6. Low birth weight related information LBW (1).pptx

To given education regarding the law.
To give the information about weight.
To reduce the chance of low birth weight
Explain details about the low birth weight

1. NURSING MA NA G E M E N T O F A LOW B I R T H W E I G H T BA B I ES

2. L o w b i r th w e i g h t ( L B W ) D e f i n i t i o n : B i r t h w e i g h t < 25 g (2.5 kg) 30 % o f n e o n a t e s in I n d i a I n c i d e n c e :

3. L B W : Si g n i f i ca n c e 75 % neona t a l dea t h s an d 50 % in f an t dea t h s o cc u r a m on g L B W i n f an t s L B W babie s a r e m o re p r on e t o : M a l nu t r i t i o n R ecurren t i n fec t i ons N eur o develo p m e nt a l d e l ay L B W b a b i es h ave h i g h e r m o r t a li t y a nd m o r b i d i t y

4. CLASSIFICATION: According to Size: LBW- < 2500 gm Moderately LBW- 1500-2500 gm Very LBW- <1500 gm Extremely LBW- <1000 gm

5. Cont.. 2. According to gestational Age: a. gestational Age with weight: AGA- wt falls bw 10 th & 90 th % SGA- < 10 th % LGA- > 90 th % IUGR b. gestational Age regardless of weight: Preterm : < 37 wks Full Term : 38-42 wks Post Term: > 42 wks

6. I n tr a u t e r i n e g r o wth c h a rt

7. Cont.. 3. According to Mortality: Fetal Death: after 20 wk of gestational age, before delivery Neonatal death: Early & late Perinatal Mortality Postnatal Death

8. A. PRETERM INFANTS: Infant Born before the 37 wk of gestation.

9. Characteristics : P r e t e rm FEATURES SPECIFICATION Size Small <47 cm; wt <2.5 kg Posture Relaxed attitude, Limbs are extended Head Large, Sutures widely separated & fontanels large Hair Fine, Fuzzy & wooly Skin Thin, Pinkish & appear shiny, Abundant lanugo & little vernix caseosa Scarf Sign Infant elbow easily brought across chest Heel to ear maneuver Heel easily brought to the ear

10. Cont.. Br east n o d u l e P r e t e r m T e r m P r e t e rm T e rm

11. M a l e g e ni t a li a Cont.. P r e t e rm T e rm P r e t e rm T e rm

12. F e m a l e g e ni t a li a Cont… P r e t e rm T e rm

13. Cont.. S o l e c r ease s P r e t e rm T e r m

14. E ar C a rt il a g e Cont.. P r ete r m T e r m

15. ETIOLOGY OF PRETERM BIRTH Fetal Factors: Fetal Distress Multiple gestation Erythroblastosis Fetalis

16. Cont.. 2. Placental factors: Placental dysfunction Placenta Previa Abruptio Placental

17. Cont.. 3 . Uterine Factors: Bicornuate Uterus Incompetent Cervix

18. Cont.. 4. Maternal Factors: Pre- eclampsia Chronic medical illness Infection Drug Abuse

19. Cont.. 5. Other Factors: PRM Polyhydramnios Trauma

20. PROBLEM ASSOCIATED WITH PREMATURITY: Respiratory Problems Cardiovascular Problems GI Problems CNS Problems Problem associated with renal system Other Problems

21. B. SMALL FOR DATES/SFG AGE BABIES A baby wt falls below the 10 th percentile on intrauterine growth curves- SFD/SGA .

22. CLASSIFICATION: Malnourished SFD Infants: Growth arrest in later pregnancy Reduction in cell size but not cell number Baby look marasmic & less subcutaneous fat

23. Cont.. 2 . Hypoplastic SFD Babies: Growth retardation in early part of pregnancy Reduction in number of body cell Babies smaller in all parameters including head size

24. Cont.. 3. Mixed: Growth retardation in early & mid pregnancy Reduction in both cell number & size

25. ETIOLOGY OF SFD BABY Fetal Factors: Chromosomal anomalies Infection Multiple gestation Pancreatic hypoplasia Insulin deficiency

26. Cont.. 2. Placental Factors: Placental weight Abruptio Placenta Infection of Placenta

27. Cont.. 3. Maternal Factors: Toxemia of pregnancy HTN Hypoxemia Malnutrition Short status of mother Primi /grand multipara Young mother (<20 year) Smoking, alcohol, drug abuse

