Low birth weight Baby Low birthweight is when a baby is born weighing less than 5 pounds, 8 ounces or below

2500grams. About 1 in every 12 babies in the United States is born with low birthweight. Some low birthweight babies are healthy, even though they’re small. But being low birthweight can cause serious health problems for some babies. What causes a baby to be born with low birthweight? There are two main reasons why a baby may be born with low birthweight: 1. Premature birth. This is birth before 37 weeks of pregnancy. About 7 of 10 lowbirthweight babies are premature. The earlier a baby is born, the lower her birthweight may be. About 1 in 8 babies in the United States is born prematurely. Talk to your health provider about things you can do to help reduce your chances of having a premature baby. 2. Fetal growth restriction. This means a baby doesn’t gain the weight she should before birth. You may hear the terms “growth-restricted,” “small-for-gestational age” or “smallfor-date” to describe these babies. They may have low birthweight simply because their parents are small. Others may have low birthweight because something slowed or stopped their growth in the womb. About 1 in 10 babies (10 percent) are growthrestricted. Your health care provider may think your baby isn’t growing normally if your uterus (womb) isn’t growing. He may use ultrasound and heart rate monitoring to check your baby’s growth. In some cases, a baby’s growth can be improved by treating health conditions in the mother, like high blood pressure. Can a mother’s health condition lead to premature birth or fetal growth restricition? Yes. These conditions in the mother may lead to premature birth and/or fetal growth restriction: Preterm labor This is labor that starts too soon, before 37 weeks of pregnancy. Chronic health conditions These are health conditions that last for a long time or that happen again and again over a long period of time. Chronic health conditions need treatment from a health care provider. Conditions that may lead to low birthweight include high blood pressure, diabetes and heart, lung and kidney problems. Infections Certain infections, especially infections in the uterus, may increase your chances of having a premature baby. Problems with the placenta The placenta grows in your uterus and supplies your baby with food and oxygen through the umbilical cord. Some problems in the placenta can reduce the flow of blood and nutrients to your baby, which can limit your baby’s growth. In some cases, a baby may need to be born early to prevent serious complications for both mom and baby. Not gaining enough weight during pregnancy Women who don’t gain enough weight during pregnancy are more likely to have a lowbirthweight baby than women who gain the right amount of weight. Smoking, drinking alcohol and using street drugs Pregnant women who smoke cigarettes are nearly twice as likely to have a low-birthweight baby than women who don’t smoke. Smoking slows a baby’s growth and increases your chances of

PDA is a common heart problem for premature babies. your baby may be treated with medicine. a surgeon may insert a tube into the baby’s brain to drain the fluid. To reduce the fluid. usually in the first 3 days of life. These conditions in the baby may lead to premature birth and/or fetal growth restriction: Birth defects These are health conditions that are present at birth. Using alcohol and street drugs during pregnancy can slow your baby’s growth in the womb and can cause birth defects. a large artery called the ductus arteriosus lets the baby’s blood bypass his lungs. When the artery doesn’t close properly. chickenpox and toxoplasmosis.having a premature birth. which may lead to low birthweight. Birth defects change the shape or function of one or more parts of the body.  Bleeding in the brain (called intraventricular hemorrhage or IVH). Treatment with surfactant helps these babies breathe more easily. In some cases. Bleeding in the brain can affect low-birthweight premature babies. Most brain bleeds are mild and fix themselves with no or few lasting problems. Babies with RDS also may need oxygen and other breathing help to make their lungs work. Brain bleeds usually are diagnosed with an ultrasound. like cocaine.  Patent ductus arteriosus (PDA). a baby may need surgery. Before birth. Babies with RDS don’t have a protein called surfactant that keeps small air sacs in the lungs from collapsing. If the drug doesn’t work. More severe bleeds can cause pressure on the brain that can cause fluid to build up in the brain. rubella. may increase your chances of having premature birth. They may limit a baby’s development in the womb. This can cause brain damage. This artery usually closes after birth so that blood can travel to the baby’s lungs and pick up oxygen. These include cytomegalovirus. Babies with PDA are treated with a drug that helps close the artery. Babies with birth defects are more likely than babies without birth defects to be born prematurely. it can lead to heart failure. . Some drugs. What medical problems can low birthweight cause for newborns? Low-birthweight babies are more likely than babies with normal weight to have health problems as a newborn. or in how the body works. This breathing problem is common in babies born before 34 weeks of pregnancy. They can cause problems in overall health. Some need special care in a hospital’s newborn intensive care unit (NICU) to treat medical problems like:  Respiratory distress syndrome (RDS). Other conditions You’re more likely than other women to have a low-birthweight baby if you:  Have low income  Don’t have a lot of education  Are black  Are younger than 17 or older than 35 Can a baby’s health condition lead to premature birth or fetal growth restricition? Yes. Infections Certain infections in the baby can slow growth in the womb and cause birth defects. how the body develops. Providers use tests like ultrasound to check for PDA.

