nursing management of Low birth weight babies.ppt

nursing management of Low birth weight babies

4. LBW: Significance
75% neonatal deaths and 50% infant
deaths occur among LBW infants
LBW babies are more prone to:
Malnutrition
Recurrent infections
Neuro developmental delay
LBW babies have higher mortality and morbidity

5. Types of LBW
Preterm
< 37 completed
weeks of gestation
Account for 1/3
rd
of
LBW
Small-for-date (SFD) /
intra uterine growth
retardation (IUGR)
 < 10
th
percentile for
gestational age
Account for 2/3
rd
of
LBW neonates
2 types based on the origin

6. Intrauterine growth chart
400
800
1200
1600
2000
2400
2800
3200
3600
4000
4400
31 33 35 37 39 42 44 45
PRETERM TERM POST-TERM
APPROPRIATE FOR DATE
SMALL FOR DATE
LARGE FOR DATE
90
th
percentile
10
th
percentile
Gestation (weeks)
B
i
r
t
h

w
e
i
g
h
t

(
g
r
a
m
s
)

7. Causation: LBW
Etiology of prematurity
Low maternal weight, teenage / multiple
pregnancy
Previous preterm baby, cervical incompetence
Antepartum hemorrhage, acute systemic disease
Induced premature delivery
Majority unknown

8. Etiology of SFD / IUGR
Poor nutritional status of mother
Hypertension, toxemia, anemia
Multiple pregnancy
Chronic malaria, chronic illness
Tobacco use
Causation: LBW

9. LBW (Preterm) : Problems
Birth asphyxia (failure to establish breathing at birth)
Hypothermia
Feeding difficulties
Infections
Hyperbilirubinemia
Respiratory distress(lung failure due to fluid buildup
in lungs and low blood oxygen levels.)

10. Retinopathy of prematurity (causes blood
vessels to grow abnormally in the retina)
Apneic spells(the cessation of respiratory effort
lasting more than 20 seconds, or lasting a shorter
duration but accompanied by bradycardia or
cyanosis)
Hypoglycemia etc.
LBW (Preterm) : Problems

11. Birth asphyxia
Meconium aspiration syndrome (when a
newborn breathes a mixture of meconium and
amniotic fluid into the lungs around the time of
delivery)
Hypothermia
Hypoglycemia
Infections
LBW (SFD) : Problems

12. LBW: Issues in delivery
Transfer mother to a well-equipped centre
before delivery
Skilled person needed for effective
resuscitation
Prevention of hypothermia - topmost priority

13. LBW: Indications for
hospitalization
Birth weight <1800 g
Gestation <34 wks
Unable to feed*
Sick neonate*

14. LBW: Keeping warm at home
Birth weight (Kg) Room
temperature (
0
C)
1.0 – 1.5 34 – 35
1.5 – 2.0 32 – 34
2.0 – 2.5 30 – 32
> 2.5 28 - 30
Skin-to-skin contact Warm room, fire or heater
Prevent heat losses Baby warmly wrapped
Conduction
Radiation
Convection
Evaporation

15. Well covered newborn
LBW: Keeping warm at home

16. LBW: Keeping warm in hospital
Skin-to skin method
Warm room, fire or
electric heater
Warmly wrapped
Heated water-filled mattress Air-heated Incubator
Radiant warmer

17. Overhead
Radiant warmer
LBW: Keeping warm in hospital

18. LBW: Fluids and feeding
Weight <1200 g; Gestation <30 wks*
Start initial intravenous fluids
Introduce gavage feeds once stable
Shift to katori-spoon feeds over next few
days. Later on breast feeds

19. Weight 1200-1800 g; Gestation 30-34 wks*
Start initial gavage feeds
Katori-spoon feeding after 1-3 days
Shift to breast feeds as soon as baby is able to
suck
* May need intravenous fluids, if sick
LBW: Fluids and feeding

20. Weight >1800 g; Gestation > 34 wks*
Breast feeding
Katori-spoon feeding, if sucking not
satisfactory on breast
Shift to breast feeds as soon as possible
LBW: Fluids and feeding

21. LBW: Feeding schedule
Begin at 60 to 80ml/kg/day
Increase by 15ml/kg/day
Maximum of 180-200ml/kg/day
First feed at 2 hrs of age then every 2
hourly

22. LBW: Feeding
Gavage feeding

23. Katori-spoon feeding
LBW: Feeding

24. Guidelines for fluid requirements
First day 60-80 ml/kg/day
Daily increment 15 ml/kg till day 7
Add extra 20-30 ml/kg for infants under
radiant warmer and 15 ml/kg for those
receiving phototherapy

25. Fluid requirements (ml/kg)
Birth Weight
Day of life
>1500 g 1000 – 1500g
1
2
3
4
5
6
7 onwards
60
75
90
105
120
135
150
80
95
110
125
140
155
170

26. LBW: Supplements
Vitamins : IM Vit K 1.0 mg at birth
Vit A* 1000 I.U. per day
Vit D* 400 I.U. per day
Iron :Oral 2 mg/kg per day from 8
weeks of age

27. Transportation of LBW baby
Adequate warmth
Life support
With mother
Referral note

28. Prognosis
Mortality
Inversely related to birth weight and gestation
Directly relaated to severity of complications
Long term
Depends on birth weight, gestation and
severity of complications