lowbirthweight-150616163502-lva1-app6892.pptx

Lbw infants

1. Problems & Management of LBW Newborns Dr Sarfaraz Ahmad Assistant Professor Dept Of Pediatrics MMIMSR

2. Introduction Of 136 million births every year 90% are in third world , 20-30% of the the se babies are underweight(<2 .5kg) . About 40% of total infant mortality occurs in the 1 st month of the life. Many low cost measures like immunization, breast feeding,war m care etc. are available to save these precious lives.

3. Objectives of early neonatal care Establish and maintenance of cardio-respiratory functions. Maintenance of body temperature. Avoidance of infections. Establishment of suitable feeding regimen. Early detection and treatment of congenital and acquired disorders

4. Immediate neonatal care Drying and Clearing the airway. The airway should be cleared of mucus and other secretions. Stimulation of breathing. Ensure stable cardiopulmonary functions. For newborns already subjected to hypoxia resuscitation requires more active measures. Warm care and early breast feeding.

5. Apgar score Taken at 1min and again at 5min after birth. Requires immediate and careful observation of Heart rate ( pulse rate) Respiration Muscle tone ( activity ) Reflex response ( grimace) Colour of the infant ( A ppearance). Each sign is given a score of 0,1or 2 Perfect score is >7 , of a total score of 10 . A score of 0-3 indicates baby is severly depressed, 4-6 indicate moderate depression

6. Cont… Score below 6 demands prompt action Low Apgar score at the end of 5 min is associated with…. ….high risk of complications and …..death during neonatal period APGAR Appearance Pulse Activity Grimace Respiration

7. Apgar score chart

8. Cont… Care of cord Cord should be cut only after cessation of pulsation. Stump should be kept dry with no application. Care of eyes Should be cleaned before opening with sterile swabs from inner to outer side Any discharge from eyes is pathological and demands immediate treatment As a preventive measure maternal genital tract infections should be treated beforehand

9. Cont…. Care of skin First bath/sponging may be delayed for 24 hrs after birth Thereafter no need of bathing till discharged Maintenance of body temperature Normal body temperature of a newborn is 36.5º to 37.5º C Most of the heat loss occurs trough evaporation of amniotic fluid from the body of the wet child About 75% of heat loss occurs from the head It is important to dry the baby quickly with a clean cloth and wrapped in warm clothing

10. A naked newborn exposed to an environmental temperature of 23 C suffers the same heat loss as a naked adult in C Do you know…..?????

11. Cont…. Breast feeding Initiated within 1/2 hour in case of a vaginal delivery and within 4-6 hours in case of a C/S. (IYCF) First milk called “colostrum” should be given to the baby Exclusive breast feeding should be practiced for six months Baby should be breastfed ON DEMAND i.e. whenever the baby cries for feeds. Time interval between each feed is about 2 to 3 hours. Frequency of feeds should be at least 8-10 times in 24 hours and compulsory night feeds

12. Warm chain At delivery: Ensure the delivery room is warm (25° C), with no draughts. Dry the baby immediately; remove the wet cloth. Wrap the baby with clean dry cloth. Keep the baby close to the mother to stimulate early breastfeeding. Postpone bathing/sponging for 24 hours. After delivery: Keep the baby clothed and wrapped with the head covered. Minimize bathing especially in cool weather or for small babies. Keep the baby close to the mother. Use kangaroo care for stable LBW babies and for re-warming stable bigger babies .

13. Low birth weight babies

14. Introduction Newborns with birth weight of <2.5kg . Birth weight is the single most important determinant of chances of child survival, healthy growth and development. Low Birth Weight (LBW)babies are grouped as : Preterm (short gestation) : below 37 weeks Small for Age/Date (SFA/D): term ( weight is <10 gentile for gestation age).

15. Cont… By international agreement LBW is considered as Low Birth Weight (LBW) : Any neonate weighing less than 2500 gm at birth irrespective of gestational age. Very Low Birth Weight baby (VLBW) : Any neonate weighing less than 1500 gm at birth irrespective of gestational age. Extremely Low Birth Weight baby (ELBW) : Any neonate weighing less than 1000 gm at birth irrespective of gestational age. …when measured preferably within one hour of life

16. Cont… Besides this babies are also classified according to the gestational age Pre-term Baby : Babies born before 37 completed weeks (<259 days) of gestation irrespective of the birth weight. Term baby : Babies born between 37 to 42 weeks of pregnancies (259-294 days) irrespective of the birth weight. Post-term baby Babies born at 42 completed week or thereafter (> 294 days of gestation)

17. Cont… A LBW is any infant with birth weight <2.5 kg irrespective of gestation and includes…. 1.Pre term Extremely preterm (<28 weeks of gestation) Very preterm (28-32 weeks of gestation) Moderate preterm (32-3 4 weeks of gestation) Late pre term ( 34-36 weeks). Even though born early their intrauterine growth may be normal according to the gestation. Given good care, these babies catch up good growth and by 2-3 years of age will be of normal size and performance.

