low birth weight child health nursing bsc
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May 07, 2024
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About This Presentation
child health nursing low birth weight
Slide Content
LOW BIRTH
WEIGHT
SMALL FOR
DATE
VERY LOW
BIRTH WEIGHT
EXTREMELY
LOW BIRTH
WEIGHT
INTRAUTERINE
GROWTH
RETARDATION
PREMATURE
INFANT
WEIGHT
SMALL FOR
DATE
VERY LOW
BIRTH WEIGHT
EXTREMELY
LOW BIRTH
WEIGHT
INTRAUTERINE
GROWTH
RETARDATION
PREMATURE
INFANT
1. LOW BIRTH WEIGHT- A baby whose birth weight is less
than 2.5kg regardless of gestational age.
1. VERY LOW BIRTH WEIGHT — A baby whose birth weight is
less than 1.5 kg.
1. EXTREMELY LOW BIRTH WEIGHT - A baby whose birth
weight is less than 1kg.
than 2.5kg regardless of gestational age.
1. VERY LOW BIRTH WEIGHT — A baby whose birth weight is
less than 1.5 kg.
1. EXTREMELY LOW BIRTH WEIGHT - A baby whose birth
weight is less than 1kg.
4. SMALL FOR DATES/SMALL FOR GESTATIONAL AGE INFANTS- An
infant whose rate of intrauterine growth was slowed and whose
birth weight falls below the 10“ percentile on intrauterine growth
curves.
5. INTRAUTERINE GROWTH RETARDATION- Babies who donot grow
adequately in utero.
6. PREMATURE/PRETERM INFANT —A baby born before completion of
37th weeks of gestational age regardless of birth weight.
infant whose rate of intrauterine growth was slowed and whose
birth weight falls below the 10“ percentile on intrauterine growth
curves.
5. INTRAUTERINE GROWTH RETARDATION- Babies who donot grow
adequately in utero.
6. PREMATURE/PRETERM INFANT —A baby born before completion of
37th weeks of gestational age regardless of birth weight.
PROBLEM STATEMENT
+ More than 20 million infants worldwide,
representing 15.5 % of all births are born with low
birth weight.
+ As per WHO criteria, incidence of LBW in India is
33% each year.
> Prematurity is the worlds single biggest cause of
new born deaths and 2" leading cause of all child
deaths after pneumonia.
+ More than 20 million infants worldwide,
representing 15.5 % of all births are born with low
birth weight.
+ As per WHO criteria, incidence of LBW in India is
33% each year.
> Prematurity is the worlds single biggest cause of
new born deaths and 2" leading cause of all child
deaths after pneumonia.
Latin America/Caribbean
1.0
CEE/CIS (developing
countries only)
Middle E
t/North Africa
1.4 million
200,000
Sub-Saharan Afri
4.1 mil
South Asia
(excluding India
1.0
CEE/CIS (developing
countries only)
Middle E
t/North Africa
1.4 million
200,000
Sub-Saharan Afri
4.1 mil
South Asia
(excluding India
TYPES OF LBW
+ Low birth weight infants are of two clinical types:
SMALL FOR DATE/
PRETERM/PREMATURE SMALL FOR GESTATION
AGE
+ Low birth weight infants are of two clinical types:
SMALL FOR DATE/
PRETERM/PREMATURE SMALL FOR GESTATION
AGE
Birth weight (grams)
1200
800
400
percentile
3
33
36 37 39
Gestation (weeks)
42
44
45
1200
800
400
percentile
3
33
36 37 39
Gestation (weeks)
42
44
45
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.
Placental dysfunctions.
Incompetent cervix
10. x Ralyhıydranises etc.
er
$ Pa ee au N
Hypertension, toxemia, anemia..
Multiple pregnancy, post maturity.
Chronic malaria, chronic illness.
Tobacco, alcohol, drug use.
Young mother.
Primi / grand multipara.
Placental dysfunctions.
Incompetent cervix
10. x Ralyhıydranises etc.
er
$ Pa ee au N
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.
Young mother.
Primi or grand multipara.
Insulin deficiency etc.
10. o. Majority unknown.
era mn > = De
Previous preterm baby, cervical incompetence.
Antepartum hemorrhage, acute systemic disease.
Induced premature delivery.
Infections, Trauma.
Drug abuse, alcohol consumption.
