TN 2 (02-16)
DI 24598.003 Low Birth Weight (LBW)
A. What is LBW?
LBW is a birth weight:
B. When is LBW a medically determinable impairment (MDI)?
LBW is an MDI for children from birth to the attainment of age 1 whose birth weight is less than 2000 grams.
NOTE: While many LBW infants are born prematurely, prematurity is not a prerequisite for the establishment of a LBW MDI.
C. When is LBW not a MDI?
LBW is not an MDI for children from birth to attainment of age 1 whose birth weight is more than 2000 grams.
D. When is it appropriate to establish LBW?
Establish LBW when we have the following documentation:
1. Listing 100.04
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.
2. Child’s birth weight
Birth weight is the first weight recorded after birth.
3. Gestational Age (GA)
Consider the date of conception as recorded in the medical record as the gestational age of the infant. GA may be:
expressed in terms of the time elapsed from the first day of the last menstrual period of the mother; or
calculated based on certain physical signs at birth using scoring systems designed for this purpose, such as the Dubowitz forms for assessment.
If there is a significant discrepancy between the GA calculated using these two methods, the age determined based on the physical signs is usually more accurate.