higher are chances of the infant being born with low birth weight
  • Height: The height of a mother affects the birth weight of the infant; if the mother’s height is not more than 145 cms, there are higher chances of the infant being born with low birth weight.
  • Pre-pregnancy body mass index: Higher the body mass index of the mother, lesser are chances of low birth infants being born.
  • Haemoglobin levels: Pregnant women who have haemoglobin levels lower than 11g/dl are more prone to have children with low birth weight.
  • Previous pregnancies resulting in still birth, neonatal death, etc.
  • Multiple and consecutive abortions: Women who have had three consecutive abortions are more likely to have premature children or infants born with low birth weight.
  • Preeclampsia: Preeclampsia affects the arteries that supply blood to the placenta, when these arteries are compromised the placenta does not get enough blood that hampers the supply of blood, nutrients and oxygen to the baby, leading to slow growth and low birth weight or preterm birth.
  • Hyper-anxiety and stress: Excessive anxiety and acute stress during pregnancy can cause preterm birth and low birth weight. Depression has also been linked to low birth weight among infants.
  • Renal insufficiency: Renal insufficiency negatively affects the pregnancy and can cause low birth weight in infants.
  • Cardio-respiratory diseases: Cardio-respiratory issues such as asthma in pregnant women increases the risk of low birth weight in infants.
  • Autoimmune disorders: For women who have autoimmune disorders such as thyroiditis before pregnancy, which is not controlled – have higher chances of giving birth to low birth weight infants.

Factors such as diabetes, malnutrition, bleeding, infection and fetal anomalies – also increase the likelihood of mothers giving birth to low weight infants.

Risk Factors for Low Birth Weight

Several factors other than pre-mature birth and IUGR, can also cause higher risk of low birth weight. These include:

  • Infection during pregnancy
  • Not gaining adequate weight during pregnancy
  • Smoking
  • Alcohol
  • Drug abuse
  • Previous pregnancy with low birth weight delivery
  • Race – African-American

Symptoms of Low Birth Weight

Apart from infants weighing less than 2.5 kg at birth, infants that have low birth weight seem much smaller as compared to those with normal weight. Moreover, the infant has very low body fat and also may have a head that looks bigger in proportion to the entire body.

Diagnosis of Low Birth Weight

Weight of infants is measured right after their birth. A baby weighing less than 2500 grams or 2.5 kgs is considered to be born with low birth weight; a baby weighing less than 1500 grams at birth are considered to have very low birth weight; and a baby weighing less than 1,000 grams at birth has very low chances of survival.

Low birth weight is checked during pregnancy via ultrasound that provides assessment of baby’s growth and development. Low birth weight can also be detected during pregnancy and that is the main reason regular health check-ups during pregnancy are recommended. These tests help determine growth of the baby during pregnancy via methods such as fundal height, which is measured from the top of the pubic bone to top of the uterus. The fundal height (in cms) is of the same as the number of weeks of pregnancy. In case, the fundal height is lower than expected, the growth of the baby is not appropriate.

Treatment of Low Birth Weight

Most babies grow normally if they do not have any other complications other than low birth weight; however, infants that weight even lower than 1 pound are less likely to survive. That said, the treatment of low birth weight depends on the symptoms, age and general health of the infant. Some treatment options include:

  • Neonatal intensive care unit (NICU)
  • Temperature-controlled rooms and bed
  • Feeding the baby through intravenous lines

Complications of Low Birth Weight

Though not all low birth weight infants tend to face similar problems; however some of the complications that arise because of low birth weight in infants are:

  • Oxygen problem at birth
  • Problem in staying warm due to lack of fat
  • Problems in feeding
  • Inability to gain weight
  • Nutritional deficiency
  • Breathing problems
  • Immature lungs
  • Problems with nervous system
  • Digestive issues
  • Sudden infant death syndrome (SIDS)
  • Cerebral palsy
  • Vision problems
  • Deafness
  • Delayed growth and development

That said, maternal factors and other reasons affecting infants and causing low birth weight can be prevented by following a healthy diet during pregnancy, avoiding alcohol, and quitting smoking and drugs. Moreover, regular health check-ups promote proper growth and steady nutritional to the baby, they help monitor any problems and take preventive steps.