28. PROBLEMS OF SFD BABIES: Birth asphyxia Polycythemia & hyperviscosity of blood Hypothermia Congenital malformation

29. Principles of Management of LBW babies: Care at Birth: Suitable place for delivery If premature labour administer Betamethasone (12mg IM, 2 dose at interval of 18 hrs)/ Hydrocortisone 100 mg to the mother-improve in the lung maturity Delayed cord clamping Avoid sedatives to the mother Administer vit K 0.5 mg IM Prevent hypothermia

30. Cont.. 2. Appropriate place of care: BW >1800 gm- home care BW 1500-1800 gm – Secondary level care BW <1500 gm – Tertiary Level care

31. Cont.. 3. Thermal Protection 4. Nutrition 5. Monitoring & early detection of complications 6. Appropriate management of specific complications especially infection

32. NURSING INTERVENTION: Nursery Care: Clear airway Initiate breathing Care of umbilical cord Eye care Vit . K administraion

33. 2. Thermal control: S k in - t o - sk i n c o n t a c t W a rm r o om, f i re o r h e a t e r P r e v e n t h e a t lo s s e s B a b y w a rm l y w r a p p e d C o ndu c t i on R a d i at i on C o nve c t i on Eva p o r a t ion B i r t h w e i g ht ( K g ) R oo m te m p e r at u r e ( C ) 1 . – 1.5 34 – 35 1 . 5 – 2.0 32 – 34 2 . – 2.5 30 – 32 > 2 . 5 28 - 30

34. W e l l c o ve r e d n e w b o r n Cont..

35. Cont.. S k in -t o s k in m e t ho d W a rm r oo m , f i re o r e l ec tr i c h e a t e r W a r ml y w r a p p e d Hea t e d w a t e r- f ill e d m a ttr e s s A i r- h e a t e d I n c ub a t o r R a d i a n t w a rm e r

36. O ve r h ea d Ra d i a n t w a rm e r Cont..

37. 3. G uid e l in e s f o r f lu id r eq u i r e m e n ts F i r st da y 60 - 8 m l / k g / da y Dai l y in cr e m e n t 1 5 m l / k g t il l da y 7 A d d e x t ra 20 - 3 m l / kg f o r in f an t s unde r r adian t wa r m e r an d 1 5 m l / kg f o r t ho se r e c ei v in g pho t o t he r ap y

38. Fluid re q ui r em e n ts ( m l / kg ) D a y o f l i fe B i rth W e i g h t > 1500 g 1000 – 1 5 g 1 6 8 2 7 5 9 5 3 9 1 1 4 1 5 1 2 5 5 1 2 1 4 6 1 3 5 1 5 5 7 on w a r ds 1 5 1 7

39. 4. Feeding & Nutrition: Age Categories of Neonates Birth Weight <1200 gm <30 weeks 1200-1800 gm 30-34 weeks >1800 gm >34 weeks Initial IV Fluid & Try Gavage feeding Gavage Breast feed/ Katori spoon After 1-3 days Gavage Katori spoon Breast feed 2-4 weeks Katori spoon Breast feed Breast feed 4-6 weeks Breast feed Breast feed Breast feed

40. L B W: F e eding G a va g e f e e d i n g

41. Ka t o r i - s p o o n f ee d i n g L B W : F e e d i n g

42. Cont.. 5 . Management of complications: Infection Jaundice Metabolic derangement Hematological abnormality Retinopathy of Prematurity

43. D a n g e r s ig n a l s (E a r l y d ete c t ion and r e fe r r a l ) Le t ha r g y, r e f u s a l t o f e e d H y po t he r m i a T a c h y pnea , ga s ping , apne a S ei z u r e s A bdo m ina l di st en s io n B leed i n g , i ct e r u s o ve r pal m s / s ole s

44. T r ans p o r t at i on o f L B W b a b y A dequa t e wa rm t h Li f e suppo r t W i t h m o t he r Re f e rr a l no t e

45. Pro g n o s i s M o r t ali t y In v e r sely re l a te d t o b i r t h w e i g h t an d g e s t a t i on Di r ec t l y re l a te d t o s ever i t y o f co m p li ca t i ons Lon g t e rm D epe n d s o n b i r t h w e i g ht , g esta t i o n a n d seve r i t y o f co mp li c a t i o n s

46. Strategies to reduce incidence of LBW: Proper education for women Optimal Nutrition Health check up Avoid early marriage & teenage pregnancy Inter pregnancy interval at least 3 year Caloric intake, Protein, iron & folic acid supplementation Avoid smoking, alcohol Early detection of disease