Young mother.
Primi or grand multipara.
Insulin deficiency etc.
10. o. Majority unknown.
era mn > = De
CHARACTERISTICS
OF
PRETERM
OF
PRETERM
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.
fontanelles are large.
5.SKIN
+ Thin, pinkish, appears shiny.
Covered with abundant lanugo
and little VERNIX CASEOSA
'
+ Thin, pinkish, appears shiny.
Covered with abundant lanugo
and little VERNIX CASEOSA
'
6.EAR
Ear Cartilage:Ear cartilage poorly is poorly developed and ear
may fold easily.
Ear Cartilage:Ear cartilage poorly is poorly developed and ear
may fold easily.
7.Breast nodule
Breast nodule:Small in size, usually less than 47 cm, less than 2.5 kg
Breast nodule:Small in size, usually less than 47 cm, less than 2.5 kg
8.Sole creases
* Sole creases: Preterm
appears more turgid and
may have only one fine
wrinkles.
+ The creases are absent.
* Sole creases: Preterm
appears more turgid and
may have only one fine
wrinkles.
+ The creases are absent.
1. The female infants clitoris is prominent and labia majora are poorly developed and
gaping.
2. The scrotum is underdeveloped and not pendulous, testes may be in the inguinal
canal or in the abdominal cavity.
Term
gaping.
2. The scrotum is underdeveloped and not pendulous, testes may be in the inguinal
canal or in the abdominal cavity.
Term
11.SCARF SIGN
Elbow may be easily brought cross chest with little or no
resistance.
Elbow may be easily brought cross chest with little or no
resistance.
12.HEEL TO EAR
Heels can easily brought to the ear, meeting with no resistance.
Heels can easily brought to the ear, meeting with no resistance.
CHARACTERISTICS
OF
SFD/IUGR
OF
SFD/IUGR
Decrease in Intrauterine
growth chart.
Head bigger Physical
than chest by
Sam, characteristics
Lack of
subcutaneous
tissue.
Emaciated
look.
Loose
folds of
skin.
growth chart.
Head bigger Physical
than chest by
Sam, characteristics
Lack of
subcutaneous
tissue.
Emaciated
look.
Loose
folds of
skin.
Birth weight (grams)
1200
800
400
percentile
3
33
36 37 39
Gestation (weeks)
42
44
45
1200
800
400
percentile
3
33
36 37 39
Gestation (weeks)
42
44
45
SFD / IUGR
(2.1 Kg “IUGR > (3.2 Kg - SFD_)
(2.1 Kg “IUGR > (3.2 Kg - SFD_)
O Birth asphyxia.
o Hypothermia.
O Feeding difficulties.
O Infections.
o Hyperbilirubinemia.
o Respiratory
distress.
© Retinopathy of prematurity.
© Apneic spells.
O Seizures.
© Hypoglycemia.
O Metabolic acidosis.
O Nutritional deficiencies.
O Bradychardia.
o Hypothermia.
O Feeding difficulties.
O Infections.
o Hyperbilirubinemia.
o Respiratory
distress.
© Retinopathy of prematurity.
© Apneic spells.
O Seizures.
© Hypoglycemia.
O Metabolic acidosis.
O Nutritional deficiencies.
O Bradychardia.
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.
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.
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
mglM, 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.
handling LBW baby.
2.In case of premature labor is indicated, administered Betamethasone (12
mglM, 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.
6.Vit K 0.5 mg.
7.Prevent hypothermia.
1.1f birth weight > 1800 gm- Home care, if baby is well.
2.1f birth weight 1500-1800 gm- Secondary level new born unit (Level II)
3.1f birth weight < 1500 gm - Tertiary level new born care (Level III)
7.Prevent hypothermia.
1.1f birth weight > 1800 gm- Home care, if baby is well.
2.1f birth weight 1500-1800 gm- Secondary level new born unit (Level II)
3.1f birth weight < 1500 gm - Tertiary level new born care (Level III)
©. Skin-to skin method
+ Warm room, fire or
electric heater
+ Warmly wrapped
+ Warm room, fire or
electric heater
+ Warmly wrapped
o Start initial intravenous fluids.
o Expressed breast milk with NG tube or Katori and spoon.
o Direct breast feeding, if possible for baby too suck and
swallow.
o Expressed breast milk with NG tube or Katori and spoon.
o Direct breast feeding, if possible for baby too suck and
swallow.
