CARE OF LBW BABY.pdf

Care Of LBW baby in child health nursing

1. Management of
Low Birth Weight
Babies

2. Low birth weight (LBW)








 Definition : Birth weight
<2500 g

 Incidence : 30% of neonates
in India

3. LBW: Significance

LBW babies have higher mortality and morbidity


 75% neonatal deaths and 50% infant
deaths occur among LBW infants
 LBW babies are more prone to:
 Malnutrition
 Recurrent infections
 Neuro developmental delay

4. Types of LBW

2 types based on the origin







A. Preterm


 < 37 completed
weeks of gestation
 Account for 1/3
rd
of
LBW
B. Small-for-date (SFD) /
intra uterine growth
retardation (IUGR)


< 10
th
centile for
gestational age
 Account for 2/3
rd
of
LBW neonates

5. Causation: LBW






Etiology of prematurity

 Low maternal weight, teenage / multiple
pregnancy
 Previous preterm baby, cervical incompetence
 Antepartum hemorrhage, acute systemic
disease
 Induced premature delivery
 Infections, Trauma.
 Drug abuse, alcohol consumption.
 Majority unknown

6. Causation: LBW





Etiology of SFD / IUGR

 Poor nutritional status of mother.
 Hypertension, toxemia, anemia..
 Multiple pregnancy, post maturity.
 Chronic malaria, chronic illness.
 Tobacco, alcohol, drug use.
 Young mother.
 Primi / grand multipara.

7. Identification: Preterm LBW



SIZE Small in size, usually less than 47 cm, less than 2.5 kg
POSTURE Lies in RELAXED attitude and limbs are extended.
HEAD Head is relatively large, sutures are widely separated and fontanelles are large.
HAIR FINE, FUZZY AND WOOLY.
SKIN Thin, pinkish, appears shiny. Covered with abundant lanugo and little VERNIX CASEOSA.
EAR Ear cartilage poorly is poorly developed developed and ear may fold easily.
BREAST Absent or less than 5 mm wide.
SOLE Preterm appears more turgid and may have only one fine wrinkles. The creases are absent.
FEMALE
GENETALIA
The female infants clitoris is prominent and labia majora are poorly developed and gaping.
MALE
GENETALIA
The scrotum is underdeveloped and not pendulous, testes may be in the inguinal canal or in
the abdominal cavity.
SCARF SIGN Elbow may be easily brought cross chest with little or no resistance.
HEEL TO EAR Heels can easily brought to the ear, meeting with no resistance.

8. Identification: Preterm LBW

Preterm Term






Preterm Term







Breast nodule

9. Identification: Preterm LBW

10. Identification: Preterm LBW

11. Identification: Preterm LBW


Preter
m
Ter
m







Female genitalia

12. Identification: Preterm LBW

13. Identification: Preterm LBW

14. Identification: Preterm LBW

Preterm
Term
Sole creases

15. Identification: Preterm LBW

Preterm Term





Ear Cartilage

16. LBW: Identification of types







SFD / IUGR
 Intrauterine growth chart
 Physical characteristics
 Emaciated look
 Loose folds of skin
 Lack of subcutaneous tissue
 Head bigger than chest by >3cm

17. Intrauterine growth chart
4400

4000


3600

LARGE FOR

DATE
90
th
percentile

3200

2800

APPROPRIATE FOR DATE

2400

2000

1600



SMALL FOR DATE
10
th
percentile

1200

800

400
31 33 35 37 39 42 44 45
Gestation (weeks)
POST-TERM TERM PRETERM
Birth weight (grams)

18. Identification: SFD / IUGR




3.2 Kg - AFD 2.1 Kg - IUGR

19. LBW (Preterm) : Problems



 Birth asphyxia
 Hypothermia
 Feeding difficulties
 Infections
 Hyperbilirubinemia
 Respiratory
distress
 Retinopathy of
prematurity
 Apneic spells
 Intraventricular
hemorrhage
 Hypoglycemia
 Metabolic acidosis

20. LBW (SFD) : Problems




 Birth asphyxia
 Meconium aspiration syndrome
 Hypothermia
 Hypoglycemia
 Infections
 Polycythemia

21. LBW: Issues in delivery




 Transfer mother to a well-equipped
centre before delivery
 Skilled person needed for effective
resuscitation.
 Prevention of hypothermia - topmost
priority.

