Small birth weight babies

Small for Gestational Age | Cedars-Sinai

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What does it mean to be small for gestational age?

Small for gestational age is a term used to describe babies who are smaller than usual for the number of weeks of pregnancy. These babies have birth weight below the 10th percentile. This means they are smaller than many other babies of the same gestational age. Many babies normally weigh more than 5 pounds, 13 ounces by the 37th week of pregnancy. Babies born weighing less than 5 pounds, 8 ounces are considered low birth weight.

What causes babies to be small for gestational age?

Some babies are small because their parents are small. But most babies who are small for gestational age have growth problems that happen during pregnancy. Many of these babies have a condition called intrauterine growth restriction. This happens when the unborn baby doesn’t get the nutrients and oxygen needed to grow and develop organs and tissues. This can begin at any time in pregnancy.

Growth restriction early in pregnancy (early onset) happens because of chromosome problems in the baby. It also happens because of disease in the mother,or severe problems with the placenta. Growth restriction is called late onset if it happens after week 32 of the pregnancy. It is usually related to other problems.

Who is at risk for being small for gestational age?

When the unborn baby doesn’t get enough oxygen or nutrients during pregnancy, the baby’s body and organs don't grow as much as they should. Some of the problems that cause babies to be small for gestational age limit how much blood flows through the placenta. This can cause the baby to get less oxygen than normal. This increases the baby’s risks during pregnancy and delivery, and later. Things that can cause babies to be small for gestational age are listed below.

Problems with the mother

High blood pressure
Chronic kidney disease
Diabetes
Heart disease or respiratory disease
Malnutrition or anemia
Infection
Alcohol or drug use
Cigarette smoking
Weighing less than 100 pounds

Problems with the uterus and placenta

Decreased blood flow in the uterus and placenta
Placenta detaches from the uterus
Placenta attaches low in the uterus
Infection in the tissues around the baby

Problems with the developing baby

Multiple pregnancy, such as twins or triplets
Infection
Birth defects
Chromosome problems

What are the symptoms of small for gestational age babies?

Small for gestational age babies may look mature, but they are smaller than other babies of the same gestational age. They may be small all over, or they may be of normal length and size but have lower weight and body mass. These babies may be born:

Premature. Before 37 weeks of pregnancy.
Full-term. Between 37 and 38 weeks (early term) through 41 weeks.
Post-term. After 42 weeks of pregnancy.

Many small for gestational age babies have low birth weight. But not all are premature. They may not have the same problems as premature babies. Other babies, especially those with intrauterine growth restriction, may look thin and pale, and have loose, dry skin. The umbilical cord is often thin and dull-looking rather than shiny and fat.

How are small for gestational age babies diagnosed?

Babies with this problem are often diagnosed with intrauterine growth restriction before birth. During pregnancy, a baby’s size can be guessed in different ways. The height of the top of a mother’s uterus can be measured from the pubic bone. This measurement in centimeters usually links with the number of weeks of pregnancy after the 20th week. If the measurement is low for the number of weeks, then the baby may be smaller than expected.

Other tests used for diagnosis may include:

Ultrasound to estimate the baby’s size
Doppler flow to help check blood flow to the baby during pregnancy
Mother’s weight gain to tell how a baby is growing during pregnancy
Baby’s birth weight as compared with the gestational age once the baby is born. The healthcare provider may use a formula to figure out the baby’s body mass.

How are small for gestational age babies treated?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

Babies with this problem may be physically more mature than their small size would suggest. But they may be weak and less able to take large feedings or stay warm. Treatment may include:

Temperature-controlled beds or incubators
Tube feedings if the baby does not have a strong suck
Blood tests to check for low blood sugar
Watching oxygen levels

Babies who are also premature may have other needs. They may need oxygen and a breathing machine (ventilator).

What are the complications of being small for gestational age?

Babies who are small for gestational age or who have intrauterine growth restriction may have problems at birth. These can include:

Lower oxygen levels than normal
Low Apgar scores
Breathing in the first stools (meconium) passed in the womb. This can cause breathing problems.
Low blood sugar
Difficulty keeping a normal body temperature
Too many red blood cells

Can small size for gestational age be prevented?

Prenatal care is important in all pregnancies. It is especially helpful to see any problems with the baby’s growth. For a healthy pregnancy, stop smoking if you smoke, and don't use drugs or alcohol while you are pregnant. Eating a healthy diet during pregnancy may also help.

