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This document discusses the management of low birth weight babies. It begins by defining low birth weight as under 2500g and categorizes it into grades. It then discusses the significance, types, causes, identification, problems, care and feeding of low birth weight babies. Special care involves prevention of infections, hypothermia and malnutrition. Hospital care focuses on the same along with use of incubators. Kangaroo mother care is also described which involves skin-to-skin contact between the mother and baby.
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- 1. Management of Low BirthWeight Babies
- 2. LOW BIRTH WEIGHT Birthweight<2500 g GRADING Birth weight Grade 2500 – 2000 gm Low birth weight 2000 – 1000 gm Very low birth weight < 1000 gm Extremely low birth weight
- 3. LBW: Significance Incidence: 30% of neonates in India 75% neonatal deaths and 50% infant deaths occur among LBW infants LBW babies are more prone to: Malnutrition Recurrent infections Neuro developmental delay LBW babies have higher mortality and morbidity
- 4. Types of LBW Preterm < 37 completed weeks of gestation Account for 1/3rd of LBW Small-for-date (SFD) / intra uterine growth retardation (IUGR) < 10th centile for gestational age Account for 2/3rd of LBW neonates 2 types based on the origin
- 5. CAUSES of LBW Lowbirth weight includes 2 groups 1) Preterm babies(<37 wks ) 2) IUGR In nearly 50% of cases of LBW the cause is not known. In remaining 50% the causes are grouped into a) medical b) social
- 6. a) Medical causes 1.Maternal causes : all high risk mothers except Diabetics 2. Placental causes : Placenta previa , Congenital defects of placenta etc, 3. Fetal causes : Multiple gestation, Hydramnios, intrauterine infections etc. b) Social causes Poverty, Illiteracy, Ignorance, Poor standard of living, lack of knowledge on family planning, early marriages, smoking etc
- 7. Causation: LBW Etiology ofprematurity Low maternal weight, teenage / multiple pregnancy Previous preterm baby, cervical incompetence Antepartum hemorrhage, acute systemic disease Induced premature delivery Majority unknown
- 8. Etiology of SFD/ IUGR Poor nutritional status of mother Hypertension, toxemia, anemia Multiple pregnancy, post maturity Chronic malaria, chronic illness Tobacco use Causation: LBW
- 9. LBW: Identification oftypes Prematurity Date of LMP Physical features Breast nodule Genitalia Sole creases Ear cartilage / recoil
- 10. Identification: Preterm LBW Breastnodule Preterm Term Preterm Term
- 11. Male genitalia Identification: PretermLBW Preterm TermPreterm Term
- 12. Female genitalia Identification: PretermLBW Preterm Term
- 13. Identification: Preterm LBW Solecreases Preterm Term
- 14. Ear Cartilage Identification: PretermLBW Preterm Term
- 15. SFD / IUGR Intrauterine growth chart Physical characteristics Emaciated look Loose folds of skin Lack of subcutaneous tissue Head bigger than chest by >3cm LBW: Identification of types
- 16. Intrauterine growth chart 400 800 1200 1600 2000 2400 2800 3200 3600 4000 4400 3133 35 37 39 42 44 45 PRETERM TERM POST-TERM APPROPRIATE FOR DATE SMALL FOR DATE LARGE FOR DATE 90th percentile 10th percentile Gestation (weeks) Birthweight(grams
- 17. 2.1 Kg -IUGR 3.2 Kg - AFD Identification: SFD / IUGR
- 18. LBW (Preterm) :Problems Birth asphyxia Hypothermia Feeding difficulties Infections Hyperbilirubinemia Respiratory distress Retinopathy of prematurity Apneic spells Intraventricular hemorrhage Hypoglycemia Metabolic acidosis
- 19. Birth asphyxia Meconium aspiration syndrome Hypothermia Hypoglycemia Infections Polycythemia LBW (SFD) : Problems
- 20. LBW: Issues indelivery Transfer mother to a well-equipped centre before delivery Skilled person needed for effective resuscitation Prevention of hypothermia - topmost priority
- 21. Care of LBWbabies Depends upon birth weight 2500 – 2000 gm - Requires special care at home <2000 gm - Requires special care at hospital <2000 gm & >1800 gm & stable Hemodynamically - Requires kangaroo mother care
- 22. Special care atHome Principles: Prevention of infections Prevention of hypothermia Correction of malnutrition 1.Prevention of infections - Gentle and minimal handling - Handling with clean hands - Room must be warm, clean and dust-free - Immunization at right time
- 23. 2.Prevention of hypothermia Avoid bath till baby attains 2500g weight Cover baby with clean dry & warm cloth Bottles filled with warm water & covered with thin cloth are kept on both sides (or) baby without blanket is kept near 60 candle bulb burning. 3.Correction of malnutrition As LBW babies cannot suck milk actively , it gets tired faster. So frequent breast feeding must be given almost
- 24. LBW: Keeping warmat home Birth weight (Kg) Room temperature (0 C) 1.0 – 1.5 34 – 35 1.5 – 2.0 32 – 34 2.0 – 2.5 30 – 32 > 2.5 28 - 30 Skin-to-skin contact Warm room, fire or heater Prevent heat losses Baby warmly wrapped Conduction Radiation Convection Evaporation
- 25. Special care atHospital 1.Prevention of infections Prophylactic antibiotics to prevent septicemia. Separate nurses for feeding and toilet attending. Barrier nursing to prevent cross infections.
