Management of

Low Birth Weight Babies

 Low birth weight (LBW)

 Definition : Birth weight

<2500 g

 Incidence : 30% of neonates

in India
 DEFINITION

Low-birth-weight (LBW): Babies with a birth

weight of less than 2500 g, irrespective of the
period of their gestation are classified as low
birth weight babies..
 Very low-birth-weight infant :an infant whose
birth weight is less than 1500g.
 Extremely low birth weight infant: an infant
whose birth-weight is less than1000g
 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

 Types of LBW

2 types based on the origin

Small-for-date (SFD) /
Preterm
intra uterine growth
retardation (IUGR)

 < 37 completed  < 10th centile for

weeks of gestation gestational age
 Account for 1/3rd of  Account for 2/3rd
LBW of LBW neonates
 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
 Causation: LBW

Etiology of SFD / IUGR

 Poor nutritional status of mother

 Hypertension, toxemia, anemia
 Multiple pregnancy, post maturity
 Chronic malaria, chronic illness
 Tobacco use
 LOW BIRTH WEIGHT BABY

• Physical Characteristics

• – Weight under 2500 gm.

• – Length under 47 cm.

• – Head outline under 33 cm.

• – Chest outline not as much as head perimeter by in

excess of 3 cm.

• –
• General movement poor and powerless cry.

• – Attitude loose and appendages reached out with poor

tone.

• – Sucking, gulping, hack and moro reflexes are slow or

fragmented.

• – Skin sparkling, free, slight, fragile, pink with meager

vernix and bounty lanugo.
 LBW: Identification of types

Prematurity
 Date of LMP
 Physical features
 Breast nodule
 Genitalia
 Sole creases
 Ear cartilage /
recoil
• – Less subcutaneous fat and edema.

• – Head bigger than body, skull bones are delicate,

sutures and fontanelles are wide.

• – Ears are delicate and level, ligament not completely

created.

• – Eyes stay shut and jutting.

 Identification: Preterm LBW

Breast nodule

Preter Term
m

Preterm Term
 Identification: Preterm LBW

Male genitalia

Preterm
Preterm Term
Term
 Identification: Preterm LBW

Female genitalia

Preterm Term
 Identification: Preterm LBW

Sole creases
Preterm
Term
Identification: Preterm LBW

Ear Cartilage

Preterm Term
 LBW: Identification of types

SFD / IUGR
 Intrauterine growth chart

 Physical characteristics
 Emaciated look
 Loose folds of skin
 Lack of subcutaneous tissue
 Head bigger than chest by >3cm
 Intrauterine growth chart
4400

4000 90th percentile

LARGE FOR DATE
3600
Birth weight (grams)

3200
APPROPRIATE FOR DATE
2800

2400
10th percentile
2000

1600 SMALL FOR DATE

1200

800 PRETERM TERM POST-TERM

400
31 33 35 37 39 42 44 45
Gestation (weeks)
 Identification: SFD/ IUGR

2.1 Kg - IUGR 3.2 Kg - AFD

 LBW (Preterm) : Problems

 Birth asphyxia  Retinopathy of

prematurity
 Hypothermia
 Apneic spells
 Feeding difficulties
 Intraventricular
 Infections hemorrhage
 Hyperbilirubinemia  Hypoglycemia
 Respiratory
distress
 Metabolic
acidosis
 LBW (SFD) : Problems

 Birth asphyxia
 Meconium aspiration syndrome
 Hypothermia
 Hypoglycemia
 Infections
 Polycythemia
 Care of LBW babies

Depends upon birth weight

2500 – 2000 gm - Requires special care at

home

<2000 gm - Requires special care at

hospital
<2000 gm &
>1800 gm & stable - Requires kangaroo mother care
Hemodynamically
 Special care at
Home
Principles: Prevention of infections
Prevention of hypothermia
Correction of malnutrition

1. Prevention of infections
- Gentle and minimal handling
- Handling with clean hands
- Room must be warm, clean and dust-free
- Immunization at right time
 2. Prevention of hypothermia

 Avoid bath till baby attains 2500g weight

 Cover baby with clean dry & warm cloth
 Bottles filled with warm water & covered with
thin cloth are kept on both sides (or) baby without
blanket is kept near 60 candle bulb burning.
 LBW: Keeping warm at home
Birth weight (Kg) Room
temperature (0C)
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

