Care of Low Birth Weight Babies

Introduction

Low birth weight baby(less than 2500 gm.) babies have higher morbidity and mortality. Low birth
weight baby result from either preterm birth (before 37 completed weeks of gestation) or due to
intrauterine growth restriction (IUGR) or both. IUGR is similar to malnutrition and may be present
in both term and preterm infants. Neonates affected by IUGR are usually malnourished and have
loose skin folds on face and gluteal region. Although the problem of pre-term babies and IUGR
babies are completely different.

Preterm birth is the most common direct cause of newborn mortality. Preterm birth and being
small for gestational age (SGA), which are the reasons for low-birth-weight (LBW), are also
important indirect causes of neonatal deaths. LBW contributes to 60% to 80% of all neonatal
deaths. The global prevalence of LBW is 15.5%, which amounts to about 20 million LBW infants
born each year, 96.5% of them in developing countries.

DEFINITION:-
Low birth weight (LBW) is defined as a birth weight of a live born infant of less than 2,500 g
(5 pounds 8 ounces) regardless of gestational age Subcategories include very low birth
weight (VLBW) which is less than 1500 g (3 pounds 5 ounces), and extremely low birth
weight (ELBW) which is less than 1000 g (2 pounds 3 ounces). Normal Weight at term delivery is
2500 g - 4200 g (5 pounds 8 ounces - 9 pounds 4 ounces).

What Is Infant Low Birth Weight?

Infant low birth weight (LBW) is when babies weigh less than five pounds, eight ounces at birth.
LBW often occurs in babies who are born prematurely, before 37 weeks of gestation. It is also
common in multiple birth situations. According to the Lucile Packard Children’s Hospital at
Stanford, about 7 percent of all babies born in the U.S. each year have LBW. The number is
increasing, potentially due to the fact that multiple births are increasing. Developing countries have
much higher incidences of infants with LBW.
The average birth weight in the U.S. is around seven pounds (LPCH). Babies born with LBW
appear smaller than normal newborns. They are usually thin, have minimal body fat, and have
disproportionately large heads.
 Preterm birth

Four different pathways have been identified that can result in preterm birth and have
considerable evidence: precocious fetal endocrine activation, uterine overdistension, decidual
bleeding, and intrauterine inflammation/infection From a practical point a number of factors
have been identified that are associated with preterm birth, however, an association does not
establish causality.
Being small for gestational age

Being small for gestational age can be constitutional, that is, without an underlying pathological
cause, or it can be secondary to intrauterine growth restriction, which, in turn, can be secondary
to many possible factors. For example, babies with congenital anomalies or chromosomal
abnormalities are often associated with LBW. Problems with the placentacan prevent it from
providing adequate oxygen and nutrients to the fetus. Infections during pregnancy that affect the
fetus, such as rubella, cytomegalovirus, toxoplasmosis, and syphilis, may also affect the baby's
weight.

What Causes Infant Low Birth Weight?

Low birth weight is primarily caused by premature birth. Since babies grow a lot in the later stages
of pregnancy, many babies born before the 37th week are small, or have LBW.
LBW may also be caused by:

 problems with the placenta, or intrauterine growth restriction (IUGR)

 complications with the pregnancy
 not enough weight gain by the mother
 birth defects
 Poor maternal nutrition, incomplete prenatal care, or drug or alcohol abuse by the mother
can also cause LBW.
In the U.S., babies born to African-American mothers or very young mothers (under 15 years old)
are more at risk (Child Health USA). Babies who are part of multiple births are also more likely to
be born with LBW.
 Physical features
1. Face and head:-
 Face appears small for the disproportionately large head size, sutures are widely separated and
fontanels are large.
 Small chin, protruding eyes due to shallow orbits and absent buccal pad of fat.
 Optic nerve is often unmyelinated but presence of pupillary membrane makes it visualization
difficult.
 Ear cartilage is deficient or absent with poor recoil.
 Hair appears woolly and fuzzy and individual hair fibers can be seen separately.
2. Skin and subcutaneous tissue :-
 Skin is thin, gelatinous, shiny and excessively pink with abundant lanugo and very little vernix
caseosa.
 Edema may be present.
 Subcutaneous fat is deficient and breast nodule is is small or absent.
 Deep sole creases are often not present.
3. Genitals :-
 In males, testes are undescended and scrotum is poorly developed.
 In females, labia majora are widely separated exposing labia minora and hypertrophied clitoris.