KNOW THE VACCINATION CHART FOR BABY IN INDIA

Bringing a baby into the world also demands you to attentively and carefully protect them from disease. For this purpose, vaccinations or immunizations are very critical since they safeguard babies from many preventive illnesses. With the increasing risk of health problems, existing health hazards and prevalent conditions of survival, it is important the babies are shielded from as many diseases as possible. As per records, approximately 3 million deaths worldwide can be prevented if children receive proper and timely vaccinations against preventable diseases such as tetanus, hepatitis, polio, pneumonia, diarrhea, etc.

In India, several initiatives and programs have been launched in this space to promote awareness about immunizations for babies. More so, the government also organizes campaigns and sets-up free centres to provide vaccinations at no cost. Even then, the number of children who do not receive vaccinations is very high. In India, on an average, more than 1.2 million children die each year before completing five years of age. These deaths are accountable for widespread diseases and the lack of awareness on parts of parents to immunize their child from preventable diseases. As per WHO, over 22 million children do not receive proper and complete vaccinations; the number is only increasing every year.

Hence, there is a clear lack of knowledge about the need for vaccinations, as well as awareness about the essential vaccinations required for the baby. Below is the vaccination chart for babies in India as directed by the Indian Academy of Paediatrics (IAP).

Age
(completed
weeks/months/years)
VaccinesDosesContent Tag
BirthBacillus Calmette–Guérin (BCG)1BCG
Oral Polio Vaccine (OPV 0)1OPV
Hepatitis B (HB 1)1Hep -B
6 weeksDiptheria, Tetanus and Pertussis vaccine (DTP 1)1DTP
Inactivated Polio Vaccine (IPV** 1)1IPV
Hepatitis B  (HB 2)1Hep -B
Haemophilus Influenzae Type B (HiB 1) 1HiB
Rotavirus 11Rotavirus
Pneumococcal Conjugate Vaccine (PCV 1)1PCV
10 weeksDiptheria, Tetanus and Pertussis vaccine (DTP 2)1DTP
Haemophilus Influenzae Type B (HiB 2)1HiB
Inactivated Polio Vaccine (IPV** 2)1IPV
Hepatitis B (HB 3)1Hep -B
Rotavirus 21Rotavirus
Pneumococcal Conjugate Vaccine (PCV 2)1PCV
14 weeksDiptheria, Tetanus and Pertussis Vaccine (DTP 3)1DTP
Haemophilus Influenzae Type B (HiB 3)1HiB
Inactivated Polio Vaccine (IPV** 3)1IPV
Hepatitis B  (HB*4)1Hep B
Rotavirus 3****1Rotavirus
Pneumococcal Conjugate Vaccine (PCV 3)1PCV
6 monthsInfluenzaOPV12TCV
9 months9-12 monthsMeasles, Mumps, and Rubella (MMR 1)Typhoid Conjugate Vaccine1MMR
12 monthsHepatitis A (Hep A1)1Hep -A
13-15 monthsMeasles, Mumps, and Rubella (MMR 2)1MMR
Varicella 11Varicella
PCV Booster 11PCV
16 to 18 monthsDiphtheria, Perussis, and Tetanus (DTP B1)1DTP
Inactivated Polio Vaccine (IPV*** B1)1IPV
Hepatitis A (Hep A2*****)1Hep – A
Haemophilus Influenzae Type B (HiB B1)1HiB
4 to 6 yearsDiphtheria, Perussis, and Tetanus (DTP B2)1DTP
Varicella 21Varicella
Measles, Mumps, and Rubella (MMR 3/MMRV)1MMR
9 to 14 yearsTdap1Tdap
Human Papilloma Virus (HPV 1 & 2)1HPV
15 to 18 YearsTd1Tdap
Human Papilloma Virus (HPV 1, 2 & 3)1HPV