Key points about small for gestational age babies

Small for gestational age means a baby is smaller than expected for the number of weeks of pregnancy.
Although some babies are small because their parents are small, most babies who are small for gestational age have growth problems that happen during pregnancy.
When the unborn baby does not get enough oxygen or nutrients during pregnancy, he or she does not grow as much as normal.
The condition is often suspected before birth.
Prenatal care is important in all pregnancies. It is especially helpful to see any growth problems of the developing baby.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

Know the reason for the visit and what you want to happen.
Before your visit, write down questions you want answered.
At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
Ask if your child’s condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if your child does not take the medicine or have the test or procedure.
If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.

Low Birthweight in Newborns | Boston Children's Hospital

What is low birthweight?

Babies are weighed within the first few hours after birth. The weight is compared with the baby's gestational age and recorded in the medical record. A birthweight less than 5 pounds, 8 ounces, is diagnosed as low birthweight. Babies weighing less than 3 pounds, 5 ounces, at birth are considered very low birthweight.

The average newborn weighs about 7. 6 pounds, and about 7.6 percent of all newborns in the U.S. have low birthweight. The overall rate of these very small babies is increasing, primarily because of the increase in multiple birth babies, who tend to be born earlier and weigh less. More than half of multiple birth babies have low birthweight.

Why is low birthweight a concern?

If your baby has a low birthweight, she may be at increased risk for complications. Her tiny body is not as strong, and she may have a harder time eating, gaining weight, and fighting infections. Because she has so little body fat, she may have a hard time staying warm in normal temperatures.

Because many babies with low birthweight are also premature, it is can be difficult to separate the problems due to the prematurity from the problems of just being so tiny. In general, the lower a baby's birthweight, the greater the risks for complications. The following are some of the common problems of low birthweight babies:

low oxygen levels at birth
inability to maintain body temperature
difficulty feeding and gaining weight
infection
breathing problems, such as respiratory distress syndrome (a respiratory disease of prematurity caused by immature lungs)
neurologic problems, such as intraventricular hemorrhage (bleeding inside the brain)
gastrointestinal problems such as necrotizing enterocolitis (a serious disease of the intestine common in premature babies)
sudden infant death syndrome (SIDS)

What causes low birthweight?

The primary cause is premature birth, being born before 37 weeks gestation; a baby born early has less time in the mother's uterus to grow and gain weight, and much of a fetus' weight is gained during the latter part of the mother's pregnancy.

Another cause of low birthweight is intrauterine growth restriction. This occurs when a baby does not grow well in utero because of problems with the placenta, the mother's health, or birth defects. Babies with Intrauterine growth restriction (IUGR) may be born early or full-term; premature babies with IUGR may be very small and physically immature, and full-term babies with IUGR may be physically mature but weak.

Any baby born prematurely is more likely to be small. However, there are other factors that can also contribute to the risk of low birthweight. These include:

Race: African-American babies are twice as likely as Caucasian babies to have low birthweight.
Mother's age: Teen mothers (especially those younger than 15) have a much higher risk of having a baby with low birthweight.
Multiple birth: Multiple birth babies are at increased risk of low birthweight because they often are premature.
Mother's health: Babies of mothers who are exposed to illicit drugs, alcohol, and cigarettes are more likely to have low birthweight. Mothers of lower socioeconomic status are also more likely to have poorer pregnancy nutrition, inadequate prenatal care, and pregnancy complications — all factors that can contribute to low birthweight.

Nearly all low birthweight babies need specialized care in the Neonatal Intensive Care Unit (NICU) until they gain weight and are well enough to go home. Fortunately, there is a 95 percent chance of survival for babies weighing between 3 pounds, 5 ounces, and 5 pounds, 8 ounces.

Can low birthweight be prevented?

Prevention of preterm births is one of the best ways to prevent babies born with low birthweight. Prenatal care is a key factor in preventing preterm births and low birthweight babies.

At prenatal visits, the health of both mother and fetus can be checked. Because maternal nutrition and weight gain are linked with fetal weight gain and birthweight, eating a healthy diet and gaining the proper amount of weight in pregnancy are essential. Mothers should avoid alcohol, cigarettes, and illicit drugs, which can contribute to poor fetal growth, among other complications.

