Low infant Birth weight

 Babies with a birth weight less than 2500g, irrespective of the period of their gestation are classified as low infant birth weight.
 Very low birth weight is 1500g or less while extremely low birth weight is less than 1000g.

Causes

 Preterm: the growth potential is normal and is appropriate for gestational period.
 SGA (small for gestational age):
o Constitutionally Small: they are most of the time genetic but the baby is well and healthy.
o IUGR (Intrauterine growth restriction) by pathological process

Low Infant birth weight/very low or extremely low birth weigh

Optimal Management at birth

 Air passage cleared by mucus
 Delayed clamping of cord helps in improving iron store
but lead to hypervolemia and hyperbilirubinemia. So
clamp the cord quickly
 Promptly dry, keep effectively covered and warm
 Vit K 0.5mg IM
 Vital signs monitoring
 Activity and behavior Monitoring
 Color of the skin: Pink, Pale Grey, Blue, Yellow
 Tissue Perfusion pink colour, capillary refill over upper
chest <2sec, warm and pink extremities, normal BP,
Urine output >1.5 ml/kg/hr, absence of metabolic
acidosis, lack of disparity between Pa02 and SPO2
 Monitor ABG and Electrolyte (needs doctors order)
 Tolerance of feeds: vomiting, gastric residuals and
abdominal girth
 Look for development of apnoeic attack (absent of
breath), sepsis

After Birth

Provide in uterus milieu by

 Create soft comfortable nestled and cushioned bed

 Avoid excessive light, sound, rough
 handling and painful procedures. Use effective
sedation and analgesia for procedures
 Provide warmth and ensure asepsis
 Prevent evaporative skin losses by effectively covering
the baby, application of oil or liquid paraffin
 Provide effective and safe oxygenation
 Provide parenteral nutrition partially and give trophic
feeds with EBM (expressed breast milk)
 Provide tactile and kinetic stimulation- skin to skin
contact, interaction, music caressing and cuddling
 Most love to lie in a prone position, cry less and feels
more comfortable
 Relieves abdominal discomfort by passage of flatus
and reduce risk of aspiration.

Increase ventilation and increase dynamic lung compliance

and enhance arterial oxygenation

Unsupervised prone position beyond neonatal period

recognized as a risk factor for SIDS (sudden Infant Death
Syndrome)
Provide thermal comfort

 Pre warmed open care system or incubator should be

available
 Care in a thermoneutral environment with servo
sensor geared to maintain skin temperature of mid
epigastric region at 36.5 degrees Celsius
 Application of oil or liquid paraffin reduce convective
heat loss and evaporative water loss
 Extremely low babies covered with cellophane or thin
transparent plastic sheet to prevent convective and
evaporative losses from skin
 As soon as condition stabilises effectively clothe the
baby
 Partial kangaroo care to prevent hypothermia

Oxygen therapy

 Oxygen should be administered with a head box when

saturation is less than 85% and withdrawn gradually
when >90%

Phototherapy

 Jaundice is common due to immaturity, hypoxia,

hypoglycaemia, infections and hypothermia Normal
jaundice is within first 24 hours after birth, if exceeded
can be consider pathologic Jaundice.
 Due to immaturity of blood brain barrier,
hyperproteinaemia and perinatal distress factors
bilirubin brain damage may occur at relatively lower
level
 Initiate phototherapy early

Prevention of nosocomial infection

 Handling should be reduced to minimum

 Vigilance maintained on all procedures

Feeding and Nutrition (Collaborative)

 Babies with weight < 1200g or gestational age < 30

weeks and sick baby should be started on IV dextrose
solution. Wt.> 1000g: 10% dextrose while Wt. <1000g:
5% dextrose
 Trophic Feeds with EBM (1-2Ml 4 times a day,
Through NG tube can be started in all babies
irrespective of birth weight
 When stabilized enteral feeds are begun with EBM
starting with a volume of 30 ml/kg/day on day1
 Depending on tolerance feeds increased by 10-20
ml/kg/day every day and IVF are reduced

Nutritional Supplements (Collaborative)

 When baby is stable, EBM can be fortified with human

milk fortifier (HMF) for additional calories and protein.
 Multivitamin drop containing folic acid started at 2
weeks of age
 Iron Supplements after 2-3 weeks
 Vitamin E which prevents powerful antioxidant and
prevent haemolytic anaemia and enema

Gentle Rhythmic Stimulation

 Gentle touch, massage, cuddling, stroke and flexing by

the nurse or preferably by mother
 Soothing auditory stimuli can be given to preterm
baby in the form of family voices or music
 Visual input provided with the help of coloured object,
diffuse light and eye to eye contact

Utility of Corticosteroids (Collaborative)

 In infants who did not receive antenatal steroids a

single dose of dexamethasone 0.2 mg/kg iv at 4 hours
of age is recommended in very LBW babies.
Weight Record

 Accurate weighing is a sensitive index of well being

 Most LBW babies’ loss weight during 1st 3 to 4days of
life up to 10 to 15% of birth weight
 The weight remains stationary for next 4 to 5 days
then starts to gain at a rate of 1.0 to 1.5% of body
weight per day and regain birth weight by the end of
2nd week.

Immunization

 The dose is not reduced in preterm babies

 Administer 0-day vaccine on the day of discharge

Family Support

 The frightened seen of NICU should be demystified

 Family should be constantly informed and involved in
care of baby
 Mother should be encouraging to touch and talk with
her baby and provide routine care under guidance of
nurses
 Assist to provide kangaroo care

Transfer From to Cot

 Baby who is feeding well, reasonably active with a

stable body temperature irrespective of weight
qualified for transfer to open cot
 The baby should be observed for another 12 hours
after putting incubator off