Preterm and Low Birth Weight Infants
Preterm and Small for Date Infants
 Low birth weight infants – weigh less than 5 ½ pounds at birth
Very low birth weight – under 3 ½ pounds
Extremely low birth – under 2 pounds
 Preterm infants – born 3 weeks or more before the pregnancy
has reached its full term (before the completion of 37 weeks of
gestation)
 Small for date infants – birth weight is below normal when the
length of the pregnancy is considered
- may be preterm of full term
- more than a fourfold increased risk of death
Increase in preterm births is likely due to:
- increasing number of births to women 35 years of age or older
- increasing rates of multiple births
- increased management of maternal and fetal conditions
- increased rates of substance abuse
- increased stress
- due to poverty
- adolescents who give birth when their bodies have not fully matured
- poor nutrition
Factors to decrease preterm births:
- Increasing use of progestin treatment and decreasing rates of
smoking
- Engaging in light leisure time physical activity had a 24% reduced
likelihood of preterm delivery and moderate to heavy leisure time had
66%
Consequences of Preterm Birth and Low Birth Weight
More health problems and developmental delays than normal birth
weight infants
Extremely preterm infants – born less than 28 weeks gestation
Very preterm infants – born less than 33 weeks gestation
Earlier preterm infants are born, the more likely they are drop out of
school
Survival rate for infants who are born very early and very small have
risen, but with this improved survival rate have come increased rates
of severe brain damage
Very preterm, low birth weight infants had abnormal axon
development in their brains and impaired cognitive development at 9
years of age
Low birth weight babies are more likely to develop a learning
disability, attention deficit hyperactivity disorder, autism spectrum
disorders, breathing problems such as asthma
50% of all low birth weight children are enrolled in special education
programs
Nurturing Low Birth Weight and Preterm Infants
 Kangaroo Care – involves skin-to-skin contact in which the
baby, wearing only a diaper, is held upright against the
parent’s bare chest
- practiced for 2 to 3 hours per day, skin-to-skin over an
extended time in early infancy
Preterm infants often have difficulty coordinating their breathing and
heart rate and the close physical contact with the parent provided by
kangaroo care can help to stabilize the preterm infant’s heartbeat,
temperature and breathing.
Advantages/effects of kangaroo care:
- preterm infants gain more weight
- kangaroo care for 16 weeks had more complex
electroencephalogram patterns which reflects neurological maturation
- led to better physical development
- decreased the risk of mortality
- better respiratory and cardiovascular functioning, sleep patterns, and
cognitive functioning from 6 months to 10 years of age
- reduced rates of diseases such as gastroenteritis and colitis
- reduced amount of crying and increased heart rate stability
- recommended as standard practice for all newborns
 Massage – equally effective as kangaroo care in improving
body weight and reducing length of hospital stay for low birth
weight infants (3 to 6 days earlier)
Advantages/effects of massage:
- improved the scores of HIV-exposed infants on both physical and
mental scales
- improved hearing and speech
- had a stress-reducing effect
- less excitable, less depressed and less agitated during sleep
- infants of depressed mothers improved emotionality, sociability and
soothability
- has benefits also to women in reducing labor pain, children who
have asthma, autistic children’s attentiveness, and adolescents who
have ADHD
The Postpartum Period
Postpartum period – period after childbirth or delivery that lasts for
about six weeks or until the mother’s body has completed its
adjustment and has returned to a nearly prepregnant state
Physical Adjustments
- May have a great deal of energy or feel exhausted and let down
- Fatigue can undermine the new mother’s sense of well-being and
confidence in her ability to cope with a new baby and a new family life
- Loss of sleep can contribute to stress, marital conflict and impaired
decision making
- poor-quality of sleep was linked to postpartum depression
- sudden and dramatic changes in hormone production
- When the placenta is delivered, estrogen and progesterone levels
drop steeply and remain low until the ovaries start producing
hormones again.
Emotional and Psychological Adjustments
- For some women, emotional fluctuations decrease within several
weeks after the delivery, but others experience more long-lasting
emotional swings
- Postpartum blues – 2-3 days after birth, they feel depressed,
anxious, and upset
- Postpartum depressions – major depressive episode that typically
occurs about 4 weeks after delivery. Have strong feeling of sadness,
anxiety, or despair that lasts for at least 2 weeks and they have
trouble coping with daily tasks; without treatment, may become worse
and will last for many months
Risk factors for developing postpartum depression:
- history of depression, depression and anxiety during pregnancy,
neuroticism, low self-esteem, postpartum blues, poor marital
relationship and low level of social support
- a number of perinatal-related stressors such as perinatal
complications, infant health and temperament and type of delivery
- history of physical abuse, migrant status and postpartum physical
complications
Postpartum depression treatments:
- antidepressant drugs
- Psychotherapy, especially cognitive therapy
- regular exercise
Effects of postpartum depression
- can affect the way she interacts with her infant
- caregiving activities are compromised
- increased in 4-month-old infants’ unintentional injuries
- fathers can also experience feelings of depression
- higher support by fathers related to a lower incidence of postpartum
depression
Bonding
- the formation of a connection especially a physical bond between
parents and the newborn in the period shortly after birth
- parents and newborn need to form an emotional attachment as a
foundation of optimal development in years to come
- bonding hypothesis – significance of the first few days of life as
critical period; extreme form of bonding hypothesis is not true
- Early bonding has not been found to be critical in the development of
a competent infant
- In some mother-infant pairs – including preterm infants, adolescent
mothers, and mothers form disadvantaged circumstances – early
close contact may improve interaction
- Rooming-in arrangement – the baby remains in the mother’s room
most of the time