May 19, 2013 | 01:11 PM (BD Time)
19 May, 2013 Sunday
Weight at birth influences child's growth
Mothers whose babies are under or over the average birthweight may be offered observations for their baby for 24 hours after the birth. Reasons for a 'small' or 'large' baby may not be initially clear to the caregiver. It may be that the baby is genetically small or large, due to their parents' build and ethnicity. If this is the case the observations could be done unnecessarily.
The concerns for the caregiver are that the baby may have an underlying health concern (such as being a baby of a mother with undetected diabetes) or that the baby may become unwell due to their body composition (having comparatively little body fat).
In past years the weight of the baby was the only defining factor to determine whether observations were required. In recent years caregivers have started to use other physical factors to identify babies 'at risk' and hopefully spare healthy under or overweight babies from unnecessary observations and interventions.
The criteria used to identify babies 'at risk' and the observations recommended for them will vary from caregiver to caregiver and hospital to hospital. The following is a guide to give you an idea of what the criteria could be and the types of observations that may be performed.
'Underweight' babies. Babies who are thought to be 'underweight' (for their gestation) are referred to as small for dates or small for gestational age (SGA). Some hospitals will use arbitrary measures (say less than 2,500 to 2,800 grams - 5lb 8oz to 6lb 3 oz) if the baby is 37 to 42 weeks gestation. Others will use a set scale that determines different acceptable weights for babies at 37, 38, 39 and 40 weeks gestation. (This tends to be more accurate for detecting babies 'at risk'). Babies who are premature can also be small for dates; twins are more susceptible to being small for dates.
Babies who are small for dates often look long and thin, with their head being quite large, compared to their body size. The skin around their legs and bottom can look loose and wrinkled and their faces can have a somewhat worried expression (often being described as 'worried little old man or woman'). The medical term often used for babies who look like this is 'wasted'. This is not a pleasant expression but one you may hear bandied around.
Babies who are truly small for dates do not usually have adequate Brown Adipose Tissue (or BAT). This is the special fat on newborn babies to help with their temperature control and body metabolism. BAT is a baby's main source of heat production and plays an important role preventing low glucose levels. The health concerns for these smaller babies are that they will start a 'cycle' of ill health.
A rough description of this cycle can be that small babies are more likely to lose body heat, which in turn means needing more glucose, which in turn means needing more feeding, but often the baby is reluctant to want to feed because they are small, cooler and have a low glucose levels and so on.
Small for dates babies may require frequent blood sugar tests and may also need to go to the Intensive Care Nursery to be kept warm in an incubator and possibly have glucose through a drip in the vein or regular feeding through a naso-gastric tube into their stomach.
At one major hospital the policy is for the baby to have 2 feeds within 6 hours of being born, then a heel prick blood test. The test is done by taking a small amount of blood from the baby's heel to check their blood sugar level. The heel prick test is repeated routinely every 4 to 6 hours (after a feed) for the next 24 hours, as well as temperature readings. The baby stays with their mother unless the blood sugar reading is abnormally low, the baby's temperature is low, or they are reluctant to want to feed.
Babies who are perceived as being 'overweight' for their gestation are referred to as 'large for dates', 'large for gestational age' (LGA) or 'macrosomic'. The birth weight is usually used to identify the 'baby at risk' being generally more than 4,500 grams (or 10lb). Babies who are large for dates may prompt concerns from the caregiver that the mother had undetected diabetes during the pregnancy. This means the baby could be at risk of having a low blood glucose level.
Some caregivers will also take into account how the baby looks, rather than just their birth weight. A truly 'macrosomic' baby will usually have extra fat tissue all over their body, often resembling a 'Buddha' or a Sumo wrestler. This is different from a baby who is large but not looking overweight.
Babies who are suspected of being macrosomic will usually be recommended to have their blood sugar levels checked after each feed, for up to 24 hours after the birth. A small amount of blood will be taken from the baby's heel to check this. If the levels are low the baby may need to go to the Intensive Care Nursery to have glucose through a drip in the vein.
This article contains general information only and is not intended to replace advice from a qualified health professional.
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