Gavage feeding
Katori-spoon feeding
LBW: Feeding
LBW: Feeding
o First day 60-80 ml/kg/day.
o Daily increment 15 ml/kg till day 7.
o Add extra 20-30 ml/kg for infants under radiant warmer
and 15 ml/kg for those receiving phototherapy.
o Daily increment 15 ml/kg till day 7.
o Add extra 20-30 ml/kg for infants under radiant warmer
and 15 ml/kg for those receiving phototherapy.
Birth Weight
Day of life
>1500g | 1000 — 15008
1 60 80
2 75 95
3 90 110
4 105 125
5 120 140
6 135 155
7 onwards 150 170
Day of life
>1500g | 1000 — 15008
1 60 80
2 75 95
3 90 110
4 105 125
5 120 140
6 135 155
7 onwards 150 170
o Vitamins : IM Vit K at birth
Vit A* 1000 1.U. per day
Vit D* 400 I.U. per day
o Iron : Oral 2 mg/kg per day from
8 weeks of age
*From 2 weeks of age
Vit A* 1000 1.U. per day
Vit D* 400 I.U. per day
o Iron : Oral 2 mg/kg per day from
8 weeks of age
*From 2 weeks of age
o Weight and other clinical signs.
o Monitoring HR, temp, O2 etc...
o Monitoring Hemoglobin, blood sugar, serum billurubin
etc.
o Monitoring HR, temp, O2 etc...
o Monitoring Hemoglobin, blood sugar, serum billurubin
etc.
« 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.
e Teach parents regarding prevention of hypothermia, infections, proper feeding,
personel hygiene etc....
+ Nutrition supplements including multivitamins, iron, calcium, vit D.
+ Baby should be immunized.
« Teach parents for feeding.
e Teach parents regarding prevention of hypothermia, infections, proper feeding,
personel hygiene etc....
o Refusal to feed.
o Lethargy.
o Hypothermia
o Tachypnea, grunt, gasping, apnea
o Seizures, vacant stare.
o Abdominal distension.
o Bleeding, icterus over palms/soles.
o Lethargy.
o Hypothermia
o Tachypnea, grunt, gasping, apnea
o Seizures, vacant stare.
o Abdominal distension.
o Bleeding, icterus over palms/soles.
o Adequate warmth.
o Life support.
o With mother.
o Referral note.
o Life support.
o With mother.
o Referral note.
o Mortality
» Inversely related to birth weight and gestation
» Directly related to severity of complications
o Long term
» Depends on birth weight, gestation and severity of
complications
» Inversely related to birth weight and gestation
» Directly related to severity of complications
o Long term
» Depends on birth weight, gestation and severity of
complications
Care of LBW babies
Depends upon birth weight
2500 — 2000 gm Requires special care at
home
<2000 gm - Requires special care at
hospital
<2000 gm &
>1800 gm & stable - Requires kangaroo mother care
Hemodynamically
Depends upon birth weight
2500 — 2000 gm Requires special care at
home
<2000 gm - Requires special care at
hospital
<2000 gm &
>1800 gm & stable - Requires kangaroo mother care
Hemodynamically
Special care at Home
Principles: Prevention of infections
Prevention of hypothermia
Correction of malnutrition
1.Prevention of infections
- Gentle and minimal handling
- Handling with clean hands
- Room must be warm, clean and dust-free
- Immunization at right time
Principles: Prevention of infections
Prevention of hypothermia
Correction of malnutrition
1.Prevention of infections
- Gentle and minimal handling
- Handling with clean hands
- Room must be warm, clean and dust-free
- Immunization at right time
2.Prevention of hypothermia
> Avoid bath till baby attains 2500g weight
> Cover baby with clean dry & warm cloth
Bottles filled with warm water & covered with thin cloth
Y
are kept on both sides (or) baby without blanket is kept
near 60 candle bulb burning.
3.Correction of malnutrition
> AsLBW babies cannot suck milk actively , it gets tired
faster. So frequent breast feeding must be given
almost
everv alternate hour.
> Avoid bath till baby attains 2500g weight
> Cover baby with clean dry & warm cloth
Bottles filled with warm water & covered with thin cloth
Y
are kept on both sides (or) baby without blanket is kept
near 60 candle bulb burning.