As per IAP-ACVIP Recommended immunization schedule for children aged 0-18 years (2018-19)

*Fourth Dose of Hepatitis B permissible for combinations vaccine only

**In case IPV is not available or feasible, the child should be offered bOPV (3 doses). In such case give two fractional doses of IPV at 6 wk and 14 wk

***b-OPV, if IPV booster (standalone or combination) not feasible

****Third dose not required for RV 1. Catch up to 1 year of age in the UIP schedule.

*****Live attenuated Hepatitis A vaccine: Single done only

******Begin influenza vaccine after 6 months of age, about 2-4 weeks before the season, give 2 doses at the interval of 4 weeks during the first year and then single dose yearly till 5 years of age

Moreover, there are some vaccinations that are recommended for children that are exposed to or living in high-risk areas. These vaccinations include:

  • Meningococcal (MCV)
  • Japanese Encephalitis (JE)
  • Cholera
  • Human Papillomavirus (HPV)

That said, there are also cases of children that are more prone to developing certain health condition because of some high-risk factors linked to them. These factors that put children at high risk are:

  • Congenital or acquired immune deficiency
  • Liver disease
  • Diabetes
  • Chronic cardiac, liver, renal, or hematologic disease
  • Frequent travelers
  • Prolonged exposure to radiation therapy, steroids, etc.
  • Hyposplenia
  • Cochlear implant surgery
  • Malignancies

Vaccinations also vary depending on the geographical location of the children. Moreover, if the child is facing exiting critical/severe health concerns, there might be a different vaccination schedule that may be prescribed. One must consult the paediatrician in both the cases above.

Further, it is also very important to remember and take into consideration the following factors before and while getting the child immunized.

  • Do not skip any vaccination, follow the schedule religiously
  • Do not get any advanced vaccination
  • Seek advice before you travel with your child or children
  • Skip the vaccination in case the child has a serious health problem or ongoing fever
  • Opt for painful vaccinations; they have no long-term side effects
  • The child might get some fever post-immunization
  • Provide comfort to your child by singing, distracting or playing with them, etc.
  • Do not panic during the vaccination, it can make the child frightful and hysteric
  • Check with your doctor before feeding the child before vaccination

In case any vaccination is missed, check with the paediatrician to know the best time to get it done. Vaccinations are easy and very essential for good health. Hence, remember to consult your paediatrician and get your child vaccinated as per recommendations.

SEVEN IMPORTANT REASONS TO VACCINATE YOUR CHILD

Children are the centre of parents’ universe and as caregivers, we aim to do all that is possible to protect our child. One such critical aspect of protection is vaccination. Vaccinating the child against possible diseases helps to ensure a child’s safety and health. It is imperative that we, as parents, do what is required to safeguard them, so that they have a healthy start in life by receiving all vaccinations as recommended by the paediatrician. Seven critical reasons that establish the need to vaccinate your child are:

Vaccinations save lives: Immunizations or vaccinationshave been curated to protect children from contacting multiple life-threatening diseases. During earlier times, when the medicine was not advanced, disease outbreaks would claim lives of thousands of children; however, with due advancements in the medical field, vaccinations to protect children from such fatal diseases were introduced. As of today, several diseases that had in the earlier times claimed several lives are now eradicated – such as smallpox, polio, rinderpest, hookworm, etc. Moreover, vaccinations also tend to minimize the chances of children contracting severe diseases such as Hepatitis A & B, chickenpox, measles, mumps, rubella, flu, rotavirus, etc. today vaccines can protect against more diseases than ever before. 