How is a low birthweight diagnosed during pregnancy?

During pregnancy, a baby's birthweight can be estimated in different ways:

The height of the fundus (the top of a mother's uterus) can be measured from the pubic bone. This measurement in centimeters usually corresponds with the number of weeks of pregnancy after the 20th week. If the measurement is low for the number of weeks, the baby may be smaller than expected.
An ultrasound is a more accurate method of estimating fetal size. Measurements can be taken of the fetus' head and abdomen, and compared with a growth chart to estimate fetal weight.

What are the treatment options for low birthweight newborns?

Care for low birthweight babies may include:

care in the NICU
temperature-controlled beds
special feedings, sometimes with a tube into the stomach if a baby cannot suck
other treatments for complications

Low birthweight babies typically "catch up" in physical growth if there are no other complications. Babies may be referred to special follow-up healthcare programs.

How we care for low birthweight newborns

The Boston Children's Hospital Infant Follow-Up Program is designed for infants born very prematurely, who weigh less than 3.3 pounds and are at high risk for development and motor delays and other problems resulting from prematurity. Our program follows children from the time of discharge until they reach age 3 to 4.

The multi-disciplinary team includes pediatricians, neonatologists, pediatric psychologists, physical therapists, social workers, and if needed, pediatric neurologists.

Every seventh baby in the world is born weighing less than 2.5 kg - new study

May 16, 2019 Health

Every seventh child in the world is born with low birth weight. So, in 2015, according to a study conducted by the United Nations Children's Fund (UNICEF), the World Health Organization (WHO) and the London School of Hygiene and Tropical Medicine, more than 20 million babies weighing less than 2. 5 kilograms were born.

Two thirds of these children were born in South Asia and Africa. However, according to experts, the problem of low birth weight exists in Europe, North America, Australia and New Zealand. Between 2000 and 2015, these states failed to make progress in reducing this rate.

“Over 15 years, we have seen almost no change, even in high-income countries where low birth weight is commonly associated with preterm birth, maternal age, smoking, unmedicated caesarean sections and infertility treatment programs that lead to multiple pregnancies,” says Hannah Blencowie of the London School of Hygiene.

In poor countries, the study reports, the main reason for the birth of children with low birth weight is the growth of the fetus in the womb. The weight of the unborn child is also affected by infectious diseases during pregnancy, chronic diseases of the mother, diet and ecology.

The study was conducted in 148 countries of the world among tens of millions of newborns. At the same time, in 47 countries, the experts were not able to access all the necessary data - some of them were missing. The authors of the study remind that the collection of information is the first step towards solving the problem of low weight in infants.

“The idea is that every newborn should be weighed. In the meantime, we have no data on the weight of almost a third of babies. We will not be able to help them if we do not have accurate data on their condition,” said UNICEF representative Julia Krasevets.

According to the study, 2.5 million babies die every year worldwide, 80 percent of them are low birth weight babies. Those babies with low body weight who manage to survive are at high risk of various diseases, including chronic ones.

Sweden has the fewest low birth weight babies, at 2.4 percent of all births. For comparison, in the US this figure is 8 percent, in the UK - 7 percent. In the post-Soviet space, the situation, according to the report, is very encouraging. Thus, only 5.8 percent of children are born with low birth weight in Russia, 5.6 percent in Ukraine, 5.1 percent in Belarus, 5.4 percent in Kazakhstan, and 4.9 percent in Turkmenistan.

Low weight children

newborns
Children
UNICEF
WHO

90,000 how to help them develop?

The birth of a small child is not uncommon today. Often, such babies are born on time or a little earlier, but due to a lack of weight, they can significantly lag behind their peers in development. Pediatricians and neuropathologists closely monitor the child's condition, because a child's body weight deficiency is a risk factor for changes in the neurological status, functional disorders of the cardiovascular and autonomic nervous systems. But because of their weakness, underweight children do not eat well, and the rate of weight gain in children born with low body weight determines their further physical and psychomotor development and the formation of the immune system.

How much weight should a newborn gain?