What Complications Does Infant Low Birth Weight Cause?

Babies born with low birth weight have a higher risk of developmental difficulties, health
complications, and death than babies born at a normal weight. These babies are often weaker than
babies with normal birth weight.
LBW babies often have trouble eating, gaining weight, staying warm, and warding off illness and
infection. Some common health complications of LBW infants include respiratory problems,
underdeveloped organs (such as lungs), eye or ear complications, digestive problems,
neurological problems, and sudden infant death syndrome (SIDS). The lower the birth weight, the
greater the risk of complications.

How Is Infant Low Birth Weight Diagnosed?

Low birth weight is determined by weighing the baby at birth. If the baby weighs less than five
pounds, eight ounces, he or she will be diagnosed with LBS. Very low birth weight (VLBW) is
the diagnosis for babies weighing less than three pounds, five ounces. 
 Doctors monitor the approximate size and weight of the baby throughout prenatal care. This
helps to identify a potential LBW situation early on. Ultrasound technology measures the baby
while in utero.

Issues in low birth baby care:-

The functional immaturity of various systems result in different clinical problems and their
knowledge is essential for the satisfactory management of these babies.

1. Central nervous system:-

 The immaturity of nervous system is seen by lethargy and inactivity.
 Poor cough reflex, Inco-ordinated sucking and swallowing in babies weighing less than 1800 gm
or born before 35 weeks of gestation.
 Resuscitation difficulties at birth and recurrent apneic attacks are common.
 Retrolental fibroplasia due to oxygen toxicity is limited to babies with a gestation of less than 35
weeks.
 They are more resistant to toxic effects of hypoxia as compared to the term babies.
 The blood brain barrier, which is possibly a function of available serum proteins, is inefficient in
preterm babies; thus brain damage may occur at lower serum bilirubin levels.

2. Respiratory system :-
 The cuboidal alveolar lining in babies with a gestational age of less than 26 weeks results in poor
alveolar diffusion of gases and therefore the infant may not be viable.
 They pose resuscitation difficulty at birth, often followed by hyaline membrane disease, if
associated with deficiency of pulmonary surfactant.
 The breathing is mostly diaphragmatic, periodic and associated with intercostal recession due to
soft ribs.
 Pulmonary aspiration and atelectasis are common.
 Resuscitation problem:-
a.Compromised intrauterine environment with higher chances of perinatal asphyxia.
b. Immature lungs that may be more difficult to ventilate and are also more vulnerable to
lung injury by positive pressure ventilation.
c.Immature blood vessels in brain are prone to hemorrhage.
d. Thin skin and large surface area which contribute to rapid heat loss.
e.Increased risk of hypovolemic shock caused by small blood volume.

3. Cardiovascular system :-
 The closure of ductus arteriosus is delayed among preterm infants. About one third infants with
gestational age of 34 weeks or less manifest clinical evidences of patent ductus arteriosus with or
without congenital heart defect.
 In grossly immature infant (less than 32 weeks) EKG shows left ventricular preponderance.

