Factors Affecting the Growth of Low Birth Weight Babies

Birth weight is one of the determinants of a child's physical growth and future brain development. However, babies with low birth weight (LBW) are at risk of death and other health problems. The purpose of this literature review is to systematically summarize research that analyzes the factors that influence the growth of low birth weight babies. The method used was a literature review using the PRISMA Protocol, with inclusion criteria, namely full text and original research, the research subjects were babies born with low birth weight (<2500g), articles in Indonesian and English, published in the last 5 years (2017-2022). The results showed that there are several factors that influence the growth of infants with a history of low birth weight such as gender (male), lower gestational age, postnatal health problems, nutritional intake, such as exclusive breastfeeding or enteral feeding, and maternal parenting practices such as Kangaroo Mother Care (KMC). Exclusive breastfeeding and maternal parenting practices (Kangaroo Mother Care) have an impact on increasing growth so it is good to apply especially for mothers who have low-birthweight babies to catch up with age-appropriate growth. Attribution-Share Alike 4.0 International (CC BY-SA 4.0)


Introduction
Birth weight is one of the determinants of a child's physical growth and future brain development and is a valid sign of fetal growth in the womb. One of the most important health indicators is weight because babies with low birth weight (BBLR) have a risk of babies at risk of neonatal death and health problems ( Khazaei et al. 2021). Babies born with a body weight of less than 2,500 g are low, even though the risk of death in BBLR babies is 25 to 30 times greater than babies with normal birth weight. Therefore, the lower the birth weight, the higher the risk of death. In addition, BBLR babies who can survive are at risk of short-term and long-term disability, 2 to 3 times more than babies with normal birth weight (Aregay et al. 2015).
As many as 16% of births are related to low birth weight babies or about 20 million babies born weighing less than 2,500 g. The percentage of births with low birth weight is higher in underdeveloped and developing countries and countries by 18.6% and 16.5% while in developed countries by 7%. Meanwhile, the prevalence of low-weight infants in Asia is 20% (Derakhshi et al. 2014;Mumbare et al. 2012). In Indonesia, premature birth and low birth weight (BBLR) in Indonesia are still relatively high. Most premature births are always followed by Low Birth Weight Babies (BBLR). The prevalence of premature babies in Indonesia is still relatively high at 7-14%, even in some districts it reaches 16% while the national prevalence of low birth weight is 11.5%. This prevalence is greater than some developing countries which are 5 -9% and 12 -13% in the USA ( Kemenkes RI 2022).
Babies with low birth weight (BBLR) have a high risk of postnatal growth retardation, and will subsequently have a long-term negative impact on health ( Liao et al. 2019). Most babies born with low body weight have a long-term life process that is less than optimal. Babies born with low body weight have a risk of growing and developing more slowly compared to babies born with normal weight. In addition to growth and development disorders, individuals with a history of low birth weight have high risk factors for hypertension, heart disease and diabetes after 8 years of age (Kosim et al. 2012).
Some studies show that babies with low birth weight have a growth pattern that is less than optimal. Research conducted by Hsu et al. (2018) showed that very low birth weight infants with associated failure to thrive (FTT) were strongly associated with poor neurodevelopmental outcomes at three different time points (6, 12, and 24 months). Comorbidities associated with postnatal growth are necrotising enterocolitis, isolated gastrointestinal perforation, and severe retinopathy of prematurity, which are associated with an adjusted mean decrease in low birth weight Z-scores (Griffin et al. 2016). Growth delays or failure to regain birth weight may occur due to prevailing postnatal care practices and/or various factors, which may be medical, nutritional or environmental related (Subramanian et al. 2011). Therefore, this study aims to systematically summarize research that analyzes the factors that influence the growth of babies with low birth weight.

Research methods
The research method used is literature review using articles from international and national journals with national reputation Sinta 1-4 using keywords: "low birth weight", "catch-up growth", "post-natal growth failure" "risk factor". The articles have been selected using PRISMA. The article inclusion criteria used are full text and original research, research subjects are babies born with low body weight (<2500g), articles in Indonesian and English, published in the last 5 years (2017)(2018)(2019)(2020)(2021)(2022). A total of 6 articles were obtained that fit the inclusion and exclusion criteria. The stages of PRISMA can be seen in Figure 1. Results and Discussion

Multiple Linear Analysis
Based on data analysis that has been carried out with systematic literature review research with prism method, research findings are obtained in Table 1. Journal search using keywords "low birth weight", "growth", "postnatal growth failure", "Risk factors", through Garuda Ristekbrin database (n=9) and Pubmed in 2017-2022 (n=298) Articles after title filtering and article duplication with the addition of keywords / keywords "factors that affect BBLR growth" (n = 25)