It mostly affects babies born before 32 weeks of pregnancy. These include high blood pressure. can be secondary to many possible factors. diabetes and heart disease. Being small for gestational age Being small for gestational age can be constitutional. without an underlying pathological cause. Infections during pregnancy that affect the fetus. and syphilis. cytomegalovirus. babies with congenital anomalies or chromosomal abnormalities are often associated with LBW. and intrauterine inflammation/infection. Retinopathy of prematurity (ROP). though. Preterm birth Four different pathways have been identified that can result in preterm birth and have considerable evidence: precocious fetal endocrine activation. For example. stays active and goes to all her health care checkups. Babies with NEC are treated with antibiotics and fed intravenously (through a vein) instead of by mouth while the intestine heals. swelling in the belly and other complications. ROP is condition that affects blood vessels in the eye. Getting regular checkups throughout childhood can help your provider spot health conditions that may cause problems as your baby grows older. Most cases heal themselves with little or no vision loss. Treatment for low birthweight: Specific management for low birthweight will be determined by your baby's physician based on: . which. or it can be secondary to intrauterine growth restriction. Problems with the placenta can prevent it from providing adequate oxygen and nutrients to the fetus. to prevent vision loss. Some babies need treatment. make sure she eats healthy food. that is. in turn. toxoplasmosis. uterine overdistension. These checkups also help make sure that your child gets all the vaccinations she needs to stay protected from certain harmful diseases. may also affect the baby's weight. It can be dangerous for a baby. What can you do to reduce your chances of having a low-birthweight baby? Learn what you can do to get healthy before and during pregnancy to help reduce your risk of having a low-birthweight baby and improve your chances of having a healthy pregnancy and a healthy baby. It can lead to feeding problems. As your child grows. decidual bleeding. The intestines are long tubes below the stomach that help digest food. however. NEC can develop up 2 to 3 weeks after birth. What medical problems can low birthweight cause later in life? Babies born with low birthweight may be more likely than babies born at a normal weight to have certain medical conditions later in life. Talk to your baby’s health care provider about what you can do to help your baby be healthy. an association does not establish causality.[3] From a practical point a number of factors have been identified that are associated with preterm birth. This is a problem in a baby’s intestines.  Necrotizing enterocolitis (NEC). such as rubella. In some cases. a baby may need surgery to remove damaged parts of intestine.