Vaccines are safe and effective: There is a notion in some parents who believe vaccines to be ineffective or particularly unsafe instead of their actual opposite functionality.Vaccines are curated after years of pioneering scientific research and are tested before being given to the babies.Thus, vaccines are 100% per cent safe and also very effective. However, some minor side effects can be experienced on the site of the injection such as redness, itching, pain, tenderness or swelling but that eventually fades in a day or two. Some children may also get fever post-vaccination, which is very typical and should return to normal easily and shortly. These side effects outweigh the diseases these vaccines protect your children against. 

Vaccines protect your family, as well as other families: Vaccines tend to not only protect and safeguard your child and family but also several other families and their children who could have contacted the disease because it was contagious. Even after the effectiveness of vaccines, there are still outbreaks of vaccine-preventable diseases, which is basically because of areas which have lower vaccination rate. This may be either because of lack of knowledge or in some cases, even because the recipient of the vaccination is either too young or has a compromised immune system and hence, cannot receive the vaccine. Thus, in such conditions, these individuals become dependent on people around them to be vaccinated so that the disease does not spread. Hence, all those who can and are able to get vaccinations for their children must do so. 

Vaccination saves time and money: If children are vaccinated and protected against diseases, they tend to stay healthy and carry on routine activities enabling the parents to focus on work and other considerations. Moreover, if a child is not vaccinated and is affected by such a disease, it would demand a lot of time and money on the part of the parents, not to forget the mental agony a parent goes through. Hospital costs, loss of work medications, etc. will create a lot of burden on the family. Vaccines help children stay safe, grow and thrive!

Immunizations protect generations: Vaccinations tend to prevent harmful diseases that can also claim the lives of children. There have been many vaccinations which have reduced or eradicated the disease completely today, such as smallpox. Children today do not receive the vaccine for smallpox because it no longer exists. Similarly, getting out children vaccinated today completely as per immunizations suggested by the paediatricians will help the future children to remain disease-free.

Vaccinations protect children even while travelling: Getting the children all vaccinations as per the schedule and specific vaccinations if travelling to a disease-prone country can ensure their safety and good health. Travelling to another country does make you children vulnerable to a lot of diseases of the country concerned; hence, to ensure that travelling is smooth and the child is protected against disease – immunizations must be taken very seriously. Before travelling, check for the diseases prevalent in the country and accordingly ask the paediatrician for the concerned vaccine, if any. Also, the vaccine chart for children approved by The Indian Academy of Paediatrics (IAP) takes into consideration globally prevalent diseases too. 

Vaccination is a public duty: Though vaccination has led to declining of multiple diseases. Yet, diseases such as measles, mumps, whooping cough, etc. are a threat and can result in an outbreak if vaccines to prevent these are not given to children. These diseases can result in serious complications such as amputation of arm or leg, paralysis, hearing loss, brain damage or even death. Hence, it becomes the duty of every citizen to ensure they get their child vaccinated to prevent not only the child but also all other children who can contract the disease if not prevented.

That said, the advantages of vaccination significantly outweigh the disadvantages. Also, today, with better education and healthcare opportunities, the rate of children getting immunizations in India has increased. However, there is still a long way to go to ensure a healthy India. 

IMPORTANCE OF BREAST FEEDING AND NEW BORN CARE

The importance of breastfeeding the baby has been known and established for decades. Breast milk is the safest and the healthiest food for the baby because it is easily digestible and contains all the nutrition required by the baby, at least for the first six months. Though the decision to breastfeed the baby is entirely a personal choice but the importance and need of breastfeeding for the baby, as well as for the mother must be understood clearly.

It is recommended that a mother should breastfeed the baby at least for 6 months, during this time the baby need not be fed any other item. Post 6 months of light food such as vegetables, grains, fruits, proteins can be given along with breastfeeding if the mother feels up for it. The advantages of breastfeeding the baby for both the baby and the mother must be considered before deciding on whether or not to breastfeed.

