Low birth weight and neonatal infections

Low birth weight and neonatal infections

1. Low birth weight and neonatal infections Mrs.Jagadeeswari.J M.Sc (N )

2. DEFINITION LOW BIRTH WEIGHT: LBW infant is defined as one whose birth weight is less than 2500gms irrespective of the gestational age. WHO/D.C.Dutta

3. LBW Very low birth weight infants weight 1500gms or less and extremely low birth weight infants weighs 1000gms or less.

4. CLASSIFICATION OF LBW INFANTS Low birth weight babies are again classified after correlating both the birth weight and gestational age into two groups. Preterm Small for gestation age(SGA)

5. Cont.. Preterm -The growth potential is normal and is appropriate for the gestational period (10 to 90 th percentile) Small for gestational age(SGA)- The term is to designate the newborn with birth weight less than 10 th percentile or less than gestational age.

6. Preterm infant DEFINITION: A baby born before 37 completed weeks of gestation calculating from the first day of last menstrual period is arbitrarily defined as preterm baby Babies born before 37 completed weeks usually weighing 2500gms or less.

7. INCIDENCE Preterm baby constitutes 2/3 rd of low birth weight babies. The incidence of low birth weight baby is about 30-40% in the developing countries as such the incidence of preterm baby is about 20-25%.

8. ETIOLOGY Spontaneous Induced

9. SPONTANEOUS Health status of the mother Multiple pregnancy Advanced parental age Placental problems Preterm labour and premature rupture of membrane Low maternal weight Chronic and acute systemic maternal disease Ante partum haemorrhage Cervical incompetence Maternal genital colonization and infections Cigarette smoking during pregnancy Acute emotional stress Physical exertion Sexual activity Trauma Bicornuate uterus Congenital malformations

10. INDUCED Maternal diabetes mellitus Placental dysfunction as indicated by unsatisfactory fetal growth Eclampsia Fetal hypoxia Ante partum haemorrhage Severe rhesus iso immunization

11. CLINICAL FEATURES Measurements: Size is small with relatively large head Crown- heel length is less than 47cm Head circumference is less than 33 cm But exceeds the chest circumference by more than 33 cm

12. Activity and posture: General activity is poor Automatic reflex response such as Moro response, sucking and swallowing are sluggish or incomplete Baby assumes an extended posture due to poor tone

13. Face and head: Face appears small large head size Sutures are widely separated Fontanels are large Small chin Protruding eyes Optic nerve is usually unmyelinated Ear cartilage is deficient or absent with poor recoil Hair appears woolly, and fuzzy and individual hair fibres can be seen separately

14. Skin and subcutaneous tissues: Skin is thin, gelatinous, Shiny and excessively pink Abundant lanugo Very little vernix caseosa Edema may be present Subcutaneous fat is deficient Breast nodule is small or absent

15. Genitals: MALE: testes undescended scrotum poorly developed FEMALES : labia majora widely separated exposing labia minora hypertrophied clitoris

16. CHARACTERISTICS OF PRETERM INFANTS Skin Bright pink, often translucent, depending on the degree of maturity Smooth and shiny ( may be oedematous) Small blood vessels clearly visible underneath the thin epidermis Fine lanugo hair is abundant

17. Ear cartilage Soft and pliable Soles and palms Minimal creases Smooth appearance Scarf sign Elbow may be easily brought across the chest with little or no resistance

18. Male genitalia Male infant’s scrotum is undeveloped and not pendulous Minimal rugae are present Testes may be in the inguinal canal or in the abdominal wall Female genitalia Clitoris is prominent Labia majora are poorly developed and gaping

19. COMPLICATIONS OF PRETERM BIRTH Central nervous system: Immaturity of central nervous system Poor cough reflex In coordinated sucking and swallowing Retrolental fibroplasias Intra ventricular and periventricular haemorrhage

20. Respiratory system Resuscitation difficulties at birth Hyaline membrane disease Breathing is periodic and associated with intercostal recessions due to soft rib Pulmonary aspiration Atelectasis Broncho pulmonary dysplasia

21. Cardio vascular system The closure of ductus arteriosus is delayed among preterm infants G I system Regurgitations and aspirations Abdominal distension and functional intestinal obstruction Enter colitis Hyperbilirubinemia Hypoglycaemia