follow. Protection from infection should be ensured by aseptic measures and effective hand washing. free from excessive sound smoothing light. vaccinization of LBW 8. Gentle early stimulation. 7. Maintenance of breathing. . Nursing care of low birth weight includes: 1. Care at neonatal intensive care unit.   your baby's gestational age. The NICU should be warm. 3. Maintenance of nutrition and hydration. “nestled” and cushioned bed.up and home care. Prevention. Prevention of low birthweight: Because of the tremendous advances in care of sick and premature babies. Prenatal care is a key factor in preventing preterm births and low birthweight babies. prevention of preterm births is one of the best ways to prevent babies born with low birthweight. Rough handling and painful procedure should be avoided. 5. Maintenance of stable body temperature. Mothers should also avoid alcohol. Family support discharge. 2. which can contribute to poor fetal growth. cigarettes. early detection and prompt management of complication. Care at neonatal intensive care unit: 1. 6. Babies may be referred to special follow-up healthcare programs. overall health. 9. Transport of sick LBW baby. At prenatal visits. or therapies your opinion or preference Care for low birthweight babies often includes:     care in the NICU temperature controlled beds special feedings. more and more babies are surviving despite being born early and being born very small. 4. the health of both mother and fetus can be checked. sometimes with a tube into the stomach if a baby cannot suck other treatments for complications Low birthweight babies typically "catch up" in physical growth if there are no other complications. Baby should be placed on soft comfortable. and medical history your baby's tolerance for specific medications. procedures. Because maternal nutrition and weight gain are linked with fetal weight gain and birthweight. and illicit drugs. 4. 2. However. among other complications. eating a healthy diet and gaining the proper amount of weight in pregnancy are essential. 3.

3.45. 2. socks. Baby’s respiration rate. 3. Maintenance of breathing: 1. One teaspoon glucose should be added to 50ml of milk prepared for the first 10 days and there after reduced to 1 teaspoon to 100ml milk. Those should be covered with cloths. 2. and mittens while giving kangaroo care. Maintenance of stable body temperature. 3. – Kangaroo mother care can be provided when the baby’s condition stabilized. to maintain satisfactory growth. – The temperature of the cot should be checked so as to maintain it up to 85’F. Baby should be positioned with neck slightly extended and air passage to be cleared by gentle suctioning to remove the secretion. and preterm milk help faster growth of baby. etc. Maintenance of nutrition and hydration: – caloric needs of non-growing LBW babies during first week of life are 60 kcal/ kg/ day on 7th is to be stepped up gradually to 100 on 14th day and about 120-150 on 21st day. nasal flaring. 5. Colostrums. – Baby birth weight of less than 1200gm should be cared in the NICU incubator with 60 to 70 % humidity.5 to 37. to be monitored at frequent interval. if needed. – Those babies who have good sucking and swallowing reflexes should start breastfeeding as early as possible. . – The baby as to be placed naked. 4. apnea. – Human milk is the first choice of nutrition for all LBW babies. signs of distress. oxygen and thermonutral environment for better thermal control and prevent heat loss. 6. Concentration of oxygen to be maintained to have saO2 between 90 and 95% and paO2 between 60 and 80 mm of Hg.4. chest retraction. – Baby’s skin temperature should be maintained 36. oxygen. 4. Desirable level of arterial blood gas values should be I) Pao2 55-65 mm Hg . saturation. – if breast milk is not available cows milk in proportion of 1:1 (milk: water) for 1st month and 2:1 during second month is an alternative substitute. 2. rhythm. – Baby should be received in a prewarmed radiant warmer or incubator. Precaution should be taken to prevent aspiration of secretion and feeds. Continuous monitoring of the baby’s clinical status are vital aspects of management which depends upon the gestational age of the baby. The bottle should be filled with hot but not boiled water. Environmental temperature should be maintained according to baby’s weight and age. If it I possible maintain temperature of the entire room. vibration and postural drainage may be needed to loosen and remove respiratory secretion. – The baby cot should be kept warm. Tackling stimulation by sole flaring can be provided to stimulate respiratory effort. Baby should be clothed with frock. 5. – Alternatively the baby should be managed under radiant warmer with protective plastic cover. cap. – Bathing should be delayed. hind milk.ii) PaCO2 3545 mmHg and iii) PH 7. 4. Chest physiotherapy by percussion. foremilk.35-7.5 degree celcious. Baby can be placed in prone position during care. cyanosis. Rubber hot water bottle may be usable for the purpose.