Even WHO claims that breastfeeding reduces child mortality and possesses health benefits that carry onto adulthood. WHO and UNICEF suggest that:

  • Breastfeeding must be initiated within the first hour of the baby’s birth
  • The infant should be on breastfeeding exclusively at least for 6 months and no additional food or drink should be given to the newborn
  • Breastfeeding should be done when wanted or pointed by the child
  • The process should be natural without the use of any bottles, teats or pacifiers

Breastfeed is often a natural act or sometimes can be a learned behaviour since it may take time for the mother and child to bond. However, it is also known that the mother requires adequate support and encouragement to initiate breastfeeding and carry appropriate breastfeeding practices. It is also because there is a lack of awareness of the multitude of benefits breastfeeding has for the newborn and also for the mother.

Importance of breast feeding for the new born

  • Supplies all essential nutrients – vitamins, proteins, and fat – in the right quantities
  • Is easily digested and creates no stomach problems
  • Protects against allergies, asthma, and sickness
  • Fights obesity and promotes healthy weight
  • Keeps away from diseases such as diabetes and cancer
  • Protects from infections
  • Contains antibodies that help fight bacteria and virus
  • Protect the proper development of the brain
  • Prevents respiratory issues
  • Protects from pneumonia
  • Prevents cold and cough
  • Protects from diarrhoea, constipation, and vomiting
  • Help fight urinary tract infections
  • Prevents meningitis
  • Protects from heat and liver disease in adulthood
  • Helps fight celiac disease
  • Promotes healthy jaw and tooth formation
  • Improves immunity
  • Reduces the risk of sudden infant death syndrome (SIDS)
  • Provides security
  • Enhances mental development

Importance of breastfeeding for the mother

  • Enhances bonding between the mother and infant
  • Heal from post-pregnancy trauma
  • Can help delay a new pregnancy
  • Avoid extreme postpartum bleeding
  • Lose weight effectively – burn 500 calories per day
  • Strengthens bones
  • Relax
  • Saves time
  • Reduces the risk of type 2 diabetes
  • Minimizes chances of osteoporosis
  • Prevents breast, ovarian and endometrial cancer

Breastfeeding is a secure way of feeding, also improves family resources and additionally is beneficial for the environment. It is readily available per baby’s need and always at the right temperature, clean and free. That said, breastfeeding is the natural and most recommended way to feed a newborn at least for 6 months post-birth. Over this course of time, breast milk changes constantly to meet the baby’s needs. The milk modified in volume, composition, colour, and texture as per the time of the day, frequency of feed, and the age of the baby. The natural change is to promote the healthy growth of the newborn. 

How often do babies breastfeed?

The frequency of breastfeeding depends on each baby differently. However, on average a baby feeds for about 8-12 times in 24 hours, though some babies might feed up to 18 times. Babies initially feed for a shorter duration, but post 8-12 weeks of birth, the babies start feeding for longer intervals. That said, the pattern can fluctuate as the baby grows; sometimes the frequency increases before eventually dropping or vice versa. Moreover, the interval of feeds is also dependent on the content of the mother’s milk. Milk with higher fat content will lead to shorter feeds, while low-fat milk content has longer feeding durations. The content of milk also varies as feeding progresses; initially, it is thin and gets denser as the feed progresses. Also, fat and energy are higher in breast milk during the day as compared to the night, which helps in easy digestion. 

That said, the simple formula for breastfeeding to remember is ABC:

  • Awareness – Be aware and watch out for baby’s signs of hunger such as movements, open mouth, etc.
  • Be Patient – Breastfeed for as long as the baby is hungry. Do not pull away before or be agitated on repeated feeds.
  • Comfort – be comfortable and relax while breastfeeding to allow the milk to flow smoothly.

However, in certain conditions such as below, the mother should refrain from breastfeeding if she has or is:

  • HIV positive
  • Active tuberculosis
  • Undergoing cancer treatment
  • Infections
  • Using illegal drugs including cocaine
  • Taking medications for arthritis, migraine, etc.

Hence, it is best to consult your doctor about your health conditions before breastfeeding.

Though a personal choice- breastfeeding is highly recommended to ensure the health and long-term safety of both the newborn and the mother.

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