22. Thermo-regulation Excess heat loss Infections Renal immaturity The blood urea nitrogen is high Acidosis Edema Toxicity of drug Nutritional problems anemia Deficiencies of folic acid and Vit E osteopenia and rickets Biochemical disturbance hypoglycaemia, hypocalcemia, hypoxia

23. MANAGEMENT Care of preterm infant Intensive care protocol

24. IMMEDIATE CARE OF NEWBORN Cord is clamped immediately to prevent hypovolemic. Cord length is kept 10-12 cms in case of exchange transfusion Airway is cleared Adequate oxygen is given Baby is wrapped including head with sterile towel Administer inj .vitamin k

25. Intensive care protocol Special care is needed incase of Inability to suckle the breast and to swallow Incapacity to regulate the temperature within limited range from 96-99F Inability to control the cardio-respiratory function without cyanotic attacks

26. PRINCIPLES OF SPECIAL CARE To maintain body temperature Adequate humidification to counter balance increased water loss Oxygen therapy and adequate ventilation To prevent infection To maintain nutrition and adequate nursing care

27. NURSING CARE Cushioned bed Avoid excessive light ,sound ,rough handling and painful procedures Use effective analgesia and sedation for procedures Provide warmth Ensure strict asepsis Cover the baby approximately

28. CONT… Provide effective and safe oxygenation Nutrition Tactile and kinesthetic stimulation Prone position or side lying with head lifted Phototherapy if needed Prevention of nosocomial infection Weight record daily Immunizations Family support

29. NEONATAL INFECTIONS • Infection is still one of the leading causes of neonatal death in developing countries. The neonates are more susceptible to infection as they are deficient in natural immunity and acquired immunity. Preterm infants are at high risk for perinatal infections . Neonates that survive from sepsis often suffer from severe neurological as well as severe parenchymal lung diseases.

30. RISK FACTORS FOR NEONATAL INFECTION Rupture of membrane > 18 hours Maternal intrapartum fever > 100.4˚F Low birth weight infant (< 2500 g) Prematurity (< 37 weeks) Chorioamnionitis Male infant Mother with (GBS ) infection Repeated vaginal examination in labour Invasive procedures of monitoring

31. MODE OF INFECTION Antenatal Transplacental : maternal infection that can affect the fetus through transplacental route are predominantely the viruses, they are rubella, cytomegalovirus , herpes virus, HIV, chicken pox and hepatitis – B virus. Other infections are syphilis , toxoplasmosis and tuberculosis. Aminonitis : F ollowing premature rupture of the membranes can affect the baby following aspiration or ingestion of infected amniotic fluid.

32. INTRANATAL A spiration of infected liquor or meconium following early rupture of the membranes or repeated internal examination . This may lead to neonatal sepsis, pneumonia and meningitis . while the fetus is passing through the infected vagina – eyes are infected – opthalmia neonatorum or oral thrush with candid albican Improper asepsis while caring the umbilical cord.

33. POSTNATAL – NOSOCOMIAL INFECTIONS Transmission due to human contact – infected mother, relative or staff of the nursery. Cross infection from an infected baby in the nursery. Infection through feeding, bathing, clothing or air-borne. Infection in environment of neonatal intensive care (NICU) or invasive monitoring.

34. THE COMMON PATHOGENS Group b streptococcus (GBS), Staphylococcus aureus, E. Coli, Klebsiella and pseudomonas, Fungus(candida) and anaerobes.

35. THE PRIMARY SITES OF INFECTION Skin, Nasopharynx, Oropharynx, Conjunctiva and Umbilical cord.

36. COMMON SITES OF INFECTION Eyes – opthalmia neonatorum Skin Umbilicus Oral thrush Severe systematic : Respiratory tract Septicaemia Meningitis Intra – abdominal infections

37. TREATMENT Antibiotic therapy – broad spectrum are given to cover the germ positive and negative organisms as well as the anaerobes . Inj. Ampicillin 150 mg/kg/every 12 hours, gentamycin 3-4 mg/kg/every 24 hours, usually are started . In a severely ill patient, cefotaxime or ceftazidime is also added.

38. CONT… Supportive therapy and management of complications as needed. E.g. mechanical ventilation for RDS, dopamine for hypotension, ant convulsion for seizure sodium bicarbonate for metabolic acidosis and Immunotherapy with hyper immune globulins.

39. THANK YOU