4. Gastrointestinal system:-
 Due to poor or Inco-ordinated sucking, there are difficulties in self-feeding although their
digestive ability is generally good.
 Regurgitation and aspiration is common because of Inco-ordinated sucking.
 Small capacity of stomach, incompetence of cardio-esophageal junction and poor cough reflex.
 Abdominal distension and intestinal obstruction are due to hypotonia.
 Immaturity of glucuronyl transferase system in the liver leads to hyperbilirubinemia, which may
be aggravated by dehydration, delayed feeding and hypoglycemia. Relatively low serum albumin,
acidosis and hypoxia in these babies predispose to the development of kernicterus at lower serum
bilirubin levels.
 The relative deficiency of vitamin- K dependent coagulation factors and increased capillary
fragility, especially following hypoxia results in intraventricular or intracerebral hemorrhage.
 The poor hepatic glycogen stores, delayed feeding, birth asphyxia and respiratory distress
syndrome contribute to the development of hypoglycemia.

5. Thermo regulation:-
 Hypothermia is invariable and life threatening unless environment temperature is monitored.
Excessive heat loss is due to relatively large surface area and poor generation of heat due to
paucity of brown fat in a baby who is equipped with an inefficient thermostat. High surface area to
body weight.

6. Infection:-
 The low level of IgG antibodies and inefficient cellular immunity predispose them to infection.
 Excessive handling, humid and warm atmosphere, contaminated incubators and resuscitators
expose them to infecting organisms, thus contribute to high risk of infection.

7. Renal immaturity:-
 The blood urea nitrogen is high due to low glomerular filtration rate. The renal tubular ammonia
mechanism is poorly developed thus acidosis occur early. They are vulnerable to develop late
metabolic acidosis especially when fed with high protein milk formula.
 The maximum tubular diluting ability in the new born is satisfactory but ability to concentrate
urea is very poor.
 Preterm baby has to pass 4 to 5 ml of urine to excrete one milliosmole of solute as compared to
0.7 ml by an adult for the same purpose. Therefore, the baby cannot conserve water and gets
dehydrated readily. The solute retention and low serum proteins explain occurrence of edema in
some preterm infants.

8. Toxicity of drugs:-
Poor hepatic detoxification and reduced renal clearance make a pre-term baby vulnerable to toxic
effects of drugs unless caution is exercised during their administration.

9. Nutritional handicaps:-
 Low birth weight babies are prone to develop anemia around 6-8 weeks of age. This is due to
diminished total score of iron due to short gestation. They may also manifest deficiency of folic
acid and vitamin –E.
 Vitamin-E deficiency occurs among infant weighing less than 1.5 kg, particularly those fed on
iron fortified milk formula. These infant are prone to develop hemolytic anemia, thrombocytopenia
and edema at 6-10 weeks of age.
 Vitamin-E is an antioxidant, and its deficiency may be associated with oxygen toxicity to
vulnerable tissues in the form of retrolental fibroplasia and broncho pulmonary dysplasia.
 Rapid growth following adequate feeding may cause osteopenia and rickets unless calcium,
phosphorus and vitamin-D are administered.
10. Biochemical disturbance:-
 These babies are prone to hypoglycemia, hypocalcaemia, acidosis and hypoxia.
 Low hepatic glycogen stores with rapid depletion in stress place these i nfant at increased risk of
hypoglycemia.
 Immature glucose homeostatic mechanism in premature babies can also leads to decreased
inability to utilize glucose and resultant hyperglycemia, especially during stressful period like
infection.
 Early onset of hypocalcemia; presenting within 3 days of life and is usually asymptomatic,
detected on investigation. It is especially seen in premature babies, infants of diabetic mothers and
those with birth asphyxia. Feed with higher phosphate load such as cow milk and some formula
result in hyperphosphotemia with subsequent hypocalcemia.

11. Hematological abnormality:-

 Polycythemia; placental insufficiency with intrauterine hypoxia leading to stimulation of
erythropoiesis and result in polycythemia, especially seen in IUGR baby. Polycythemia produces
hyperviscosity with decreased organ perfusion. Manifestations include jitteriness, respiratory
distress, cardiac failure, feeding intolerance and hypocalcemia.
 Anemia ; accelerated destruction of fetal RBCs, low reticulocyte count and inadequate response
of the bone marrow to erythropoietin cause anemia of prematurity. Low iron stores, higher
incidence of sepsis and frequent blood sampling in low birth weight babies may lead to sever
anemia.

