Original Article National Journal of Medical and Dental Research, Jan.-March.
2015: Volume-3, Issue-2, Page 89-92
Clinico-Epidemiological Profile of Low Birth Weight
Babies: A Comparison of Two Birth Cohorts Separated by
Two Decades
Manuscript Reference
Number: Njmdr_3208_15
Date of submission: 14 March 2015
Date of Editorial approval: 15 March 2015
Date of Peer review approval: 18 March 2015
Date of Publication: 31 March 2015
Conflict of Interest: Nil; Source of support: Nil
Name and addresses of corresponding author:
Jayashree Nadkarni
Associate Professor, Department of Paediatrics
3rd Floor, Kamla Nehru Hospital,
Bhopal (M.P.) India 462016
Email jayadn2007@gmail.com
Dental Journal Vol 3 Issue 2 Jan-March.indb 89
Naikey MinareA, Jayashree NadkarniB, Santosh RaghuvanshiC
A -
Senior Resident, Department of Pediatrics, Gandhi Medical College, Bhopal,
(M.P.) India
B-
Associate Professor, Department of Pediatrics, Gandhi Medical College, Bhopal,
(M.P.) India
C-
Resident, Department of Pediatrics, Gandhi Medical College, Bhopal, (M.P.) India
Abstract:
The low-birth-weight infant remains at much higher risk of mortality than the infant
with normal weight at birth. In the neonatal period, when most infant deaths occur,
the proportion of low-birth-weight infants is the major determinant of the magnitude
of the mortality rates. Objective: To study the morbidity and mortality profile in low
birth weight neonates admitted in a tertiary level medical college, hospital and its
comparison with a similar study done two decades back in the same hospital to see
the changing trends. Method: Descriptive observational hospital based study done
on 100 low birth weight neonates, admitted consecutively in a teaching hospital over
the duration of 5 months from January 2008 to May 2008. All maternal and neonatal
particulars were noted on a pre-designed proforma after taking informed consent
from parents and ethical clearance from ethical clearance committee of institution.
These neonates were followed up to one month of age. Data obtained was analyzed
and also compared with data from similar study done 2 decades back in 1988 in the
same institution. Results: Of 100 LBW babies 64% were male. The mean birth weight
in our study was 1.70.8 kg as compared to 20.39 kg in 1988 study (p value=0.006).
The mean gestational age in our study was also less i.e, 33.82.99 weeks, versus
35.83.9 weeks in previous study (p value=0.001).We had a larger cohort of preterm
newborns in our study, 77% versus 43%. The mortality in low birth weight babies
increased from 23% to 30% while mean birth weight and gestational age of expired
newborns fell from 1.70.4 kg to 1.30.36 kg and 36.63.69 weeks to 31.46.55 weeks
respectively from 1988 to 2008. The mean age of mothers in our study was 23.73.7
years and 22.44.19 years in 1988 study. The chief cause of morbidity in both cohorts
was sepsis. Conclusion: Birth weight remains an important factor affecting infant and
child mortality. To prevent occurrence of low birth weight, the public health strategy
needs to focus attention on better maternal nutrition, education and care. As low
birth weight newborns are more prone for various morbidities including perinatal
morbidity and sepsis, proper care at birth, timely referral, prevention of sepsis and
quality neonatal care can improve the outcome in these neonates.
Key words: Low birth weight, Neonate, Clinico-epidemiological
Introduction: million in 2012, however there are still huge
challenges to reduce the neonatal deaths
Globally, 4 million newborns die each and to prevent or reduce neonatal morbidity.
year and more than 80% of these deaths India contributes to more than 40% of
are due to preventable causes. India has global burden of low birth weight neonates
made significant reduction in neonatal with 7.5 million low births [1]. For the
deaths from 1.35 million in 1990 to 0.75 babies who survive, many face a lifetime of
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 National Journal of Medical and Dental Research, Jan.-March. 2015: Volume-3, Issue-2, Page 89-92