Convection
Evaporation
Radiation

Conduction

Prevent heat losses Baby warmly wrapped

LBW: Keeping warm at home

Well covered newborn

3.Correction of malnutrition

• As LBW babies cannot suck milk actively , it gets

tired faster. So frequent breast feeding must be
given
• Almost every alternate hour.
 Special care at Hospital
1.Prevention of infections
 Prophylactic antibiotics to prevent
septicemia.
 Separate nurses for feeding and toilet
attending.
 Barrier nursing to prevent cross infections.
2.Prevention of hypothermia
 Child is kept under incubator – it maintains
the
temperature , humidity and o2 supply , till
weight increases to 2000g.
Careful monitoring of O2
supply:
low O2 – hypoxia and cerebral
palsy
high O2 – retinopathy of
prematurity
 LBW: Keeping warm in hospital

Skin-to skin method

 Warm room, fire

or electric heater
 Warmly wrapped

Radiant warmer

Heated water-filled mattress Air-heated Incubator

3.Correction of malnutrition
 The baby is already malnourished.
 Further malnutrition should be prevented.
 Tube feeding is done because baby is in incubator and it
is too young to suck mothers milk.
 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

* May try gavage feeds, if not sick

 LBW: Fluids and feeding

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

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: 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
 LBW: Feeding

Gavage feeding
 LBW: Feeding

Katori-spoon feeding
 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
*From 2 weeks of age
 KANGAROO MOTHER CARE

 First suggested by Dr Edgar Ray in Colombia.

 Refers to care of preterm or low birth weight infants by

placing the infant in skin-to-skin contact with the mother or
any other caregiver.
 PARAMETERS TO BE MONITORED
DURING KMC
• : For apnea.
 Temperature : Once in 6 hrs.
 Respiration
 Feeding
Well being
 growth
 Compliance with kangaroo care.
•: Once in 90-120 min.
•: By educating mother about danger signs.
•: Gain of 15-20 g /kg/day.
 COMPONENTS OF
KMC
1.KANGAROO POSITION
Consists of specific frog like position of LBW new born with
skin-to-skin contact with mother , in between her breasts in a
vertical position.

The provider must keep herself in a semi-

reclining position to avoid gastric reflux in the
infant.
Maintained 24 hrs a day , till it gains at least
2000g.
PREPARATION OF KANGAROO BABY
 Baby must be suitably dressed in a cap , soak-proof
diaper , socks and with an open shirt to have skin to skin
contact between mother and baby and placed in a
kangaroo bag.

Mechanism of prevention of hypothermia

 THERMAL SYNCHRONY
 If the temp of the baby decreases by 1°c , correspondingly the
temp of mother increases by 2 °c to warm up the
baby.
 If the temp of the baby raises by 1°c , the temp of the
 2.KANGAROO FEEDING
POLICY
 kangaroo position is ideal for breast feeding.
 Exclusive breast feeding is the policy.
 Feeding is done once in 90-120 min.
 If the baby can suckle , it is promoted.
If baby cannot suckle , expressed breast milk to be fed.
 If the baby is unable to swallow , EBM is fed by
nasogastric tube.
 3a.EARLY
DISCHARGE
Criteria for discharge:
 Wt gain of at least 40g a day for 5 consecutive days.
 Baby should feed well on breast milk.
 Temp should be maintained.
 There should not be any evidence of illness.
 Successful ‘in-hospital adaptation’ of the mother and other
members of the family.
 3b.FOLLOW-
UP
 After discharge , KMC is continued
at home.
 Follow-up is done daily by the
health worker for one week
and ensured that baby is feeding
well and gaining about 40g
weight daily.
 Afterwards once a week till the
baby reaches 40
weeks of post conceptional age.
 BENEFITS OF KANGAROO MOTHER
CARE
1. Benefits to baby

 Baby is kept warm all the 24 hours by the mother. (natural

incubator)
 It has minimum risk of apnea.
 It gains physiological stability.
 It gets safety and love.
 Early growth is promoted.
 It is at a reduced risk of nosocomial infections.
 2. Benefits to
mother
 Mother becomes actively involved in taking care of her
child.
 Mother is relaxed , confident and empowered.
 Bonding is better established.
 Breastfeeding becomes successful.

3. Benefits to family
KMC is economical compared to cost of intensive care.
 There is better follow-up.
 KMC promotes bonding among the family members.
 4. Benefits to
Hospital
 KMC saves materials like incubators, O2 cylinders.
 Saves in man power in terms of nursing staff.

5. Benefits to Nation

 KMC reduces neonatal mortality & thus infant mortality.

