Management of LOW BIRTH WEIGHT BABY

1. h MANAGEMENT OF LOW BIRTH WEIGHT BABY FOR OPTIMAL GROWTH AND DEVELOPMENT M. Sholeh Kosim Perinatology Sub Division Pediatrics Department Medical Faculty Diponegoro University- Dr. Kariadi Hospital Semarang 1

2. Introduction Premature birth and low birth weight (LBW) still a health problems in newborn Morbidity and mortality still high accordingly to the complication Medical and technology development leads to increasing the survival at high risk of LBW for long term neurocognitive deficits . 2

3. Introduction (2) The normal birth weight of is > 2500 to 3000 gm. Low birth weight or LBW : birth weight of less than 2500 gm regardless to gestational age Incidence : 15 – 30 % Neonatal deaths : 75 % due to LBW Infant deaths : 50 % caused by LBW Complication : Prone to malnutrition Recurrent infection Neurodevelopmental handicaps 3

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8. LBW: Indications for hospitalization Birth weight <1800 g Gestation <34 wks Unable to feed* Sick neonate* Irrespective of birth weight and gestation 8

9. Danger signals (Early detection and referral) Lethargy, refusal to feed Hypothermia Tachypnea, grunt, gasping, apnea Seizures, vacant stare Abdominal distension Bleeding, icterus over palms/soles 9

10. Management of Newborn Illness Education of mothers to recognize danger signals Working with families to develop complication plan for newborns Early recognition and appropriate management of newborn illness 10

11. Minimum Preparation for any Birth The following should be available and in working order: Heat source Mucus extractor Self-inflating bag of newborn size 2 masks (for normal and small newborns) 1 clock At least one person skilled in newborn resuscitation present at birth 11

12. Care of the Low Birth Weight Newborn Birth weight = Gestation duration + intrauterine growth Most low birth weight newborns in developing countries are term or near term (Small for gestation age) Increased risk of hypothermia and poor growth 12

13. Delivery management LBW is prone to be asphyxiated Management at birth accordingly to Guidelines of Resuscitation (AHA/AAP) Consider : Early intubation Early CPAP Prevent hypothermia Prevent hyperoxia 13

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16. LBW OPTIMAL G & D Proper management Genetic Nutrition Immunization Psycho social Stimulation 16

17. OXYGEN DANGER ↑ free radial and contribute the incidence of : Chronic l ung disease retinopathy of prematurity NEC periventricular leukomalacia Effect to growth and development Defense to free radial just developped in third semester  premarure baby prone to be 17

18. Principles of Management for Low Birth Weight and Preterm Newborns Warmth Feeding Detection and management of complications (e.g., resuscitation, assisted respiration, infection ) 18

19. Warmth As for all newborns: Lay newborn on mother’s abdomen or other warm surface Dry newborn with clean (warm) cloth or towel Remove wet towel and wrap/cover with a second dry towel Bathe after temperature is stable 19

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24. Definition of Kangaroo Mother Care Early, prolonged and continuous skin-to-skin contact between a mother and her newborn Could be in hospital or after early discharge 24

25. 25 Kangaroo Mother Care

26. How to Use Kangaroo Mother Care Newborn’s position: Held upright (or diagonally) and prone against skin of mother, between her breasts Head is on its side under mother’s chin, and head, neck and trunk are well extended to avoid obstruction to airways Newborn’s clothing: Usually naked except for nappy and cap May be dressed in light clothing Mother covers newborn with her own clothes and added blanket or shawl 26

27. Newborn should be: Breastfed on demand Supervised closely and temperature monitored regularly Mother needs lots of support because kangaroo care: Is very tiring for her Restricts her freedom Requires commitment to continue How to Use Kangaroo Mother Care (2) 27

28. 28 Effectiveness of Kangaroo Mother Care Randomized controlled trial Conducted in three tertiary and teaching hospitals in Ethiopia, Indonesia and Mexico Study effectiveness, feasibility, acceptability and cost of kangaroo mother care when compared to conventional methods of care Cattaneo et al 1998.

29. Benefits of Kangaroo Mother Care (1) Is efficient way of keeping newborn warm Helps breathing of newborn to be more regular; reduce frequency of apneic spells Promotes breastfeeding, growth and extra-uterine adaptation Increases the mother’s confidence, ability and involvement in the care of her small newborn Seems to be acceptable in different cultures and environments 29

30. Contributes to containment of cost— salaries, running costs (electricity, etc.) Increases the mother’s confidence, ability and involvement in the care of her small newborn Seems to be acceptable in different cultures and environments Contributes to containment of cost— salaries, running costs (electricity, etc.) deLeeuw et al 1991; Karlsson 1996; Lamb 1983; Ludington-Hoe et al 1993; Ross 1980. Benefits of Kangaroo Mother Care (2) 30

31. Feeding Early and exclusive breastfeeding Breastmilk = best nourishment Already warm temperature Facilitated by kangaroo care If Breast milk is not availble, consider milk formula : Preterm formula --- until 2000 gm then change to After Discharged Formula 31

32. 32 START ANTIBIOTIC ADMINISTRATION EVEN WITHOUTH ANY SYMPTOMS

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39. 39 LBW: Supplements

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41. RESPIRATORY DISTRESS PROBLEM Usually due to Hyaline Membrane Disease ( HMD ) Assess : Antenatal steroids ??? Surfactant CPAP : BUBBLE CPAP 41

42. INFECTION : ANTIBIOTICS SUPPORTING TREATMENT : NUTRITION OXYGENATION WARMTH IMMUNOTHERAPY ; IF IT IS NEEDED 42

43. HYPERBILIRUBINEMIA Accordingly to Level of Serum Total Bilirubin Foto therapy Feeding : Breast milk Fluid therapy Antibiotics according to condition of infection 43

44. RETINOPATHY OF PREMATURITY Worse complication is blindness Due to : prematurity and toxic oxygen Awarness to : baby with Ventilator and high flow/consentration of O2 Opthalmologic examination : < 32 weeks of gestation < 1500 grams Done : 1 months of age Lasik surgery 44

45. APNEIC SPELL : APNEA OF PREMATURITY Very often : < 1500 grams Complication : Hypoxemia Oxygenation and breathing stimulation : Aminophylline or Theophylline Mechanical Ventilator 45

46. HYPOGLYCAEMIA Awarness of symptoms , sometime asymptomatic Blood Glucose level Hypoglycemia : < 45 mg/dL Dextrose infusion Glucose Infusion Rate ( G I R ) 46

47. INTRAVENTRICULAR HEMORRHAGE Due to weakness of blood brain barrier and hypoxemia Decreasing of consicousness , deficit neurologics, seizure USG or CT scan Consult to Pediatric Neurology Division and Neurosurgery 47

48. METABOLIC ACIDOSIS Due to hypothermia, hypoxemia and infection Confirmed by clinically and laboratory Shoulde corrected by considering anion gap Administration of bicarbonate : awarness of false route 48

49. SUMMARY Premature birth and low birth weight (LBW) still a health problem with high Morbidity and mortality The survival at high risk of LBW for long term neurocognitive deficits Two types of LBW : premature and IUGR Problems accordingly to the type Management consist of : warmth, feeding, management of complication Breast feeding is prioritized, in case of breastmilk is not available, consider milk formula 49

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