3.Correction of malnutrition
> AsLBW babies cannot suck milk actively , it gets tired
faster. So frequent breast feeding must be given
almost
everv alternate hour.
LBW: Keeping warm at home
Special care at Hospital
1.Prevention of infections
+ Prophylactic antibiotics to prevent septicemia.
> Separate nurses for feeding and toilet attending.
> Barrier nursing to prevent cross infections.
1.Prevention of infections
+ Prophylactic antibiotics to prevent septicemia.
> Separate nurses for feeding and toilet attending.
> Barrier nursing to prevent cross infections.
2.Prevention of hypothermia
> Child is kept under incubator — it maintains the
temperature , humidity and 02 supply , till weight
increases to 2000g.
+ Careful monitoring of O2
supply:
low 02 — hypoxia and cerebral
palsy
high O2 — retinopathy of
prematurity
> Child is kept under incubator — it maintains the
temperature , humidity and 02 supply , till weight
increases to 2000g.
+ Careful monitoring of O2
supply:
low 02 — hypoxia and cerebral
palsy
high O2 — retinopathy of
prematurity
3.Correction of malnutrition
+ The baby is already malnourished.
> Further malnutrition should be prevented.
> Tube feeding is done because baby is in incubator and it
is too young to suck mothers milk.
+ The baby is already malnourished.
> Further malnutrition should be prevented.
> Tube feeding is done because baby is in incubator and it
is too young to suck mothers milk.
KANGAROO MOTHER CARE
> First suggested by Dr Edgar Ray in Colombia.
>Refers to care of preterm or low birth weight infants by
placing the infant in skin-to-skin contact with the mother
or any other caregiver.
> First suggested by Dr Edgar Ray in Colombia.
>Refers to care of preterm or low birth weight infants by
placing the infant in skin-to-skin contact with the mother
or any other caregiver.
PARAMETERS TO BE MONITORED DURING KMC
+ Temperature : Once in 6 hrs.
> Respiration : For apnea.
+ Feeding : Once in 90-120 min.
>Well being : By educating mother about danger signs.
+ growth : Gain of 15-20 g /kg/day.
> Compliance with kangaroo care.
+ Temperature : Once in 6 hrs.
> Respiration : For apnea.
+ Feeding : Once in 90-120 min.
>Well being : By educating mother about danger signs.
+ growth : Gain of 15-20 g /kg/day.
> Compliance with kangaroo care.
COMPONENTS OF KMC
1.KANGAROO POSITION
> Consists of specific frog like position of LBW new born
with skin-to-skin contact with mother , in between her
breasts in a vertical position.
»The provider must keep herself in a
semi-reclining position to avoid gastric
reflux in the infant.
+ Maintained 24 hrs a day, till it gains
at least 2000g.
1.KANGAROO POSITION
> Consists of specific frog like position of LBW new born
with skin-to-skin contact with mother , in between her
breasts in a vertical position.
»The provider must keep herself in a
semi-reclining position to avoid gastric
reflux in the infant.
+ Maintained 24 hrs a day, till it gains
at least 2000g.
PREPARATION OF KANGAROO BABY
> Baby must be suitably dressed in a cap , soak-proof
diaper , socks and with an open shirt to have skin to skin
contact between mother and baby and placed in a
kangaroo bag.
Mechanism of prevention of hypothermia
> THERMAL SYNCHRONY
+ If the temp of the baby decreases by 1°c , correspondingly
the temp of mother increases by 2 °c to warm up the
baby.
> lf the temp of the baby raises by 1°c , the temp of the
rarthar darraapas lus Ada
> Baby must be suitably dressed in a cap , soak-proof
diaper , socks and with an open shirt to have skin to skin
contact between mother and baby and placed in a
kangaroo bag.
Mechanism of prevention of hypothermia
> THERMAL SYNCHRONY
+ If the temp of the baby decreases by 1°c , correspondingly
the temp of mother increases by 2 °c to warm up the
baby.
> lf the temp of the baby raises by 1°c , the temp of the
rarthar darraapas lus Ada
2.KANGAROO FEEDING POLICY
+ kangaroo position is ideal for breast feeding.
+ Exclusive breast feeding is the policy.
+ Feeding is done once in 90-120 min.
+ If the baby can suckle , it is promoted.
