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Morbidity profile and immediate outcome of low birth weight neonates in a rural tertiary care hospital of Gujarat, India

More than 20 million infants worldwide, representing 15.5 percent of all births are born with low birth weight. More than 95 percent of them are born in developing countries. The incidence of low birth weight in developing countries (16.5 per cent) is more than double the incidence in developed regions (7 per cent). In India, nearly 8 million babies are born with a low birth weight every year. In India, every 3 born child is of a low birth weight. Birth weight is a strong indicator not only of a mother’s health and nutritional status but also a newborn’s chances for survival, growth and long-term health. VLBW and ELBW neonates are of major concern because of maximum perinatal mortality found in this group. ABSTRACT


INTRODUCTION
Low birth weight has been defined as a birth weight of less than 2.5 kilogram regardless of gestational age (WHO -1960). 1 More than 20 million infants worldwide, representing 15.5 percent of all births are born with low birth weight. More than 95 percent of them are born in developing countries. The incidence of low birth weight in developing countries (16.5 per cent) is more than double the incidence in developed regions (7 per cent). In India, nearly 8 million babies are born with a low birth weight every year. 2 In India, every 3 rd born child is of a low birth weight. 3 Birth weight is a strong indicator not only of a mother's health and nutritional status but also a newborn's chances for survival, growth and long-term health. VLBW and ELBW neonates are of major concern because of maximum perinatal mortality found in this group 4 .
These neonates were examined, monitored and managed by standard protocols. Nude weight of neonate at birth is taken by electronic weighing scale having ±1 gram accuracy. Gestational age is calculated using last menstrual period and new Ballard score.
Neonates with birth weight of less than 2500 grams are classified as low birth weight (LBW), with birth weight of between ≥2500-<3500 grams as normal birth weight (NBW), and with birth weight of ≥3500 grams as large birth weight (LaBW). Low birth weight neonates were further classified as low birth weight (birth weight ≥1500 grams -<2500 grams), very low birth weight (VLBW) with birth weight of ≥1000-<1500 grams, and extremely low birth weight (ELBW) with birth weight of < 1000 grams.
For further analysis, low birth weight neonates were sub classified as LBW1 (birth weight of ≥1500-<2000 grams) and LBW2 (birth weight of ≥2000-<2500 grams). LBW1 were further classified as LBW1a (birth weight of between ≥1500 grams-<1800 grams) and LBW1b (birth weight of ≥1800 grams-<2000 grams). All the neonates were analyzed for morbidities and immediate outcome. There morbidities and outcome were compared. This study is a retrospective analysis of previously collected information. Neonates were managed by standard protocols. This study was approved by the hospital ethics committee.

RESULTS
718 (57.99%) neonates were of normal birth weight, 485 (39.17%) of low birth weight, and 35 (2.82%) of large weight.   Need for respiratory support was 4.82% in LBW vs 2.36% in normal birth weight neonates.
Incidence of birth asphyxia was only slightly higher in LBW neonates (4.82% vs 4.59%).
Incidence of MAS and PPHN were higher in normal birth weight neonates compared to LBW neonates (1.39% vs 0.44%, and 0.55% vs 0.22%).
Amongst LBW neonates; morbidities were significantly higher in VLBW and ELBW neonates. On comparing LBW2 and LBW1 neonates, it was found that morbidities were significantly lower in LBW2 group-near comparable to found in normal birth weight neonates. On comparison of LBW1a (birth weight ≥1500 -<1800 grams) and LBW1b (birth weight ≥1800 -<2000 grams); it was found that at least one morbidity occurred in 37.5% of LBW1b neonates, while in 66.66% of LBW1a neonates at least one morbidity occurred.

DISCUSSION
The prevalence of LBW is a good indicator of mother's health and maternal nutritional status. The incidence of LBW in Asia as a whole is 19.7%. That of Europe, USA and Korea is 6.5%, 7% and 6-8% respectively. 6 17 Present study results were in accordance with Singh et al.

CONCLUSION
The major determinants for mortality in low birth weight babies were the birth weight. Mortality was highest in ELBW followed by VLBW and followed by LBW. Also, there exist positive correlation between birth weight and morbid conditions.
The higher incidence and mortality of LBW especially ELBW and VLBW1 neonates in present study indicates a need for prevention of such neonates by improving maternal health and care, provision of good community based newborn care, good neonatal transport facility, up gradation of NICU facilities in Government hospitals, provision of free neonatal care by private hospitals under public private partnership program and ensuring adequate manpower with their regular training. With all these efforts together, it will be possible to achieve the INAP goal of NMR less than 10 by 2030.