Flowchart showing enrollment of cases

significant disabilities. Low birth weight babies, in turn, are LBW babies enrolled n = 100
at greater risk of developing non communicable diseases
like hypertension and diabetes, and other significant health
Admitted Admitted within Admitted
conditions later in life, creating an intergenerational cycle between 2-7 days 24 hrs of age, n = 70 after 7th day
age, n = 24 of age, n = 6
of risk [2].
Died with in
24 hrs of
Age, n = 3
This study was done to study the morbidity and mortality
Died between 2- Babies Died
pattern in low birth weight neonates and to compare data 7 days of age, n examined at n=1
=4 24 hrs of
with a similar study done two decades earlier in same age, n = 67

institution to know the changing trends after improvement Died between 2-7
days of age, n = 15
in maternal and neonatal services over the years.
B abies examined at
7th day of age, n =
72

Died between
Aims and Objectives: 8th day to 1 month
of age, n = 7

Come for follow up

To see the changes in morbidity and mortality trends over at one month of age n = 70
twenty years in low birth weight neonates admitted for
various problems in a tertiary care setting in Central India.
Results:

Material & Methods:
This prospective observational cohort study was conducted
in a teaching hospital of Central India from January 2008 to
May 2008. During this period data was collected in a pre-
designed proforma from 100 consecutively admitted low
birth weight neonates born intramurally or extramurally.
Birth weight was recorded in the hospital or was taken
from reference letter issued by referring hospital if the
baby was admitted after 24 hours and gestational age
was assessed by new Ballard gestational age assessment
system. These neonates were followed up to one month of
age and outcome was assessed in terms of diseased/healthy,
alive/dead, duration of hospital stay and weight gain on
follow up at one month of age. Disease was diagnosed
on the basis of standard criteria [3, 4]. Whenever needed
necessary investigations were done. Data of the study was
compared with the similar study done 2 decades earlier
in this hospital by Dr Anjali Patwardhan titled A study
of morbidity and mortality patterns in low birth weight
babies during first three months of life and common factors
affecting birth weight. This study was done as dissertation
for M.D. Bhopal University in 1988.
Computerized analysis of data was done by the software
SPSS window 11.5, for dichotomous variables chi square
test was used, and for comparison of means of independent
variables t test was used.
In the present study, out of the 100 enrolled neonates,
64% were male and 36% were females. 70% babies were
admitted within 24 hours of age and 94% within 7 days of
birth. The mean birth weight in our study was 1.70.8 kg as
compared to 20.39 kg in 1988 study (p value=0.006). 69%
of newborns in our study weighed 2kg as opposed to 45%
in the earlier study done in 1998. The mean gestational age
in our study was also less i.e, 33.82.99 weeks, versus
35.83.9 weeks in previous study (p value=0.001). The
admissions of VLBW babies increased in 2008 to 35% from
7% in 1988. The mortality in present study in VLBW were
74.2%. The sex ratio was nearly similar in both periods and
so also the mortality rate in both sexes. The mean duration
of stay in 2008 in surviving babies was 9.95.7 days and
was 4.95.9 days in the expired babies. Similar data could
not be obtained from previous study. The mean age of
mothers in our study was 23.73.7 years and 22.44.19
years in 1988 study. The incidence of teenage mothers
decreased from 21% to 6% over two decades. We had a
larger cohort of preterm newborns in our study, 77% versus
43% in earlier study. The mortality in low birth weight
babies increased from 23% to 30% while mean birth weight
and gestational age of expired newborns fell from 1.70.4
kg to 1.30.36 kg and 36.63.69 weeks to 31.46.55 weeks
respectively from 1988 to 2008.
The main cause of morbidity in both cohorts was sepsis
whereas hyperbilirubinemia, respiratory distress, birth
asphyxia and apnea were other contributing cause in