 Healthy and intelligent children , adds to the nation’s
health and wealth.
 NURSING ASSESSMENT

 Infant is small
 Skin is thin , blood vessels can be easily seen beneath
the epidermis
 Skin wrinkled and red with an excess of lanugo and little
or no vernix
 No subcutaneous fat deposits
 Head is large in proportion to the body
 Eyes prominent but closed
 Ears are soft and chin recedes
 Thorax is less firm
 Abdomen protruded
 Genitalia male: few scrotal rugae, testes are not
descended female: labia and clitoris are prominent
 Extremities: thin, muscle are small
 Nail: soft and short
 Palms and sole: minimal creases and appear smooth
 Generally lies inactive with arms and legs extended
 Reflex activity not fully developed
Low Birth Weight Baby
 Nursing management of low birth
weight(LBW) babies

a) Maintenance of Respiratory Function

– Position the infant with neck marginally broadened.

– Clear the air section by delicate suctioning.

– Monitor and record respiratory rate, mood, indications of

pain, withdrawals, nasal flaring, apnea, cyanosis and so
forth.
– Administer oxygen treatment with pack and veil, at first in
100% fixation at that point diminished to 40% to forestall
retrolental fibroplasia.

• –
• Provide chest physiotherapy by percusion, vibration,
postural waste to release and expel respiratory
emissions.
b) Maintenance of Thermoregulation
Environmental temperature to be kept up at 28 + 2OC via
climate control system, brilliant hotter, hot blowers, room
radiator.
• Skin temperature of the infant to be kept up at 36.5-37.5
C.

• Baby should be minded in incubater with wanted degree

of stickiness (60%-65%), oxygen and warmth.
C ) Maintenance of Nutrition and Fluid

• LBW infant required 120-150 kcal/kg body weight/day,

water 150-200 ml/kg/day, Protein 4-6 gm/kg/day for initial
scarcely any days to meet the prerequisite for ideal
development.

• – Early taking care of ought to be begun to forestall

hypoglycemia, hyperbilirubinemia and kernicterus.
• – Frequent taking care of ought to be given.

• – In poor sucking reflex, I/V liquid and naso gastric .

Dropper, spoon and pipette can be utilized to take care of
the LBW child.

• – Weight to be recorded every day to survey weight gain

ideally before taking care of, in same machine and same
measure of garments.
d)Prevention of Infections
• Poor insusceptibility power makes of LBW infant
progressively inclined to contaminations. Measures to be
taken to forestall diseases:

• Thorough hand washing with cleaning agents must be

done before contacting and caring each child.

• Each neonates ought to have separate clothings, taking

care of articles, thermometer, stethoscope, and so on.
• All staff working in exceptional consideration unit must
change their shoes and wear nursery shoes and sterile
outfit and cover.
• Any individual having any contaminations ought not enter
the neonatal consideration unit.
• Visitors ought to be limited in the unit.
• Nursery floors and surfaces to be cleaned with cleansers
or carbolic arrangement in each move. infant beds ought
to be cleaned with cleanser water and germicides.
e) Provide Stimulation
• Medical caretaker ought to give tactile incitement to the
LBW infant by talking, singing, snuggling, delicate
contacting during care.
• Visual incitement can be given by vivid hanging object.
Child’s situation to be changed at interim.
• Infant ought to be put on right side in the wake of taking
care of infant.
f) Informing the Parent about Infant’s Progress
• Infant’s condition and progress to be disclosed to the
parent to diminish their anxiety.
• Necessary treatment intend to be examined. Parent
ought to permit to see the infant.
• Care after release to be talked about with the parent.
Parent ought to find out about warmth, taking care of,
development and clean practices at home.
• The LBW infant is normally released from extraordinary
consideration unit when the infant put on adequate
weight approimately 2000 gm or more, having great
energy and ready to suck effectively.
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
 Transportation of LBW baby

 Adequate warmth
 Life support
 With mother
 Referral note
 PREVENTION OF LBW BABY
A . DIRECT INTERVENTION MEASURES

 Prevention of malnutrition - By nutritional education and

supplementation under ICDS.
 Prevention of anemia - By distribution of IFA tablets
 Control of infections - By early diagnosis and prompt
treatment.
 Avoid strenuous exercise , smoking & alcohol among
pregnant mothers.
 B . INDIRECT INTERVENTION
MEASURES
These are mainly family welfare services such as

 Deciding age at marriage.

 Deciding age at first child.
 Birth spacing.
 Deciding no of children.
 Improvement of availability of health services to women.
THANK YOU