MANAGEMENT
a) Arrest of premature labour:-
 Efforts should always be made to arrest the progress of true labour. Apart from bed rest and
sedation, a variety of tocolytic agents are recommended but none is entirely safe and effective.
 Magnesium suphate is more effective but have very high risk of fetal respiratory distress.
b) Induction of premature labour:-
 When induction of labour is contemplated before term, either in the interest of mother or the
fetus should be ascertained by examination of amniotic fluid for phosphatidyl glycerol or L/S.
 As far as possible, delivery should be postponed till fetal pulmonary maturity is assured.
 When delivery can be safely delayed for 36 to 48 hrs, administration of betamethasone or
dexamethasone to mother in a dose of 12 mg intramuscularly in three doses in an interval of 12
hours is associated with significant reduction in the incidence of hyaline membrane disease. The
prophylactic therapy benefit is seen more effective in female infant than male.
c) Labour room:-
 When a preterm baby is delivered than the delivery room should be attended by a senior doctor,
fully prepared for resuscitate the baby.
 The delayed clamping of cord helps in improving the iron stores of the bay. It may also reduce
the incidence and severity of future hyaline membrane disease.
 Vitamin-K 0.5 mg should be given intramuscularly. The baby should be kept warm and
transferred to nursery as soon as breathing is established.
d) Nursery :-
 A pre warmed incubator should be available at all times to receive any baby with hypothermia
or with birth weight of less than 1.8 kg. the following observation should be recorded by nurses:-
a) Skin and incubator temperature hourly for four hour and then every four hourly.
b) Respiratory rate should be observed hourly for 24 hrs and then four hourly.
c) Child should be observed for apneic attacks or preferably nursed on apneic monitor.
d) Colour, general activity, regurgitation, distension of abdomen and consistency of stool
should be noted at all the time after each feeding.
e) Jaundice should be checked twice a day during first week.
e) Position of the baby:-
 Prone position improves ventilation, increase dynamic lung compliance and enhance arterial
oxygenation.
 It also make child comfortable.
 It relieves abdominal discomfort by passage of flatus and reduces risk of aspiration.

f)Temperature regulation:-
 During first 24-48 hours of life is very critical for giving care to a child to prevent hypothermia.
 Kangaroo mother care.
 Special attention to maintenance of warm chain.

g) Feeding :-
 Intravenous feeding is recommended for babies weighing less than 1200 gm and those with
severe birth asphyxia, respiratory distress syndrome, apneic attacks and acute problem like
diarrhea.
 Fortified expressed breast milk is ideal for feeding the preterm babies.
 Mother room should be adjacent to nursery as it improves the child mother emotional bond and
promote lactation and feeding with human milk.
 Strict adherence to asepsis and hand hygiene. Decreasing exposure to adults with communicable
diseases particularly respiratory.

h) Respiratory problem :-
 Continuous monitoring should be done with cardiac monitor and apneic monitor.
 Oxygen is given to prevent hypoxic brain injury.
 Possible safe guard should be taken to prevent oxygen toxicity.
 Management of resuscitation problem:
a. Gentle resuscitation using small bags for positive pressure ventilation, use of CPAP.
b. Use extra care to hypothermia.

i) Phototherapy:-
 Due to immaturity of blood brain barrier, hypoproteinemia and perinatal distress factor, bilirubin
brain damage may occur at relatively lower serum bilirubin levels.
 Early phototherapy is advised to keep serum bilirubin level within safe limits and obviate the
need for exchange blood transfusion.

j) Weight record:-
 The weight should be recorded on alternate days but for sick baby it should be recorded daily.
 Mostly pre term babies lose weight during first 3-4 days of life and loss is up to 10-15percent of
birth weight. The weight remains same for the next 4 -5 days and then start gaining 1 to 1.5 percent
of body weight per day.
 They regain birth weight by second week of life. Excessive weight loss, delay in regaining the
birth weight or slow weight gain suggest that either the baby is not being fed adequately or he is
unwell and need early attention.
 Excessive weight gain of 100 gm or more per day may occur in babies with cardiac failure.