- 26. 2.Prevention of hypothermia Child is kept under incubator – it maintains the temperature , humidity and o2 supply , till weight increases to 2000g. Careful monitoring of O2 supply: low O2 – hypoxia and cerebral palsy high O2 – retinopathy of prematurity
- 27. 3.Correction of malnutrition The baby is already malnourished. Further malnutrition should be prevented. Tube feeding is done because baby is in incubator and it is too young to suck mothers milk.
- 28. Care of LBWbabies Depends upon birth weight 2500 – 2000 gm - Requires special care at home <2000 gm - Requires special care at hospital <2000 gm & >1800 gm & stable Hemodynamically - Requires kangaroo mother care
- 29. Special care atHome Principles: Prevention of infections Prevention of hypothermia Correction of malnutrition 1.Prevention of infections - Gentle and minimal handling - Handling with clean hands - Room must be warm, clean and dust-free - Immunization at right time
- 30. 2.Prevention of hypothermia Avoid bath till baby attains 2500g weight Cover baby with clean dry & warm cloth Bottles filled with warm water & covered with thin cloth are kept on both sides (or) baby without blanket is kept near 60 candle bulb burning. 3.Correction of malnutrition As LBW babies cannot suck milk actively , it gets tired faster. So frequent breast feeding must be given almost
- 31. LBW: Keeping warmat home Birth weight (Kg) Room temperature (0 C) 1.0 – 1.5 34 – 35 1.5 – 2.0 32 – 34 2.0 – 2.5 30 – 32 > 2.5 28 - 30 Skin-to-skin contact Warm room, fire or heater Prevent heat losses Baby warmly wrapped Conduction Radiation Convection Evaporation
- 32. Special care atHospital 1.Prevention of infections Prophylactic antibiotics to prevent septicemia. Separate nurses for feeding and toilet attending. Barrier nursing to prevent cross infections.
- 33. 2.Prevention of hypothermia Child is kept under incubator – it maintains the temperature , humidity and o2 supply , till weight increases to 2000g. Careful monitoring of O2 supply: low O2 – hypoxia and cerebral palsy high O2 – retinopathy of prematurity
- 34. 3.Correction of malnutrition The baby is already malnourished. Further malnutrition should be prevented. Tube feeding is done because baby is in incubator and it is too young to suck mothers milk.
