Care of the low birthweight infant in developing countries

Focus in this discussion of the care of the low birthweight infant in developing nations is on the magnitude of the problem, identification, care in the community, referral to specialized centers, hospital-based care, feeding of the low birthweight infant, morbidity and mortality, prognosis, and prevention of low birthweight. Low birthweight constitutes a significant problem in developing countries, but the priority it is given and the effort and resources expended on different weight and gestational age groups varies with circumstances. Prenatal identification of growth retardation by fundal height and risk scoring systems are useful in order to effect early referral and management. After delivery in hospital, identification by weight and evaluating the gestational age is fairly easy. Following identification of the low birthweight (LBW) infant, the decision to refer to a specialized center depends on the ability of the infant to maintain body temperature, accept oral feeds, the presence or absence of associated problems, facilities in the periphery and in the referral center, and the availability of suitable transport. Referral from the community is recommended only in instances where a suitable center is easily available. Even in the best centers the outcome is better with intrauterine than postnatal transfer of high risk babies. There are 3 types of management: rooming in, in the postnatal wards; care in conventional neonatal special care units; and care in a modified special care baby unit with close maternal involvement. Controlled randomized studies in developing countries have shown that human milk is beneficial and affords easy active protection to high risk infants. Apart from birth asphyxia, low birthweight is the most important factor which contributes directly or indirectly to high neonatal mortality. Perinatal mortality rates show a 5-6-fold increase when birthweights fall below 2500 grams. Good antenatal care including the appropriate management of specific problems such as anemia and toxemia of pregnancy will help to reduce LBW, but significant and lasting improvement depends on social reforms. Needed reforms include better education for women and raising the status of women in society and decreasing the work load of pregnant women, particularly among the least privileged groups.