18. Scenario In 2010, an estimated 15 million babies were born prematurely and about more than 1 million of these died globally. Prematurity is now the leading cause of deaths amongst under-5 year children….. ..…and single most important cause of death in the first month of life. The survivors may face a lifetime with significant disability

19. Causes of preterm birth Preterm births are classified into two groups Spontaneous preterm birth Provider initiated preterm birth Prematurity is an important risk factor for developing NCDs (HTN, DM) in later life for these babies This creates a intergenerational cycle of risk So the link between prematurity and NCDs adds a very important dimension in public health aspect… …..when increasing trend of both are observed worldwide

20. Types of preterm births and risk factors involved Spontaneous preterm births Provider initiated preterm births Age at pregnancy and spacing Multiple pregnancy Infection Underlying chronic medical condition Lifecycle/ work related Psychological health Genetic and other Medical induction / Cesarean section for maternal or foetal indication Other- Not medically indicated

21. Small for date babies May be born at term or preterm Weighs less than 10 th percentile for the gestational age Results due to intrauterine growth retardation These babies have high mortality rate not only in neonatal period but during infancy as well Hence inflate the perinatal and infant mortality rates They are frequent victims of PEM and infections

22. Cont… In developing nations 3 determining factors are associated with adverse prenatal and postnatal development of the child Malnutrition Infections Unregulated pregnancy LBW

23. Factors associated with IUGR Maternal factors Placental cause Foetal causes Malnutrition Severe anemia Heavy physical work during pregnancy Hypertension Malaria Toxemia Smoking Low socio-economic status Short maternal stature Very young age High parity and close spacing Low educational status Placental insufficiency Placental abnormalities Foetal abnormalities Intrauterine infections Chromosomal abnormalities Multiple gestation

24. Importance High incidence Association with mental retardation High risk of perinatal and infant mortality Human wastage and suffering Very high cost of special care Association with socioeconomic underdevelopment Infant mortality is 20 times higher in LBW babies Serves as an important guide for level of care to the children Indicates the malnutrition and ill health of the mother High percentage of LBW warrants need of improved care of newborn

25. What Problems Do Low Birth Weight Babies Have? Breathing problems at birth and later. Low body temperature because there is little fat on the body and the newborn’s temperature regulating system is immature. Low blood sugar because there is very little stored energy. Feeding problems because of their small size, lack of energy, small stomach and inability to suck. Infections because the infection fighting system is not mature. Jaundice (high bilirubin) because the liver is not mature. Bleeding problems due to immature clotting ability at birth.

26. Other clinical Problems related to prematurity Apnea IVH RDS/HMD NEC Oxygen toxicity

27. Prevention Despite of all efforts rate of LBW can’t be lowered more than 10% around the world. This is due to multiplicity of causes Intervention have to be cause specific Attention must be given to good prenatal care and intervention programme……. …..rather than “treatment” of the LBW babies born later

28. Direct Interventions Identifying “at risk” pregnant ladies by using mother health card…. …..primarily by the grass root level health care workers A small increase in food intake, even in the last trimester results in considerable improvement in weight of the infant Other interventions consists of supplementary nutrition, IFA tablets, food fortification etc. Infections affecting foetal growth should be detected and treated early Other medical disorders like HTN, toxemias and diabetes should be detected and treated early

29. Indirect interventions Family planning Avoidance of excessive smoking Improved sanitation measures Measures to improve health and nutrition of young girls In addition improved socioeconomic and environmental conditions with distribution of health and social services….. ….. guarantees long lasting effect Government support in form of maternity leave and child benefits.

30. Treatment For treating LBW babies, the are classified into 2 groups Those under 2 kgs Requires first class modern neonatal care in intensive care unit until gains weight >2.5 kg Those between 2-2.5 kgs Needs intensive care unit for a day or two

31. Cont…. Intensive care includes Incubatory care comprising adjustment of temperature, humidity and oxygen supply Feeding of baby with breast milk if possible by nasal catheter. Prevention of infections Leading causes of death in LBW babies Atelectesis Malformation Pulmonary haemorrhage Intracranial haemorrhage, secondary to trauma or anoxia Pneumonia and other infections

32. Kangaroo mother care(KMC) Introduced first in Colombia in 1979 by Dr. Hector Martinez and Dr Edzar Rey Intervention to combat high infection and mortality rate owing to overcrowding in hospitals. Now adopted across the developing world and considered as essential element in continuum in neonatal care

33. Cont… Four components of KMC are Skin to skin positioning of baby on mother’s chest Adequate nutrition through breast-feeding Ambulatory care as a result of earlier discharge from hospital Support for the mother and her family in caring for the baby For improved management of newborn in facilities, newer initiatives has been designed Newborn care corner Newborn stabilizing unit Special newborn care unit

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