+ lf baby cannot suckle , expressed breast milk to be
fed.
> If the baby is unable to swallow , EBM is fed by
nasogastric tube.
+ kangaroo position is ideal for breast feeding.
+ Exclusive breast feeding is the policy.
+ Feeding is done once in 90-120 min.
+ If the baby can suckle , it is promoted.
+ lf baby cannot suckle , expressed breast milk to be
fed.
> If the baby is unable to swallow , EBM is fed by
nasogastric tube.
Criteria for discharge:
+ Wt gain of at least 40g a day for 5 consecutive days.
+ Baby should feed well on breast milk.
+ Temp should be maintained.
+ There should not be any evidence of illness.
+ Successful ‘in-hospital adaptation’ of the mother and other
members of the family.
+ Wt gain of at least 40g a day for 5 consecutive days.
+ Baby should feed well on breast milk.
+ Temp should be maintained.
+ There should not be any evidence of illness.
+ Successful ‘in-hospital adaptation’ of the mother and other
members of the family.
3b.FOLLOW-UP
> After discharge , KMC is continued
at home.
> Follow-up is done daily by the
health worker for one week
and ensured that baby is feeding
well and gaining about 40g weight daily.
> Afterwards once a week till the baby reaches 40
weeks of post conceptional age.
> After discharge , KMC is continued
at home.
> Follow-up is done daily by the
health worker for one week
and ensured that baby is feeding
well and gaining about 40g weight daily.
> Afterwards once a week till the baby reaches 40
weeks of post conceptional age.
BENEFITS OF KANGAROO MOTHER CARE
1. Benefits to baby
> Baby is kept warm all the 24 hours by the mother. (natural
incubator)
> It has minimum risk of apnea.
> It gains physiological stability.
> lt gets safety and love.
+ Early growth is promoted.
> ltis at a reduced risk of nosocomial infections.
1. Benefits to baby
> Baby is kept warm all the 24 hours by the mother. (natural
incubator)
> It has minimum risk of apnea.
> It gains physiological stability.
> lt gets safety and love.
+ Early growth is promoted.
> ltis at a reduced risk of nosocomial infections.
2. 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.
3. Benefits to family
+ KMC is economical compared to cost of intensive
care.
» There is better follow-up.
> KMO nramntes hondina amnna the family memhers
+ Mother becomes actively involved in taking care of her
child.
+ Mother is relaxed , confident and empowered.
+ Bonding is better established.
> Breastfeeding becomes successful.
3. Benefits to family
+ KMC is economical compared to cost of intensive
care.
» There is better follow-up.
> KMO nramntes hondina amnna the family memhers
4. Benefits to Hospital
> KMC saves materials like incubators, O2 cylinders.
+ Saves in man power in terms of nursing staff.
5. Benefits to Nation
+ KMC reduces neonatal mortality & thus infant mortality.
> Healthy and intelligent children , adds to the nation’s
health and wealth.
> KMC saves materials like incubators, O2 cylinders.
+ Saves in man power in terms of nursing staff.
5. Benefits to Nation
+ KMC reduces neonatal mortality & thus infant mortality.
> Healthy and intelligent children , adds to the nation’s
health and wealth.
PREVENTION OF LBW BABY
A. DIRECT INTERVENTION MEASURES
> Prevention of malnutrition - By nutritional education and
supplementation under ICDS.
> Prevention of anemia - By distribution of IFA tablets
+ Control of infections - By early diagnosis and prompt
treatment.
+ Avoid strenuous exercise , smoking & alcohol among
pregnant mothers.
A. DIRECT INTERVENTION MEASURES
> Prevention of malnutrition - By nutritional education and
supplementation under ICDS.
> Prevention of anemia - By distribution of IFA tablets
+ Control of infections - By early diagnosis and prompt
treatment.
+ Avoid strenuous exercise , smoking & alcohol among
pregnant mothers.
B. INDIRECT INTERVENTION MEASURES
These are mainly family welfare services such as
> Deciding age at marriage.
+ Deciding age at first child.
> Birth spacing.
> Deciding no of children.
> Improvement of availability of health services to women.
These are mainly family welfare services such as
> Deciding age at marriage.
+ Deciding age at first child.
> Birth spacing.
> Deciding no of children.
> Improvement of availability of health services to women.
THANK You
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