CUT OFF POINT FOR LOW BIRTH WEIGHT ADMISSION TO NEONATAL INTENSIVE CARE UNIT
Bhavana B Lakhkar, Nalini Karande
Department of Pediatrics, JNMC, Sawangi Meghe, Wardha, India
Address for Correspondence
Dr. Nalini Karande, J.N.M.C, Sawangi (Meghe), Wardha, Maharashtra, India.
Abstract
Objective: This study aims at finding a new cut off point for low birth weight and intensive care based upon mortality and morbidity.

Methods: This was a retrospective study conducted at Acharya Vinoba Bhave Rural Hospital, Sawangi, Wardha, Maharashtra. All the in-borns weighing <2kg were categorized as per birth weight and gestational age and the cutoff point used for Neonatal Intensive Care Unit (NICU) admission was 1.8kg in term and 2kg if premature. If within 24hrs the baby was shifted to the post natal ward it was taken as post natal ward (PNC) admission and vice versa. Morbidity (based upon the NICU/ PNC stay) and mortality pattern of these babies was noted. Outcome of different weight groups and gestational age was analyzed and compared. Statistical package- SPSS was used for analysis.

Results: A total of 113 babies of which 65(57%) preterm and 48(42%) term weighing 2kg or less were included in the study. NICU stay was considered equivalent to presence of morbidity. Among the preterms 62(95%) were admitted in NICU and 28(58%) of term babies were in PNC. In 1.8-2kg weight group, 79% of term babies could be managed in PNC, where as 66% of preterms needed NICU care. In 1.8-1.6kg group, 95% of preterm and 35% of term babies needed NICU admission. For every weight band, mortality and morbidity was more in preterm. The mortality among the preterm babies above 1.8kg was as high as 34% where as in term babies in this weight group it was only 5%.

Conclusion: Hence this study shows that cut off point for low birth weight that needs special care can be 2kg for preterm and 1.8kg for term babies.
Keywords
Low birth weight cut off point, prematurity, special care
Introduction
Low birth weight (LBW) has been used as an indicator of adverse neonatal and infant outcome. World Health Organization (WHO) has defined LBW as babies weighing less than 2500 gm (up to and including 2499 gm) at birth [1]. In developing countries, LBW is reported between 25-36% of total births as compared with developed countries where it is less than 10% [2,3]. If special care is given to this weight group it will be an unmanageable load for developing countries like India. It has been noted that babies with birth weight of 2000-2500 grams are mostly term babies (though small) and do not differ significantly in morbidity and mortality when compared with babies weighing more than 2500 g [2]. Moreover if 2000 gm is taken as the cut off point for LBW, more manageable 10% infants would require special care [2,3,4]. Therefore, most Indian workers recommend the use of 2000 gm as the limit for identifying low birth weight [5]. This study aims at reaching a cut off point for Low birth weight and weight for NICU admissions based upon morbidity and mortality in babies whose birth weight is 2 kg or less.
Methods & Materials
All the babies weighing 2kg or less were categorized as per birth weight and gestational age. The cutoff point used for Neonatal Intensive Care Unit (NICU) admission was 1.8kg in term and 2kg if preterm. If within 24hrs, the baby was shifted to the post natal ward (PNC) it was taken as post natal ward admission and if baby was shifted to NICU from PNC then it was considered NICU admission. Morbidity (based upon the NICU/ PNC stay) and mortality pattern of these babies was noted. Baby in NICU was considered sick baby. Outcome of different weight groups and gestational age was analyzed and compared using Statistical package-SPSS.
Results
A total of 113 newborns were studied of which 65(57%) were preterm and 48(43%) were term babies. Of these preterm babies, 62(95%) were admitted in NICU and 28(58%) of term babies were in post natal ward (p-<0.001, significant). Male and female ratio was 1.5:1. When babies were distributed according to the weight 73% of babies who were >1.8kg could be managed in the PNC, but babies between 1.6-1.8kg, only 32% could be managed in the Post natal ward. This difference was statistically significant (p=0.008). Among preterms above 1.8 kg, 66% needed NICU care and below 1.8 kg 95% needed intensive care. (TABLE-1). As the weight reduced and prematurity increased more and more babies needed special care. Below 1.6 kg irrespective of maturity status almost all needed NICU care. The mortality among preterm babies was 33% as compared to 6.5% in the term babies (Z=2.41). This trend of high mortality among preterms persists in each weight group and is statistically significant. The mortality of preterm babies above 1.6kg was 11.5% (3 babies). It suddenly increases in babies below 1.6kg to 49%. In term babies, mortality was high below 1.4kg. This depicts high mortality in preterms as compared to term in every weight group. (TABLE-2).