k) Nutritional supplement :-
 Hemoglobin and reticulocyte count should be checked once weekly. Multivitamin drops with
folic acid supplementation should be stared at two weeks of age. Early supplementation of iron is
not recommended because it may increase the requirements of vitamin-E. Early loading of iron in
infants make them prone to infection by depletion of unsaturated lactoferrin, which is credited to
possess useful antibacterial properties.
 Free radical lipid peroxidation in cell membranes is catalyzed by iron and polyunsaturated fatty
acids (PUFA) thus increase requirement of vitamin-E in very low birth weight babies. The
requirements of vitamin-E are, therefore, related to linoleic acid content formula. It is
recommended that vitamin-E to linoleic ac id ratio should be greater than 1 iu/gm of linoleic acid.
Vitamin –E is powerful antioxidant and prevents hemolytic anemia and edema of prematurity.
 Supplementation of calcium and phosphorus are essential to prevent osteopenia of prematurity.

l) Transfer from incubator to cot:-

 A baby who is able to feed properly is responsibly active with a stable body temperature,
irrespective of his body weight, qualifies transfer to cot. The baby should be observed for another
12 hours after putting the incubator off to see whether he can maintain his body temperature.
 The infant should be stay in incubator for as short a period as possible because incubators are a
potent source of iatrogenic infection.

Child-parent contact:-

 Parents must be fully informed about progress of baby.

 Mother should be encouraged to come in nursery and touch her baby.
 Mother should be involved in the care of baby to promote infant mother bonding.
 During her visit to nursery routine care of the baby, art of feeding , need for warmth, importance
of hand washing and prevention of infection should be explained to her.

LBW: Indications for hospitalization

 Birth weight <1800 g
 Gestation <34 wks
 Unable to feed*
 Sick neonate Irrespective of birth weight and gestation

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

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

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

OXYGEN DANGER :-

• ↑ free radial and contribute the incidence of :

– Chronic lung disease

– retinopathy of prematurity

– NEC

– periventricular leukomalacia

– Effect to growth and development

Principles of Management for Low Birth Weight and Preterm Newborns:-

• Warmth

• Feeding

• Detection and management of complications (e.g., resuscitation, assisted respiration,

1. 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
 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.

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
• 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
Benefits of Kangaroo Mother Care
• 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
• 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.)

Feeding of low birth weight babies:-

Nutritional management influences immediate survival as well as subsequent growth and

development of low birth weight infants. Early nutrition could also influences the long term
neurodevelopmental outcomes. Term infants with normal birth weight require some assistance for
feeding in immediate postnatal period, but they are able to feed directly from mother’s breast. In
contrast, feeding of low birth infants, in particular the preterm infants, is relatively difficult
because of the following limitations-
 i. Majority of these infants are born at term, a significant proportions are born premature with
inadequate feeding skills.
ii. They are prone to have significant illnesses in the first few weeks of life, the underlying
condition often precludes enteral feeding.
iii. Preterm infants have higher fluid requirements in the first few days of life due to excessive
insensible water loss.
iv. Since intrauterine accretion occurs mainly in the later part of the third trimester, preterm infants
have low body stores of various nutrients at birth which necessitates supplementation in the
postnatal period.
v. Because of the gut immaturity, they are more likely to experience feed intolerance necessitating
adequate monitoring and treatment.

Methods of feeding:-

Direct and exclusive breast feeding is the main aim for LBW babies. However because of various
limitation, not all low birth weight baby will be able to have breast feeding at least in the initial
few days of life. These infants have to be fed by spoon, paladai or intragastric tube. Those babies
who cannot accept oral feedings they would require intravenous fluids.

The appropriate methods of feeding actually depend upon following factors:-

 Whether the infant is sick or not.

