Evaluate LBW using DI 34005.100, Low Birth Weight and Failure to Thrive, under listing section 100.04 in infants
from birth to attainment of age l. In listing sections 100.04A and 100.04B, birth
weight means the first weight recorded after birth. If the infant’s impairment meets
the requirements for listing 100.04A or 100.04B, see Medical Diary Criteria for Low
Birth Weight (LBW) Infants under Title XVI per DI 25235.006.
NOTE: Values in the table in 100.04B represent the weight considered small for gestational
age (i.e., less than the 3rd percentile). We did not provide a value for 31 weeks because the small for gestational
age value for 31 weeks is below 1200 grams, and would meet the criterion in 100.04A.