The lower the birth weight and gestational age of the newborn, the higher the risk of complications and death and the more attention he or she needs. The special care they will need should take into account the classification of early and tiny babies, as described below.

Classification based on birth weight

Most preterm babies are low birth weight or very low-birth-weight, as classified below:

Low-birth-weight: Babies born with birth weight between 1,500-2,499 gm. These babies can usually be managed safely at home with some extra care and support.
Very low-birth-weight: Babies born with birth weight less than 1,500 gm. A life-threatening problem in such tiny babies is that sucking, swallowing and breathing are not well coordinated, so they require special attention in order to feed them adequately and safely. They also have great difficulty in maintaining their body temperature, so they are at increased risk of hypothermia. These babies need advanced life support and should be referred immediately to a hospital with special care facilities for very tiny babies. However, at the present time, such facility-based care may not be accessible to rural families in some parts of Ethiopia.

Classification by gestational age

A premature baby is a baby born before 37 completed weeks of pregnancy. Based on the gestational age, preterm babies are further classified as follows:

Preterm baby: Babies born between the gestational ages of 32-36 weeks of gestation, as calculated from the mother‘s last normal menstrual period (LNMP date). These babies can usually be managed safely at home with some extra care and support, which you will learn later in this study session.
Very preterm baby: Babies born between the gestational ages of 28-31 weeks as calculated from the LNMP date. Like very low birth weight babies. And for the same reasons, they have problems in feeding and maintaining their body temperature. If possible, they should be referred urgently for specialist care at a hospital.

The following table summarises these classifications and what action to be taken.

Birth weight and gestational age	Classification	Action
Weight less than 1,500 gm	Very low birth weight	Refer urgently to a hospital, making sure to keep the baby warm on the journey.
Gestational age less than 32 weeks	Very preterm	Keep the newborn baby warm and refer him soon.
Gestational age less than 32 weeks	Low birth weight	If there is no other problem: counsel on optimal breastfeeding, prevention of infection and keeping the baby warm.
Gestational age 32-36 weeks	preterm	As above for low birth weight babies.
Weight equal to or above 2,500 gm; gestational age equal to or above 37 weeks	Normal weight and full term	As above for low birth weight and preterm babies.

Table 7. 2. Classification of preterm and low-birth-weight newborns and actions to be taken.