Transport o sick LBW babies: . 6. 7. OPV. heart rate and skin color.600IU 3. 1. – Intravenous dextrose less than 1200 gm or sick babies. – Gavages or nasogastric tube feeding can be given with EBM to all babies with poor sucking reflex. Additional suplimentation: supplement of minerals and vitamin after 2 weeks should be started. BCG. Very LBW babies ( <1500gm. vaccinization of LBW: • If the LBW baby is not sick. should be placed on one side with the head raised a little to prevent regurgitation. activity feeding bahaviour. a liquid preparation of iron 12mg/kg/day should be given in the second or 3ed week. etc. Vitamin-B1. – Starvation to be avoided and early enteral feeding should be started as soon as the baby is stable. IV gamma globulin therapy (400mg/kg/dose) may be given to prevent infection in selected cases. eyes and oral cavity and Any abnormal signs like edema. the vaccination schedule is the same as for the normal babies. 7.5mg. 8. early detection and prompt management of complication: • The baby should be observed for respiration. condition of umbilical cord. Folic acid. Fluid requirement for LBW babies. bleeding. Position should be checked at every 2 hours. Vitamin-A-25000IU 2. • Mother should be allowed to take care of baby whenever condition permits. passage of meconium or stool and urine. Katorisspoon or palady can also be used for feeding the preterm babys. • The first day the fluid requirement ranges from 60 to 100ml/kg ( the difference from each categories being 20ml/kg each) • The daily increment in all group is around 10 to 15 ml per kg till day 9. vitamin-D. and HBV vaccine should be given at the time of discharge. <32 weeks gestation) need vitamin-E. skin temperature.50mg. 5.65mg. biochemical and electronic monitoring should be done if needed. gentle and early stimulation. 6. – Commencement: early feeding between 1-2 hours of birth is now widely recommended. the interval of feeding ranges from hourly in extreme prematurity to 3 hourly feeds in babies born after 36 weeks. The baby when kept in the cot. vomiting. vitamiv-C. Baby should be placed in right side after feeding to prevent regurgitation and aspiration.0. • Weight recording should be done daily in sick babies or at alternative days. • Need extra requirement in case of phototherapy (20-40ml/kg/day) and radiant warmer (4080ml/kg/day) 5. Prevention.– Expressed breast milk can be given through spoon and bowl at 2 hour’s interval. 4. Calcium and phosphorus supplementation also essential.

Parental fear and anxiety related to NICU procedures and child condition 6. Parental knowledge deficit regarding care of low birth weight babies related to lack of exposure. Mother should be prepared mentally and trained to provide essential care to the preterm baby at home. environmental hygiene. general cleanliness. • Hot water rubber bottle may be used as heat source. Fluid volume deficit hypovolumia related to poor intake. and follow-up plan. after discharge at home. 8. 7. Treatment plan should be discussed.up and home care: • Baby’s condition and progress to be explained to the parent’s to reduce their anxiety. Nursing diagnosis. • At the discharge the baby should have daily steady weight gain with good vigor and able to suck and maintain warmth. But a transport incubator is ideal. 8. • The baby should be clothed and placed in a pre warmed basket or box. breast feeding. 1. Altered body temperature hypothermia related to immature thermoregulation centre secondary to less subcutaneous fat. Family support discharge. 3. • Mostly healthy infant with a birth weight of 1800gm or more and gestational maturity of 3weeks or more can be managed at home. Altered nutrition less than body requirement related to poor sucking reflex. infection prevention measures. • Ultimate survival of the baby depends upon continuity of care. This will allay her anxiety and ensure breast milk feeding of the baby. . High risk for complication like hypoglycemia related to poor feeding. 4.• It is essential to provide warmth during transport cold injury. Need for warmth. High risk for infection related to poor immunity. The community health nurse should visit the family every week for a month and provide necessary guidance and support. Altered breathing dyspnea related to poor lung maturity secondary to respiratory distress 2. However make sure to cap them tightly and wrap 2 layers of towel to avoid direct contact with the baby. 5. • Parents should be informed about the care of baby. should be explained to the parents. Immunization etc. follow. • Mother of the baby should also be transferred to the hospital along with the baby as for as possible.