 Feeding ability of infant.
Level of sickness:-

Low birth weight babies are categorizing in two groups, sick and healthy, before deciding the
initial method of feeding.

a.Sick infants-
This group constitutes infants with respiratory distress requiring assisted ventilation, shock
seizures, necrotizing enterocolitis, hydrops. These infants should be started on IV fluids. Enteral
feedings should be initiated as soon as they are hemodynamically stable with the choice of feeding
method based on the infants’ gestation and clinical condition.
It is important to understand that enteral feeding is important even for sick neonates. Oral feeds
should not be delayed in them without any valid reason. Even infants with respiratory distress and
assisted ventilation can be started on enteral feeds once the acute phase is over and infants color,
saturation and perfusion have improved.
b. Healthy low birth infant-
Enteral feeding should be initiated immediately after birth in healthy LBW infants with appropriate
feeding method determine by their oral feeding skills and gestation.

How much to feed?

a. Infant who are breast feed-
Infants who are able to suckle effectively at the breast should be breast feed on demand. Small
babies should be feed every 2-3 hours sometimes more frequently. Small infant who does not
demands to be fed for 3 hours or more, can be offered the breast and encouraged to feed.
b. Infants who are feed by spoon or intragastric tube-
Preterm infants need more liquids because of insensible loss of fluid from their body.it is usually
practice 80 ml/kg fluids on the first day of life and increase by 10-15 ml/kg/day to maximum of
160 ml/kg/day by the end of first week of life. After deciding the total fluid requirement, the
individual feed volume to be given every 2 or 3 hours.
Home care:-

It is true and unfortunate that many low birth weight babies come after the discharge with the
complaint of diarrhea, sepsis and cold. It is essential that proper appraisal of available physical
facilities, resources and environmental conditions be made by a pre-discharge home visit by a
health visitor or a public health nurse before the baby get discharge. Periodic home visit should be
done after the discharge of baby.

a) Environmental control:-
 The infant should be well covered; like woolen cap, socks and mitten should be worn.
 Infant should lie next to mother as it is useful as biological controlled heat source.
 In winter, room should be warmed with room heater. The cot of the mother and infant should be
located away from walls to reduce radiation heat loss.
 Mother should be trained to assess baby temperature and advised to ensure that extremities are
warm and pink.
 The visitors handing should be restricted to bare minimum. The hand should be wash before
touching to baby and before feeding.
 The linen should be clean and sun dried.
b) Feeding :-
 Breast feeding should be encouraged.

Criteria for discharge:-

 Screening test are performed before discharge or on follow up e.g. those for ROP detection in
infants<32 weeks and auditory brainstem evoked response (ABER).
  Nutrition supplements including multivitamins, iron, calcium and vitamin-D are started.
 Immunization with BCG, hepatitis B and OPV is given.
 Weight gain should be consistently demonstrated before discharge and plotted on growth chart,
which can be used on follow up to determine if growth is adequate.
 Baby should be feeding well, if on alternate feeding technique like paladai feeding, the mother
should be confident regarding its detail.
 Absence of danger signs and completion of treatment like IV antibiotics. If baby is being
discharged on oral medication then parents should be well educated regarding how to administer.
 Method of temperature regulation, either KMC practice or other method should be well known to
parents.
 All danger sign should be explained to parents in details like:
i. History of difficulty in feeding.
ii. Movement only when stimulated.
iii. Temperature below 35.5 degree Celsius -37.5 degree Celsius.
iv. Respiratory rate over 60 breaths per minute.
v. Severe chest indrawing.
vi. History of convulsion.
 Follow up within 3-7 days of discharge to ensure the baby has been adapted well to home
environment.

General nursing management in low birth weight baby care-

1. Maintenance of body temperature –
 Thermal stability, maintenance of normal core temperature within narrow limits, results when a
balance exists between production and conservation of heat and dissipation. So provision of
neutral temperature.
 Thermal sensor should always be placed on a part of the body that is exposed to the circulating
incubator air and not where the skin temperature may be influenced by cooler substance. Child
should be put in incubator. If incubator not available radiant warmer should be available.
 Mother should be educated about kangaroo mother care.