22. LBW: Indications for
hospitalization


 Birth weight <1800 g
 Gestation <34 wks
 Unable to feed*
 Sick neonate*


* Irrespective of birth weight and gestation

23. PRINCIPLES OF MANAGEMENT OF
LBW INFANTS

1. Care at birth.
2. Appropriate place of care.
3. Thermal protection.
4. Nutrition.
5. Motoring and early detection of complications.
6. Appropriate management of specific complications
especially infection.

24. CARE AT BIRTH
1. Select a suitable place for delivery which has optimum facilities for
handling LBW baby.
2. In case of premature labor is indicated, administered Betamethasone (12
mgIM, 2 doses at the interval of 18 hours) or 100 mg hydrocortisone to
mother as they help in improving the lung maturity.
3. Avoid sedatives to mother.
4. Delayed cord clamping to help improves iron stores of baby and prevent
anemia.
5. Efficient resuscitation.

25. 6. Vit K 0.5 mg.
7. Prevent hypothermia.


APPROPRIATE PLACE OF CARE

1. If birth weight > 1800 gm- Home care, if baby is well.
2. If birth weight 1500-1800 gm- Secondary level new born unit
(Level II)
3. If birth weight < 1500 gm – Tertiary level new born care (Level III)

26. LBW: Keeping warm at 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

Convection
Evaporation
Conduction
Radiation
Prevent heat losses Baby warmly wrapped









Warm room, fire or heater Skin-to-skin contact

27. LBW: Keeping warm at home






Well covered newborn

28. LBW: Keeping warm in hospital

Skin-to skin method
Warm room, fire or
electric heater
Warmly wrapped
Heated water-filled mattress Air-heated Incubator








Radiant warmer

29. LBW: Keeping warm in hospital











Overhead
Radiant warmer

30. LBW: Fluids and feeding




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

31. LBW: Fluids and feeding




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

32. LBW: Fluids and feeding




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

33. 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

34. LBW: Feeding





Gavage feeding

35. LBW: Feeding





Katori-spoon feeding

36. Guidelines for fluid requirements



 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

37. Fluid requirements (ml/kg)




Day of life
Birth Weight
>1500 g 1000 – 1500g
1 60 80
2 75 95
3 90 110
4 105 125
5 120 140
6 135 155
7 onwards 150 170

38. LBW: Adequacy of nutrition



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

39. LBW: Supplements



 Vitamins : IM Vit K 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

40. Early detection


 Weight and other clinical signs.
 Monitoring HR, temp, O2 etc…
 Monitoring Hemoglobin, blood sugar,
serum billurubin etc..

41. DISCHARGE AND FOLLOW UP

 Before discharge, the baby is evaluated for any
complication of maturity.
 Nutrition supplements including multivitamins, iron,
calcium, vit D.
 Baby should be immunized.
 Teach parents for feeding.
 Teach parents regarding prevention of hypothermia,
infections, proper feeding, personel hygiene etc….

42. DANGER SIGNS
 Refusal to feed.
 Lethargy.
 Hypothermia
 Tachypnea, grunt, gasping, apnea
 Seizures, vacant stare.
 Abdominal distension.
 Bleeding, icterus over palms/soles.

43. Transportation of LBW baby



 Adequate warmth.
 Life support.
 With mother.
 Referral note.

44. Prognosis


 Mortality
 Inversely related to birth weight and gestation
 Directly related to severity of complications
 Long term
 Depends on birth weight, gestation and
severity of complications