To assess the development of your child and the compliance with the norm of the main indicators (height, weight), you can contact a pediatrician or independently - according to existing tables. In the first months, the child is actively growing, adding up to 25-60 grams per day. Small children with adequate nutrition can increase body weight more intensively than their peers. For the first month of life, children should gain up to 1.3-1.7 kg. After 5-6 months of life, the intensity of weight gain decreases somewhat - in 30 days, the increase can be only 400-700 grams.

The length of the child's body increases by 4-7 cm during the first month, and after 5-6 months of life, growth increases less intensively - by 2-3 cm. But parents should understand that these figures are approximate. Each child is individual. Its weight and height depend on many factors: heredity, the quality of the mother's nutrition, the state of health of the newborn, the severity of childbirth.

Why is the child not gaining weight well?

The main cause of underweight in the neonatal period is the baby's refusal to breastfeed. Small children have poor appetite and spend most of the day sleeping. Often, parents have to wake up the child for a long time, and after a few minutes of sucking on the breast or a bottle of formula, the newborn falls asleep again. Children are especially sleepy, in whom pronounced physiological jaundice was observed in the first days of life.

As a result, after the next weighing, the doctor can tell the mother that the newborn has not gained weight at all or the increase is insignificant. If the situation does not improve for several months, the mother and baby may be hospitalized for a comprehensive examination and tube feeding in a hospital setting.

Sometimes the reason for low weight gain lies in non-compliance with breastfeeding tactics. Pediatricians recommend applying the baby to only one breast during feeding so that it sucks out the "hind" milk, which is of particular energy value and rich in nutrients. Due to their inexperience, mothers offer both breasts to newborns. In this case, the child sucks the upper milk without making any effort and quickly falls asleep, slightly satisfying his hunger.

If the baby has had an infectious disease, has been ill for a long time, suffered from a high temperature or an intestinal disorder, then the monthly weight gain may be significantly less than usual. In this case, the timing of the introduction of complementary foods is also shifted, and during the period of illness, in general, many children practically refuse to eat, which is reflected in their weight. Parents should actively communicate with the pediatrician, if necessary, ask him questions of interest and adhere to all recommendations.

How to help a child gain weight and catch up with their peers in their development?

If you are breastfeeding, pay special attention to your diet. Drink as much liquid as possible: low-fat milk, compotes, hypoallergenic juices. Your diet must include boiled or baked meat. Take extra vitamins (as advised by the doctor). Breastfeed your baby immediately after waking up, when he is active, in a good mood and does not want to sleep.

But sometimes women's milk is produced in insufficient quantities or the baby does not have enough strength to suck it out. In this case, it is necessary to start supplementing with special infant formula as soon as possible. For children prone to allergic reactions, special hypoallergenic products are intended, which can be bought at a pharmacy, having previously discussed the mixture option with a pediatric nutritionist or pediatrician. Small babies are not adapted to intensive sucking, so the nipple on the bottle must be soft and pliable so that the child can fill up without problems.

In addition, to increase the rate of weight gain and, accordingly, for the proper growth and development of the child, it is recommended to give courses of preparations containing L-carnitine (levorcarnitine), an essential vitamin-like substance that has anabolic properties and has proven itself well for normalizing body weight in case of its deficiency. In addition, by increasing the secretory and enzymatic activity of gastric and intestinal juices, appetite and digestion improve. One of these drugs is Elkar, containing an aqueous solution of L-carnitine. Elkar is included in the "National program for optimizing the feeding of children in the first year of life" as a means of correcting malnutrition of the II degree.

In children, in contrast to the adult body, where levocarnitine is among the substances produced, the synthesis of this compound covers only 1% of the required amount. Of course, the required amount of L-carnitine is found in breast milk, but if natural feeding is impaired or impossible, the drug must be added to the diet.

In underweight children, psychomotor development is often retarded, which can subsequently manifest itself in the form of speech defects, instability of the nervous system. Elcar improves the energy supply of brain activity, which will help to avoid or reduce the degree of development of functional failure in various areas of the child's neuropsychic response (motor, emotional-motivational, vegetative, cognitive spheres).

Another very important point: levocarnitine improves immunity, which is vital for small children, since almost all of them are predisposed to the development of infectious diseases.

Many external and internal factors influence the rate of weight gain. The task of parents is to help the crumbs get stronger as soon as possible. Walk more with your child in the fresh air so that his body receives the necessary amount of oxygen. And don't forget to visit your pediatrician. Small children need professional medical supervision and the attention of loved ones.