low_birth_weight_babies[1] [Autosaved].pptx

A Brief Presentation on Low Birth Weight Babies.

1. Low birth weight Babies Submitted to – Ms. Neet i chauhan [clinical instructor] Submitted by - Ms. Isha B.Sc. [n] 3 rd year Roll no. – 45 Submitted on – 22 / 09 / 202 3

2. LOW BIRTH WEIGHT BABIES A neonate with a birth weight of less than 2500g irrespective of the gestational age are termed as LOW BIRTH WEIGHT ( LBW ) BABIES . Low birth weight is a term used to describe babies who are born weighing less than 5 pounds, 8ounces (2.5kg). An average newborn usually weighs about 8 pounds.

3. LOW BIRTH WEIGHT

4. INCIDENCE According to UNICEF :- More than 20 million infants born each year, weighs less than 2.5kg. In India 30 -40% neonates are born LBW. Approximately 80% of all neonatal deaths & 50% of infant deaths are related to low birth weight.

5. TERMINOLOGIES VERY LOW BIRTH WEIGHT (VLBW) :- Babies with a birth weight of less than 1500gm. EXTREMELY LOW BIRTH WEIGHT (ELBW) :- Babies with a birth weight of less than 1000gms.

6. Low Birth Weight Are of two clinical types :- PRETERM NEONATES :- Babies born before 37 weeks of gestation . Approximately 10 -20% Indian neonates are born before 37 weeks of gestation. These infants are more vulnerable to phyisiological handicapped conditions with high mortality rate. SMALL FOR DATE BABIES/ INTRAUTERINE GROWTH RETARDATION :- A baby whose weight falls below the 10th percentile on intrauterine growth curves . Infants born small compared to other babies carried in the womb for the same amount of time

7. SFD(IUGR)/ PRE TERM BABY VS BABY WITH NORMAL BIRTH WEIGHT IUGR/ PRETERM BABY NORMAL BABY

8. PRETERM INFANTS Preterm infants are further divided into 3 subcategories :- EXTREMELY PRETERM :- Less than 28 weeks of gestation. VERY PRETERM:- 28 – 32 weeks of gestation. MODERATE -LATE PRETERM:- 32 to less than 37 weeks of gestation.

9. CAUSES OF PRE TERM BIRTH The etiology of preterm birth is multifactorial and involves a complex interaction between fetal , placental , uterine , and maternal factors . Fetal Factors:- distress, multiple gestations, Placental Factors:- Placental dysfunction, Placental previa. Uterine Factors:- Biocornuate uterus, incompetent. Maternal Factors:- Preeclampsia, chronic medical illness, infections, drug abuse. Other Factors:- Premature rupture of membrane, trauma, polyhydramnios, Iatrogenic.

10. CHARACTERSTICS OF PRE-TERM BIRTH :- FEATURES SPECIFICATION SIZE Small in size, less than 47cm, weighs less than 2.5kg. POSTURE Lies in a “relaxed attitude”, limbs are extended. HEAD Large fontanels & widely separated sutures. HAIR Fine, fuzzy & wooly. SKIN Thin, pinkish, appears shiny dues to generalized edema, covered with abundant lanugo. EAR Cartilage is poorly developed, ear may fold easily. BREAST Breast nodule is absent or less than 5mm wide. SOLE More turgid, may have fine wrinkles, creases are absent. FEMALE GENITALIA Clitoris is prominent, Labia majora are poorly developed & gaping. MALE GENITALIA Undeveloped scrotum, testes maybe in inguinal canal or in abdominal cavity. SCARF SIGN Elbow maybe easily brought across chest with little or no resistance.

11. SMALL FOR DATE/ SMALL FOR GESTATIONAL AGE BABIES Classification of Small – for-Date:- Malnourished SFD Babies :- Growth arrest in later part of pregnancy leads to reduction in cell size but not cell numbers, resulting in small & malnourished baby. Hypoplastic SFD Babies :- Growth retardation in early stage leads to reduction of number of cells resulting in hypoplastic SFD babies. Mixed SFD Babies :- When adverse factors operate during early & mid- pregnancy, reduction in both cell numbers & size occurs leading to mixed SFD baby.

12. Causes of SFD/IUGR :- FETAL FACTORS:- Chromosomal anomalies, Infections, Infarction, Insulin deficiency, Multiple gestations . PLACENTAL FACTORS :- Placental weight or cellularity(size), Infection of placenta, Abruptio placentae. MATERNAL FACTORS:- Toxemia of pregnancy, Hypertension or renal disease Hypoxemia, Malnutrition, Young mother(below 20years) Smoking, Alcohol or Drug abuse

13. PROBLEMS OF SFD/IUGR BABIES BIRTH ASPHYXIA HYPOTHERMIA FEEDING DIFFICULTIES INFECTIONS HYPERBILIRUBINEMIA RESPIRATORY DISTRESS POLYCYTHEMIA HYPOGLYCEMIA RETINOPATHY OF PREMATURITY APNEIC SPELLS INTRAVENTRICULAR HEMORRHAGE METABOLIC ACIDOSIS MECONIUM ASPIRATION SYNDROME

14. MANAGEMENT OF LBW BABIES OPTIMAL MANAGEMENT AT BIRTH- Attended by senior pediatrician. Air passage cleared of mucus. Clamp the cord quickly. Promptly dry, keep effectively covered and warm. Vit K 0.5mg/IM. V ital signs monitoring . Color : pink, pale grey, blue, yellow. Tissue perfusion.

15. Monitor ABG & electrolyte. Tolerance of feeds: vomiting, gastric residuals & abdominal girth. Look for development of apneic attack, sepsis. Weight gain velocity. Provide IN UTERUS MILIEU – Create soft comfortable nestled & cushioned bed. Avoid excessive light, sound, rough handling & painful procedures. Provide warmth & ensure asepsis. Cover the baby properly to avoid evaporative skin losses Provide effective & safe oxygenation. Provide the baby skin to skin contact,

16. POSITION OF THE BABY- Most love to lie in a prone position, cry less & feels more comfortable. Relives abdominal discomfort by passage of flatus & reduce risk of aspiration. Increase ventilation, & increase dynamic lung compliance & enhances arterial oxygenation. Unsupervised prone positioning beyond neonatal period is recognized as a risk factor for SIDS . THERMAL COMFORT- Pre warmed open care system or incubator should be available. Care in a thermoneutral environment with a servo sensor geared to maintain skin temperature of mid epigastric region at 36.5 degree C Application of oil or liquid paraffin reduce convective heat loss & evaporative water loss. Partial KANGAROO MOTHER CARE To prevent hypothermia.

17. OXYGEN THERAPY- Oxygen should be administered with a head box when saturation is less than 85% & withdrawn gradually when >90%. FEEDING & NUTRITION- Intravenous fluids for very small babies & those who are sick. Expressed breast milk with nasogastric tube or katori and spoon. Direct breast feeding if possible for the baby to suck & swallow. AGE CATEGORIES OF NEONATES BIRTH WEIGHT 12OOgm Less than30 weeks 1200-1800gm 30-34weeks >1800gm >34weeks INITIAL IV feeds & gavage feeds Gavage Breastfeed Katori- spoon 1-3 DAYS Gavage feed Katori -spoon Breast feed 2-4 WEEKS Katori - spoon Breast feed Breast feed 4-6WEEKS Breast feed Breast feed Breast feed

18. FLUID REQUIREMENT- DAY OF LIFE BIRTH WEIGHT (>1,500G) BIRTH WEIGHT (>1,000- 1,500GM) TYPE OF FLUID 1 60 80 10% Dextrose 2 75 90 10%Dexotrose 3 90 110 Normal saline (N/S) in 10% 4 105 125 N/S in 10% 5 120 140 N/S in 10% 6 135 155 N/S in 10% 7 150 170 N/S in 10%

19. COMPLICATIONS INFECTION METABOLIC DERANGEMENTS NEONATAL JAUNDICE HEMATOLOGICAL ABNORMALITY (ANEMIA , POLYCYTHEMIA) RETINOPATHY OF PREMATURITY

20. PROGNOSIS- MORTALITY :- Inversely related to birth weight & gestation. Directly related to severity of complications . LONG TERM :- Depends on birth weight , gestation & severity of complications .