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 National Journal of Medical and Dental Research, Jan.-March. 2015: Volume-3, Issue-2, Page 89-92
later study. In 1988 study, birth asphyxia and aspiration
pneumonia were the causes of morbidity followed by birth
trauma, apnea and hyperbilirubinemia in equal number
of cases. Tetanus neonatorum was seen in 5% newborns
in earlier study and none in later study done. Neonatal
sepsis was found to be chief contributing factor to neonatal
mortality in 2008 followed by respiratory distress, apnea
and aspiration pneumonia whereas aspiration pneumonia
followed by tetanus neonatorum, birth asphyxia was
responsible for deaths in earlier study (Table:1). The
difference of birth weight and gestational age was
statistically significant between the two cohorts (Table:2).
Sex and place of birth did not affect the outcome.
Discussion:
A positive trend in epidemiology of low birth weight has
been noted in our study. Preterm birth complications,
intrapartum related complications (birth asphyxia) and
neonatal sepsis or meningitis or other infections are
leading causes of neonatal deaths and contributed around
80% of neonatal mortality worldwide [5]. The mean
gestation age and birth weight of admitted low birth
weight babies has significantly decreased in twenty years
in our hospital, pointing to better survival chances of
this group at birth and possibly timely referral. A rise in
mortality (30% versus 23%) in two decades could thus be
explained by accessibility of more preterm and low birth
weight newborns to tertiary health care. As per Million
Death study 2005, three causes accounting for 78% of
all neonatal deaths in India are prematurity and low birth
weight, neonatal infections, birth asphyxia. Mortality rates
from neonatal infections are higher in poorer states (31%)
than richer states (17.5%) but were high in all regions [6].
In 2010, the scenario, regards causation of neonatal deaths
in India remained same as shown by Liu et al (Lancet
2012); Preterm births (35%), severe infections (31%) and
complications during child birth and asphyxia still lead to
more than 80% of deaths among newborns [7].Noteworthy
in our study is the rise in mean age of mothers of low
birth weight newborns. The fall in incidence of teenage
mothers is similar to the observation by Ashok Kumar [8].
A strong correlation exists between maternal age and low
birth weight .Interventions like RCH and health awareness
aimed at delaying pregnancy in young adolescents can help
in reducing burden of LBW. Besides, efforts should also be
directed at prolonging duration of gestation.
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Dental Journal Vol 3 Issue 2 Jan-March.indb 91
Major indications for admission in our study were
prematurity, poor feed acceptance and respiratory distress.
LBW infants are at particular risk of infection as compared
to their normal counterparts both as a result of increased
susceptibility as well as poor capability to mount an
inflammatory response against infectious organisms [9].
Globally, systemic infections are single most common
cause of neonatal mortality [10].Suspected neonatal
infections are amongst common causes of care-seeking
in neonates brought to hospital from community and
are also second common reasons of hospital admission
following discharge after birth [11, 12, 13]. Incidence of
infections with multidrug resistant bacteria is also higher
in settings where burden of neonatal infections is high
[14]. Hyperbilirubinemia has a higher incidence in low
birth weights and was second commonest morbidity in our
study. The recent every newborn Lancet Series (2014) has
provided new insights into the impact of evidence based
interventions in years to come. It has been estimated that
high coverage and quality of preconception, antenatal,
intrapartum, and postnatal interventions could save
additional neonatal deaths by 2025 (over 70% of current
burden) [10]. Janani Shishu Suraksha Karyakram (JSSK)
has increased the proportion of deliveries occurring in
health services [15]. In addition with opening of special
newborn care units at district hospitals, facility based care
has received tremendous boost in India over last few years.
Conclusion:
Thus LBW continues to be widely used as a useful composite
indicator of maternal, neonatal, social, educational and
development status in both developed and developing
countries. The prevention of morbidity and mortality in
low birth weight infants starts well within antenatal period.
The antenatal prevention begins well before conception and
includes improvement of socioeconomic status, maternal
education, adequate nutrition, avoiding teenage pregnancy,
timely referral, administration of anetenatal steroids,
antibiotics to mothers with premature rupture of membranes
and proper management of women with chronic diseases.
With better neonatal services and awareness of neonatal
problems in the country, it is expected that outcome of
low birth weight babies will improve further. At the same
time, measures for reducing neonatal infections should
deserve high priority in every neonatal unit. Dividends of
increasing health facility births and improved availability of
facility based sick newborn care may be lost if systems and
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 National Journal of Medical and Dental Research, Jan.-March. 2015: Volume-3, Issue-2, Page 89-92
processes are not in place to prevent neonatal infections.
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