Health Evidence Bulletins - Wales

Date of Completion: 23.6.97

The contents of this bulletin are likely to be valid for approximately one year, by which time significantly new research evidence may become available

19. Care of the low birth weight baby

(Users are advised to consult the supporting evidence for a consideration of all the implications of a recommendation)

An infant may be born small for gestational age, be born early or a combination of the two. The evidence regarding management of both suspected fetal growth impairment and of premature labour are considered in Chapters 13 and 14. Respiratory support is considered in Chapter 20.
The Statements The Evidence
19a. Both premature labour and labour associated with an infant suspected to be small for gestational age should be managed in a unit with appropriate facilities and experienced staff(i).
(Health gain notation - 1 "beneficial")
i. Department of Health. Confidential Enquiry into Stillbirths and Deaths in Infancy 1993. London: HMSO,1996

(Type IV evidence - well designed non-experimental studies)

19b. Current data are not sufficient to justify a policy of elective Caesarean Section of all small babies (i).

(Health gain notation - 4 "unknown")

i. Grant A. Elective versus selective Caesarean delivery of the small baby. Cochrane database of systematic reviews. Cochrane Library 1997 Issue 2
(Type I evidence - systematic review)
19c. Standards for resuscitation of the newborn are available from expert groups and include(i):
(Health gain notation - 1 "beneficial")
  • the presence of someone skilled in neonatal resuscitation at the birth of all infants likely to be at risk;
  • oxygen for resuscitation of distressed newborn infants;
  • Naloxone for infants with respiratory depression due to narcotic administration before birth.
i. British Paediatric Society. The report of the British Paediatric Society Working Party, Neonatal Resuscitation. London: BPA, 1993
(Type V evidence - expert opinion);
ii. Royal College of Obstetricians and Gynaecologists, Royal College of Paediatrics and Child Health and others. Joint advice for the resusitation of the newborn, 1997. London:
RCOG, in press
19d. Care should be provided after birth in units staffed and equipped to the appropriate level for the needs of the child (i).

(Health gain notation - 1 "beneficial")

i. Enkin M, Keirse MJNC, Renfrew M, Neilson J. A guide to effective care in pregnancy and childbirth. 2nd ed. Oxford: Oxford University Press. 1995. pp. 282, 335-345)
(Type V evidence - expert opinion)
19e. Administration of Vitamin K to the infant (1 mg intramuscular) is currently an effective way of reducing the incidence of late haemorrhagic disease (i). An association with childhood cancer has been reported but not substantiated.
(Health gain notation - 2 "likely to be beneficial")
i. See statements 21a. and 21b. in Chapter 21: ‘Prevention of neurological handicap’.

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Health Evidence Bulletins: Wales, Duthie Library, UWCM, Cardiff CF14 4XN. e-mail: