Low birth weight baby

Description of low birth weight baby and management.

1. Low Birth Weight Baby DR.BICKEY KHADGI

2. According to WHO Low Birth Weight Baby - < 2.5 kg Very Low Birth Weight Baby - <1.5 kg Extreme Low Birth Weight Baby - <1.0 kg

3. CAUSES of LBW Low birth weight includes 2 groups Preterm babies(<37 wks ) IUGR (Intrauterine Growth Retardation) In nearly 50% of cases of LBW the cause is not known. In remaining 50% the causes are grouped into Medical S ocial

4. Medical causes Maternal causes : Urinary Tract Infection, Multiple Pregnancy, Chronic medical illness – CHD, CKD Placental causes : Placenta previa , Congenital defects of placenta etc , Social causes Poverty , Illiteracy, Ignorance. Poor standard of living. lack of knowledge on family. planning , early marriages, smoking etc

5. Problems of Prematurity A. Early Hypothermia Hypoglycemia Respiratory Distress Syndrome Apneic spells Infection Feeding difficulties – Inability to suck & tolerate feed Haematological problems – Anaemia, Vit . K deficiency Electrolyte imbalance

6. B. Late Mental Retardation & poor school performance Seizures Microcephaly Hearing & Visual impairment Growth failure

7. Management >1.8 kg otherwise normal Requires special care at home 1 . 5 kg - 1.8 kg Requires Hospital care < 1.5 kg Management in NICU(Neonatal ICU) Management depends on the birth weight of the baby

8. Home Management 1 . Feeding : Exclusive Breast Feeding 2. Thermal Regulation : Proper wrapping of the baby Maintenance of the room temperature Kangaroo Mother Care (KMC ) 3. Prevention of infection 4. Immunisation 5. Follow up after 2 wks or if any problem arises

9. Danger signals for early detection and referral to hospital Lethargy , refuse to feed Hypothermia Tachypnea , grunting apnea Seizures Abdominal distension Bleeding , icteric over palms/soles

10. Principle of Management of LBW in hospital Correction of hypothermia Correction of hypoglycemia Detection of other complications Treatment of other complications Follow up with all vital signs being monitored continuously

11. Criteria for discharge : Weight gain of at least 40g a day for 5 consecutive days. Baby should feed well on breast milk. Temperature should be maintained. There should not be any evidence of illness. Parents confident enough to take care of baby at home .

12. Kangaroo Mother Care (KMC ) KMC is a special way of caring of low birth weight babies . It fosters their health and well being by promoting effective thermal control, breastfeeding, infection prevention and bonding . Kangaroo mother care was invented in 1978 by Colombian pediatrician Edgar Rey .

13. Usually the infant is placed in an upright position against the mother’s bare chest and between her breasts . The infant is kept naked except for a nappy, socks and woollen cap. Both mother and infant are usually covered by a blanket or shirt . The kangaroo position is also called skin-to-skin contact, as much of the infant’s skin is in direct contact with the mother’s skin.

14. BENEFITS OF KANGAROO MOTHER CARE Benefits to baby Baby is kept warm all the 24 hours by the mother. It has minimum risk of apnea. It gains physiological stability. It gets safety and love. Early growth is promoted. It is at a reduced risk of infections .

15. Benefits to mother Mother becomes actively involved in taking care of her child. Mother is relaxed , confident and empowered. Bonding is better established. Breastfeeding becomes successful.

16. INTRAUTERINE GROWTH RESTRICTION (IUGR ) Intrauterine growth restriction  (IUGR) refers to a condition in which an unborn baby is smaller than it should be because it is not growing at a normal rate inside the womb.

17. Problems Low birth  weight Hypoglycemia Low resistance to infection Meconium aspiration (inhalation of stools passed while in the uterus), which can lead to  breathing problem) Trouble maintaining  body temperature In the most severe cases, IUGR can lead to stillbirth . Growth retardation

18. Causes of Intrauterine Growth Restriction Advanced  Diabetes High blood pressure or  heart disease Infections such as  rubella, cytomegalovirus , toxoplasmosis, and  syphilis Kidney disease or  lung disease Malnutrition or anemia Smoking , drinking alcohol, or abusing drugs Other possible fetal causes include chromosomal defects

19. IUGR Symptoms Specifically , the baby's estimated weight is below the 10th percentile -- or less than that of 90% of babies of the same gestational age. T he baby may be small all over or look malnourished. They may be thin and pale and have loose, dry skin The umbilical cord is often thin and dull instead of thick and shiny.

20. Diagnosis History – Medical disease, drugs, Infection, bleeding during pregnancy. Examination – Maternal height, weight, poor maternal weight gain, Vitals Sign. Fundal height

21. Before diagnosis IUGR, check LMP is correct. Cycles were regular. Calculate Gestational Age by USG.

22. Investigation for early onset Ultrasonography : The main test for checking a baby's growth in the uterus.   Amniocentesis :   Detects Chromosomal anomaly. In this procedure, a needle is placed through the skin of the mother's abdomen and into her uterus to withdraw a small amount of amniotic fluid for testing. 

23. Treatment for early onset. Termination of pregnancy if. USG shows congenital abnormality. Chromosomal abnormalities. Continue pregnancy if no problem and continue monitoring.

24. IUGR Treatments Although IUGR can occur even when a mother is perfectly healthy, there are things mothers can do to reduce the risk of IUGR Keep all of your prenatal appointments. Be aware of your baby's movements. Check your  medications . Eat healthfully. Get plenty of rest. Practice healthy lifestyle habits