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Sunday, 15 December 2013

Pregnancy and Low Birth Weight - The consequences

Low birth weight is a condition of a baby who was born below the weight of gestational age due to several reasons, including, the baby was born too soon, were small for gestational age, the poor health of the mother, nutritional deficiency, certain diseases, etc. According to the statistic of the World health organization, globally, more than 20 million infants were born with low birth weight.

The consequences of low birth baby (Symptoms)
Some LBW babies can have life-long health problems as well as the risk of dying in the first year of life. Most common diseases of low birth weight baby include
1. Respiratory distress syndrome (RDS)

As the lung is a last organ to develop of the fetus during 40 weeks of pregnancy, respiratory problem is a very common for baby who was born with low weight. Babies who were born before the week of 34 are at risk of lacking surfactant to keep the small air sacs in the lungs from collapsing. The introduction of additional oxygen is very helpful to keep the baby lung to expand, but according to the antioxidant theory, it can also induce the chain of oxidation, causing vary health problem to the baby, if the additional oxygen has to be used it for a prolonged period of time, as the baby has weakened immune system to defend it due to low birth weight.

2.
Intraventricular hemorrhages (IVH) (bleeding in the brain
Bleeding can occurs within the first days of life in the brain of some very low-birthweight. According to the article of "Treatment reduces brain hemorrhages in very low birthweight babies" posted in the National Institue of neorological institutes, "between 20 to 40 percent of very low birthweight infants have intracranial hemorrhages, putting them at very high risk for major neurodevelopmental problems" and "Very low-birthweight babies who are treated with indomethacin within 6-12 hours after birth have a lower incidence and reduced severity of brain hemorrhage, a frequent and often debilitating complication of such births".

3. Patent ductus arteriosus (PDA)
PDA is a heart problem that is common in premature babies. It is defined as a condition of a congenital disorder in the heart with persistent opening between two major blood vessels leading from the heart.
According to the study of Patent ductus arteriosus in infants of low birth weight.
D R Smith, D H Cook, T Izukawa, P M Olley, P R Swyer, and R D Rowe, researchers found that In 48 patients whose heart failure could not be controlled by other medical therapy indomethacin was given, and in 20 (42%) it was judged successful. Surgical ligation of the ductus was performed at a median age of 30 days in 33 infants who either failed to respond to indomethacin or in whom its use was contraindicated; there were no intraoperative deaths, but 11 (33%) of the infants died 4 days to 6 months after the operation.

3. Necrotizing enterocolitis (NEC)
Necrotizing enterocolitis (NEC) is defined as a condition of premature death of cells of portions of the bowel tissue after 2-3 weeks of birth, causing feeding intolerance, increased gastric residuals, abdominal distension, bloody stools, etc.. Treatments of babies with NEC include supportive care antibiotics and in some case, clostomy may be necesesary depending to the disgnosis.

4. Retinopathy of prematurity (ROP)
Retinopathy of prematurity (ROP) is defined as acondition of a blinding eye disease of premature babies and very low birth weight infants born before 32 weeks of pregnancy as a result of an abnormal growth of blood vessels in the eye. According to the strudy of Retinopathy of "Prematurity in Extremely Low Birth Weight Infants" by C. Gregory Keith, Lex W. Doyle, researchers found that the increase in the survival rate of ELBW infants is not always accompanied by an increase in the rate of severe ROP or blindness, at least for ELBW infants born in some large level-3 centers. In most cases, the disease can heal themselves with little or no vision loss. In severe cases, laser therapy or cryotherapy is necessary to destroy the peripheral areas of the retina but it may cause some vision loss. In latest stage of ROP, Scleral buckle and vitrectomy may be necessaery depending to retcam screening.

5. Psychological effects
According to the study of "Psychiatric symptoms in low birth weight adolescents, assessed by screening questionnaires." by Indredavik MS, Vik T, Heyerdahl S, Kulseng S, Brubakk AM., researchers found that very low birth weight(VLBW) adolescents are at risk of developing psychiatric symptoms, and reduced social and academic skills by the age of 14. Term SGA adolescents may have discrete emotional, behavioural and attention deficit symptoms. ASEBA and SDQ provide a useful supplement to psychiatric interview.

6. Later in the baby life
In a study of Emotional, behavioral, social, and academic outcomes in adolescents born with very low birth weight. by Dahl LB, Kaaresen PI, Tunby J, Handegård BH, Kvernmo S, Rønning JA., researchers found that From parents' point of view, significant proportions of very low birth weight adolescents experience more emotional and behavioral problems and less competence than normative adolescents. In contrast, very low birth weight adolescents state less problems and similar or higher competence than normative adolescents. Very low birth weight adolescent girls report more emotional and behavioral problems compared with their parents than very low birth weight adolescent boys do. Externalizing problems in very low birth weight adolescent girls are often not recognized by parents. To better understand these seemingly paradoxical findings and to develop adequate intervention programs, there is a need for prospective longitudinal studies.

7. Short stature
In a study of "Low birth weight--additional important factor of diagnosis in children with short stature". [Article in Polish] by Majcher A, Pyrżak B, Bielecka-Jasiocha J, Witkowska-Sędek E., researchers found that
a. Low birth weight is diagnosed in every sixth child with short stature in the Clinic of Endocrinology.
b. Children born on time with low birth weight should be diagnosed early towards congenital genetic disorders and development defects.

8. Metabolic syndrome and ischemic heart disease.
Baby who was born low birth weight is at higher risk of heart diseases and diabetes as a result of inflammatory processes in adulthood. According to the study of "Low birth weight and markers of inflammation and endothelial activation in adulthood", The ARIC study by Lucia C. Pellanda, Bruce B. Duncan, Alvaro Vigo, Kathryn Rose, Aaron R. Folsom, Thomas P. Erlinger, researchers found that LBW predicted greater inflammation and endothelial activation, as indicated by the higher score of blood markers, consistent with the hypothesis that early life events may result in a hyper-responsive innate immune system. Such a pro-inflammatory tendency could help explain the association of low birth weight with elements of the metabolic syndrome and ischemic heart disease.

9. Etc.

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