TABLE -1 Showing distribution as per weight, gestational age and place of admission
Wt. group
1.8-2 kg n=22
1.6-1.8kg
n=43
1.4-1.6kg
n=20
<1.4kg
n=28
Total
Gest. age
PNC*
NICU**
PNC
NICU
PNC
NICU
PNC
NICU
 
Preterm
1
34%
2
66%
1
5%
22
95%
1
7%
15
93%
0
23
100%
65
57%
Term
15
79%
4
21%
13
65%
7
35%
0
4
100%
0
5
100%
48
43%
Total
16
73%
6
27%
14
32%
29
68%
1
5%
19
95%
0
28
100%
113


*indicates healthy babies shifted to PNC, ** indicates sick babies admitted to NICU, NICU- neonatal intensive care unit, PNC- post natal care

TABLE-2 Outcome based on weight and gestational age
n=113
Preterm outcome n=65
 
Term outcome n=48
Wt. grp
Death
Discharge
Wt. grp
Death
Discharge
1.8-2kg
(n=3)
1
34%
2
66%
1.8-2
n=19
1
5%
18
95%
1.6-1.8kg
(n=23)
2
9%
21
91%
1.6-1.8
n=20
0 20
100%
1.4-1.6kg
(n=16)
5
31%
11
69%
1.4-1.6
n=4
0 4
100%
<1.4kg
(n=23)
14
60%
9
40%
<1.4
n=5
2
40%
3
60%
Total
(n=65)
22(33%) 43(67%) Total n=48 3(6.5%) 45(93.5%)

Discussion
Present study depicts high mortality in preterms as compared to terms for each weight group. Same pattern is seen with morbidity (NICU stay) also. Morbidity in term babies increases below 1.6 kgs and mortality below 1.4 kgs. Neonatal Perinatal Database 2000 also shows this [2]. Reproductive Child Health (RCH) program of Govt. of India has chosen weight below 2 kg to give institutional care [5]. Other Indian scientists also found that problems like prematurity, respiratory distress and feeding problems were still less if low birth weight cut off point is taken 2kg or less [6]. How much less than 2kg has not been defined. This study clearly shows that 79% of term babies between 1.8 and 2 kg can be managed in the postnatal ward which will result in better utilization of resources.

In the present study, preterms are more than the term babies which is unlike what other authors have found [7,8]. This may be because this is a hospital based study and this hospital is a referral hospital with a tertiary level NICU. This also reflects the fact that term low birth weight babies of similar weight may have been managed at home or in the peripheral centers. To conclude, the present study suggests the cut off point for low birth weight in India can be taken as 1.8kg if term and 2kg if the baby is preterm and the same criteria can be used for NICU admission also. Those preterms above 1.8kg who do very well for 12-24hrs can be shifted to postnatal ward. This will also cut down on expenditure for patient and need for resources.
Funding
None
Conflict of Interest
None
References :
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  2. Neonatal Perinatal Database; 1995- 2000. National Neonatology Forum, New Delhi.
  3. Module for Medical Officer (primary health centre). Integrated Skill development training. National Institute of health & family welfare New Delhi. 2000; 532-533.
  4. McCornick MC. The contribution of low birth weight to infant mortality and childhood morbidity. New Eng J Med 1985, 312: 82-90.
  5. Paul VK. National Health Priorities in developing countries. J Neonatol 2001; 1: 4-11.
  6. Park JE. Preventive medicine in Obstetrics, Pediatrics and Geriatrics. In: Park JE (eds). Park-s textbook of preventive and social medicine. 19th Edition, Jabalpur,2007; pp 428.
  7. Sachdev HPS. Low birth weight in South Asia. In: Gillespie S (eds). Malnutrition in South Asia: A regional profile 1st edn. United Nations Children Fund, Regional office for South Asia, Publication No. 5, 1997; pp 43-75.
  8. Villar J, Belizan J. The relative contribution of prematurity and fetal growth retardation to low birth weight in developing and developed countries. American Journal of Obstetrics and Gynecology, 1982, 143: 793-798.
Last Updated : Saturday, August 01, 2009 Vol 6 Issue 8 Art #42
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Lakhkar B B, Karande N. CUT OFF POINT FOR LOW BIRTH WEIGHT ADMISSION TO NEONATAL INTENSIVE CARE UNIT . Pediatric Oncall [serial online] 2009[cited 2009 August 1];6. Art #42. Available From : http://www.pediatriconcall.com/Journal/Article/FullText.aspx?artid=248&type=J&tid=&imgid=&reportid=154&tbltype=
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