Screenned articles (n= 25)
Full text of notability-tested articles (n= 20) Research that goes into synthesis (n= 6) Low birth weight (BBLR) significantly indicates infant survival and intrauterine growth. Differences in postnatal growth rates, especially in babies with low birth weight, are associated with sex, nutritional factors, chronic diseases, lung diseases or sepsis. Some research suggests that male sex, early respiratory distress, bronchopulmonary dysplasia and postnatal steroid exposure exposure are risk factors for postnatal growth disorders in infants with low body weight (Griffin et al. 2016). These results are also in line with research by Sinha et al. (2022) and Lim et al. (2021) which also shows boys and other health disorders such as pneumonia, periventricular leukomalacia, retinopathy of prematurity and VP shunt are risk factors for postnatal disorders in infants with low birthweight. The presence of health problems in BBLR infants can increase the length of time the baby is hospitalized while the duration of hospitalization for more than 7 days (AOR: 4.2; 95% CI: 2.3 -7.6; p value <0.001) is independently associated with growth failure in infants with low birth weight (Namiro et al. 2012).
Although, the results of research conducted by Santri et al. (2014) did not show a significant association of sex factors to growth rates in infants with a history of low birthweight, but family economic status and parental education had a significant relationship to growth rates. This is because poverty is always associated with lack of food, poor environmental health, and ignorance of information about how to take good care of children, how to maintain children's health so that it can hinder efforts to increase growth in children.
Research conducted by Lee et al. (2018) and Durá-Travé et al. (2020) showed that postnatal growth disorders in BBLR infants were associated with lower gestational age, very low body weight and having lower Apgar scores at birth. Infants with postnatal growth disorders also experienced RDS, air leakage, and pulmonary hypertension that required longer ventilation support, longer ventilation support than the BBLR group without postnatal growth disorders. Research conducted by Lim et al. (2021) shows that maternal hypertension during pregnancy is also a risk factor for postnatal growth disorders in infants with low birthweight, especially with Small Gestational Age (SGA). Babies born with low body weight with smaller SGA had a 1.89 and 2.32 times greater risk of stunting and underweight at 6 months of age compared to infants under gestational age (AGA). Babies who did not regain birth weight for two weeks also had a 1.51 and 1.55 greater risk of stunting and underweight compared to babies who gained weight. Therefore, early intervention is necessary that includes optimal feeding support, growth monitoring is important to be given to enable proper weight gain and proactivity in the management of babies with low birth weight.
Nevertheless, early and aggressive intervention for adequate weight gain may further reduce the risk of growth retardation of children with a history of low birth weight (Liao et al. 2019). One of the nutritional interventions that can be given is full enteral feeding and this is a factor that inhibits postnatal growth disorders in AGA and SGA infants so it is recommended to provide aggressive nutrient intake used to prevent postnatal growth disorders in BBLR babies. The ESPGHAN Committee recommends supplementation of enteral nutrient intake with a reasonable energy intake range of 110-135 kcal/kg/day (Agostoni et al. 2010). In addition, research conducted by Sinha et al. (2022) and Omidi et al. (2022) also shows that aggressive nutrient intake, one of which is exclusive breastfeeding, can also be an inhibiting factor of growth disorders. Babies with low birth weight (BBLR) have high nutritional needs so they must get nutritional intake, especially from breast milk (ASI) which can significantly affect their weight and length. In addition, exclusive breastfeeding up to six months of age or breastfeeding is recommended for babies with a history of birth weight with low birth weight because it can reduce the risk of lateonset sepsis, necrotizing entercolitis, reduce food intolerance so as to catch up growth (De Halleux et al. 2019). In addition, early initiation of breastfeeding within 48 hours after birth.
The existence of support for mothers, one of which is education related to breastfeeding and Kangaroo Mother Care (KMC) also affects the increase in body weight of babies with low birth weight (Kurniawati et al. 2019;Omidi et al. 2022). Education to mothers related to breastfeeding can increase the weight of babies with a history of birth with low body weight, namely 2297.5 grams to 2565.6 grams for 14-15 days after education, while in the control group the baby's weight is still relatively low after 14-15 days (Omidi et al. 2022). Significant differences were also seen from infant weight gain between the control group (1735.7 ± 297 gr) and the KMC intervention group (1923.4 ± 281 gr) (α<0.05) (Kurniawati et al. 2019). These results are also in line with research conducted by Siswanti et al. (2022) which showed an increase in the body weight of infants receiving kangaroo care, the average weight of babies born low before kangaroo treatment was 1900 grams, while the body weight of infants after receiving kangaroo care increased by 2150 grams (p-value = 0.000).

Conclusion
The results of this study show that there are several risk factors for growth failure of children with a history of low birth weight such as gender (male), lower gestational age, and postnatal health problems such as pneumonia, periventricular leukomalacia, retinopathy of prematurity and VP shunt as well as maternal conditions during pregnancy, especially hypertension. However, there are also factors that can inhibit the growth failure of children with a history of low birth weight, including early and aggressive intervention, especially in nutritional intake, namely exclusive breastfeeding or enteral food and maternal parenting practices such as Kangaroo Mother Care (KMC).
The results of this literature review are expected to be a reference for health practitioners to give more attention and treatment to babies with low birth weight by providing early intervention to infants or mothers to increase their confidence in caring for babies with low birth weight so that they can catch up with growth. Suggestions for future research can develop related interventions both to mothers and families to increase self-confidence or the ability to care for babies with low birth weight as an optimal health effort so that children can achieve age-appropriate growth and development processes.
Factors Affecting the Growth of Low Birth Weight Babies