- 35. LBW: Indications for hospitalization Birth weight <1800 g Gestation <34 wks Unable to feed* Sick neonate* * Irrespective of birth weight and gestation
- 36. LBW: Keeping warmat home Birth weight (Kg) Room temperature (0 C) 1.0 – 1.5 34 – 35 1.5 – 2.0 32 – 34 2.0 – 2.5 30 – 32 > 2.5 28 - 30 Skin-to-skin contact Warm room, fire or heater Prevent heat losses Baby warmly wrapped Conduction Radiation Convection Evaporation
- 37. Well covered newborn LBW:Keeping warm at home
- 38. LBW: Keeping warmin hospital Skin-to skin method Warm room, fire or electric heater Warmly wrapped Heated water-filled mattress Air-heated Incubator Radiant warmer
- 39. Overhead Radiant warmer LBW: Keepingwarm in hospital
- 40. LBW: Fluids andfeeding Weight <1200 g; Gestation <30 wks* Start initial intravenous fluids Introduce gavage feeds once stable Shift to katori-spoon feeds over next few days. Later on breast feeds * May try gavage feeds, if not sick
- 41. Weight 1200-1800 g;Gestation 30-34 wks* Start initial gavage feeds Katori-spoon feeding after 1-3 days Shift to breast feeds as soon as baby is able to suck * May need intravenous fluids, if sick LBW: Fluids and feeding
- 42. Weight >1800 g;Gestation > 34 wks* Breast feeding Katori-spoon feeding, if sucking not satisfactory on breast Shift to breast feeds as soon as possible LBW: Fluids and feeding
- 43. LBW: Feeding schedule Begin at 60 to 80ml/kg/day Increase by 15ml/kg/day Maximum of 180-200ml/kg/day First feed at 2 hrs of age then every 2 hourly
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- 46. Guidelines for fluidrequirements First day 60-80 ml/kg/day Daily increment 15 ml/kg till day 7 Add extra 20-30 ml/kg for infants under radiant warmer and 15 ml/kg for those receiving phototherapy
- 47. Fluid requirements (ml/kg) BirthWeight Day of life >1500 g 1000 – 1500g 1 2 3 4 5 6 7 onwards 60 75 90 105 120 135 150 80 95 110 125 140 155 170
- 48. LBW: Adequacy ofnutrition Weight pattern* Loses 1 to 2% weight every day initially Cumulative weight loss 10%; more in preterm Regains birth weight by 10-14 days Then gains weight up to 1 to 1.5% of birth weight daily Excessive loss or inadequate weight Cold stress, anemia, poor intake, sepsis * SFD - LBW term baby does not lose weight
- 49. LBW: Supplements Vitamins: IM Vit K 1.0 mg at birth Vit A* 1000 I.U. per day Vit D* 400 I.U. per day Iron : Oral 2 mg/kg per day from 8 weeks of age *From 2 weeks of age
- 50. Danger signals (Earlydetection and referral) Lethargy, refusal to feed Hypothermia Tachypnea, grunt, gasping, apnea Seizures, vacant stare Abdominal distension Bleeding, icterus over palms/soles
- 51. Transportation of LBWbaby Adequate warmth Life support With mother Referral note
- 52. Prognosis Mortality Inverselyrelated to birth weight and gestation Directly related to severity of complications Long term Depends on birth weight, gestation and severity of complications
- 53. KANGAROO MOTHER CARE Firstsuggested by Dr Edgar Ray in Colombia. Refers to care of preterm or low birth weight infants by placing the infant in skin-to-skin contact with the mother or any other caregiver.
- 54. PARAMETERS TO BEMONITORED DURING KMC Temperature : Once in 6 hrs. Respiration : For apnea. Feeding : Once in 90-120 min. Well being : By educating mother about danger signs. growth : Gain of 15-20 g /kg/day. Compliance with kangaroo care.
- 55. 1.KANGAROO POSITION Consists ofspecific frog like position of LBW new born with skin-to-skin contact with mother , in between her breasts in a vertical position. COMPONENTS OF KMC The provider must keep herself in a semi-reclining position to avoid gastric reflux in the infant. Maintained 24 hrs a day , till it gains at least 2000g.
- 56. Baby mustbe suitably dressed in a cap , soak-proof diaper , socks and with an open shirt to have skin to skin contact between mother and baby and placed in a kangaroo bag. PREPARATION OF KANGAROO BABY Mechanism of prevention of hypothermia THERMAL SYNCHRONY If the temp of the baby decreases by 1°c , correspondingly the temp of mother increases by 2 °c to warm up the baby.
- 57. 2.KANGAROO FEEDING POLICY kangaroo position is ideal for breast feeding. Exclusive breast feeding is the policy. Feeding is done once in 90-120 min. If the baby can suckle , it is promoted. If baby cannot suckle , expressed breast milk to be fed. If the baby is unable to swallow , EBM is fed by nasogastric tube.
- 58. 3a.EARLY DISCHARGE Criteria fordischarge: Wt gain of at least 40g a day for 5 consecutive days. Baby should feed well on breast milk. Temp should be maintained. There should not be any evidence of illness. Successful ‘in-hospital adaptation’ of the mother and other members of the family.
- 59. 3b.FOLLOW-UP After discharge, KMC is continued at home. Follow-up is done daily by the health worker for one week and ensured that baby is feeding well and gaining about 40g weight daily. Afterwards once a week till the baby reaches 40 weeks of post conceptional age.