2. Proper checking of vital signs:-

 Child should be well observed for apneic episode or any type of periodic breathing.

3. Prevention of infection and injury:-

 Thorogh handwashing and complete sterilization or disinfection of equipment and supplies are
two important points to be remember to prevent the risk of nosocomial infection.
 Meticulous handwashing by all the persons entering in nursery is absolutely essential. Hand
washing should also be done in between handling different infants.
 Before giving any medication nurse should be clear about the action of the drug and should be
prepared for any emergency condition like if vitamin-K is to be given than nurse should be prepare
with its analogus, novobiocin and oxygen.the computation, prepration and administration of
parentral fluids or medication should be done with serious responsibilities of the nurse.
 Proper infusion pump should be used so that exact amount of fluid in minutes is given to infant.
 Nurse must look infilterated fluids around insertion site like palmar area when the insertion
cannula is at the back of hand.
4. Use of equipment:-
 Nurse should have proper knowledge and skill regarding monitoring devices, ventilation, oxygen
therapy and infusion pumps.
 She should be well skilled in parentral and enteral feeding procedure.
 If any malfunctioning or hazard is not treated by nurse she should immediately report and proper
action should be taken.

5. Supporting and educating parents:-

 Parents should be encouraged to confront the problem reliastically instead of trying to pretend
that it does not exceed.
 Parents need to know that their infant will develop normally both physically and mentally.
 Parents should be encouraged to report any concern they have to primary nurse who know about
their infant.
 Parents should be informed about the sources available in community.
 Early infant stimulation programme should be started which is beneficial to parents and their
children. By this parents have the opportunity to learn about infant development and about
methods of physical and psychological stimulation as well as interacting with the parents of same
concern.
 Parents needs encouragement in learning to handle a small, delicate neonate when they visit in
nursery.help the parents to feel secure in their ability to care for the premature infant is probably
the most important factor in forming good parent child relationship.

Prognosis:-

Prognosis for survival is directly related to the birth weight of the child and quality of neonatal
care. Over three fourth of neonatal death occur among low birth weight babies. Therefore in
countries with high incidence of low birth babies, neonatal mortality is likely to occur. The
prognosis for mental development is good if there is no incident birth hypoxia, apneic attacks,
respiratory distress and hypoglycemia. Neurological prognosis is adversely affected by degree of
immaturity, intrauterine growth retardation, intraventricular hemorrhage and severity of respiratory
failure demanding assisted ventilation.
Summary

Low birth weight baby(less than 2500 gm.) babies have higher morbidity and mortality. Low birth
weight baby result from either preterm birth (before 37 completed weeks of gestation) or due to
intrauterine growth restriction (IUGR) or both. IUGR is similar to malnutrition and may be present
in both term and preterm infants. Low birth weight babies have lot off complication like
neurological, respiratory, renal system, temperature regulation, infection . then we also discussed
criteria for discharge and management of low birth weight babies issues.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

Conclusion
Low birth weight babies have high survival rate if they are managed well at the initial stage of
their problem and get cured. If there is no incidence of hypoxia and apneic episode then these
infants are neurologically also normal.

Refrences
Books:
1) Marlow and Redding. Text book of paediatric nursing. Sixth edition. Elsevier
publication.2010. Page no-990-1100.
2) Wongs and Werry. Text book of pediatric nursing. Third edition, Elsevier
publication.2005. page no-1145-1167
3) Bagga and Paul. Ghai essential pediatrics. Eighth edition. CBS publishers and distributors
pvt. Limited. 2013. Page no-155-162.
4) Singh meharban, care of the new born, fifth edition, sagar publication,1996,page no-112-
120.
Net:
1) http://www.intelihealth.com/IH/ihtIH/EMIHC000/20722/8632/187947.
2) http://www.chadd.org.