h<br />MANAGEMENT OF <br />LOW BIRTH WEIGHT BABY <br />FOR OPTIMAL  GROWTH AND DEVELOPMENT <br />M. Sholeh Kosim <br />Per...
Introduction <br /><ul><li>Premature birth and low birth weight (LBW) still a health problems in newborn
Morbidity and mortality still high accordingly to the complication
Medical and technology development leads to increasing the survival at high risk of LBW  for long term neurocognitive defi...
Introduction (2) <br /><ul><li>The normal birth weight of is > 2500  to 3000 gm.
Low  birth weight  or  LBW :   </li></ul>birth weight  of  less  than  2500 gm regardless to gestational age <br /><ul><li...
Neonatal deaths : 75 %  due to LBW
Infant deaths  : 50 %  caused  by LBW
Complication :
 Prone to malnutrition
Recurrent infection
Neurodevelopmental handicaps </li></ul>3<br />
4<br />
5<br />
6<br />
7<br />
LBW: Indications for hospitalization<br /><ul><li> Birth weight <1800 g
 Gestation <34 wks
 Unable to feed*
 Sick neonate*
 Irrespective of birth weight and gestation</li></ul>8<br />
Danger signals <br />(Early detection  and referral)<br /><ul><li> Lethargy, refusal to feed
 Hypothermia
 Tachypnea, grunt, gasping, apnea
  Seizures, vacant stare
 Abdominal distension
 Bleeding, icterus over palms/soles</li></ul>9<br />
Management of Newborn Illness<br /><ul><li>Education of mothers to recognize danger signals
Working with families to develop complication plan for newborns
Early recognition and appropriate management of newborn illness</li></ul>10<br />
Minimum Preparation for any  Birth<br />The following should be available and in working order:<br /><ul><li>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</li></ul>11<br />
Care of the Low Birth Weight Newborn<br /><ul><li>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</li></ul>12<br />
Delivery management <br /><ul><li>LBW is prone to be asphyxiated
Management at birth accordingly to Guidelines of Resuscitation (AHA/AAP)
Consider :
 Early intubation
 Early CPAP
 Prevent hypothermia
 Prevent  hyperoxia   </li></ul>13<br />
14<br />
15<br />
Genetic <br />Nutrition <br />LBW <br />OPTIMAL  G  & D   <br />Immunization  <br />Proper management  <br />Psycho social...
OXYGEN  DANGER <br /><ul><li>↑  free radial and contribute the incidence of:
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Management of LOW BIRTH WEIGHT BABY

  1. 1. h<br />MANAGEMENT OF <br />LOW BIRTH WEIGHT BABY <br />FOR OPTIMAL GROWTH AND DEVELOPMENT <br />M. Sholeh Kosim <br />Perinatology Sub Division <br />Pediatrics Department <br />Medical Faculty Diponegoro University- Dr. Kariadi Hospital <br />Semarang <br />1<br />
  2. 2. Introduction <br /><ul><li>Premature birth and low birth weight (LBW) still a health problems in newborn
  3. 3. Morbidity and mortality still high accordingly to the complication
  4. 4. Medical and technology development leads to increasing the survival at high risk of LBW for long term neurocognitive deficits .</li></ul>2<br />
  5. 5. Introduction (2) <br /><ul><li>The normal birth weight of is > 2500 to 3000 gm.
  6. 6. Low birth weight or LBW : </li></ul>birth weight of less than 2500 gm regardless to gestational age <br /><ul><li>Incidence : 15 – 30 %
  7. 7. Neonatal deaths : 75 % due to LBW
  8. 8. Infant deaths : 50 % caused by LBW
  9. 9. Complication :
  10. 10. Prone to malnutrition
  11. 11. Recurrent infection
  12. 12. Neurodevelopmental handicaps </li></ul>3<br />
  13. 13. 4<br />
  14. 14. 5<br />
  15. 15. 6<br />
  16. 16. 7<br />
  17. 17. LBW: Indications for hospitalization<br /><ul><li> Birth weight <1800 g
  18. 18. Gestation <34 wks
  19. 19. Unable to feed*
  20. 20. Sick neonate*
  21. 21. Irrespective of birth weight and gestation</li></ul>8<br />
  22. 22. Danger signals <br />(Early detection and referral)<br /><ul><li> Lethargy, refusal to feed
  23. 23. Hypothermia
  24. 24. Tachypnea, grunt, gasping, apnea
  25. 25. Seizures, vacant stare
  26. 26. Abdominal distension
  27. 27. Bleeding, icterus over palms/soles</li></ul>9<br />
  28. 28. Management of Newborn Illness<br /><ul><li>Education of mothers to recognize danger signals
  29. 29. Working with families to develop complication plan for newborns
  30. 30. Early recognition and appropriate management of newborn illness</li></ul>10<br />
  31. 31. Minimum Preparation for any Birth<br />The following should be available and in working order:<br /><ul><li>Heat source
  32. 32. Mucus extractor
  33. 33. Self-inflating bag of newborn size
  34. 34. 2 masks (for normal and small newborns)
  35. 35. 1 clock
  36. 36. At least one person skilled in newborn resuscitation present at birth</li></ul>11<br />
  37. 37. Care of the Low Birth Weight Newborn<br /><ul><li>Birth weight = Gestation duration + intrauterine growth
  38. 38. Most low birth weight newborns in developing countries are term or near term (Small for gestation age)
  39. 39. Increased risk of hypothermia and poor growth</li></ul>12<br />
  40. 40. Delivery management <br /><ul><li>LBW is prone to be asphyxiated
  41. 41. Management at birth accordingly to Guidelines of Resuscitation (AHA/AAP)
  42. 42. Consider :
  43. 43. Early intubation
  44. 44. Early CPAP
  45. 45. Prevent hypothermia
  46. 46. Prevent hyperoxia </li></ul>13<br />
  47. 47. 14<br />
  48. 48. 15<br />
  49. 49. Genetic <br />Nutrition <br />LBW <br />OPTIMAL G & D <br />Immunization <br />Proper management <br />Psycho social<br />Stimulation <br />16<br />
  50. 50. OXYGEN DANGER <br /><ul><li>↑ free radial and contribute the incidence of:
  51. 51. Chronic lung disease
  52. 52. retinopathy of prematurity
  53. 53. NEC
  54. 54. periventricular leukomalacia
  55. 55. Effect to growth and development
  56. 56. Defense to free radial just developped in third semester  premarure baby prone to be</li></ul>17<br />
  57. 57. Principles of Management for Low Birth Weight and Preterm Newborns<br /><ul><li>Warmth
  58. 58. Feeding
  59. 59. Detection and management of complications (e.g., resuscitation, assisted respiration, infection )</li></ul>18<br />
  60. 60. Warmth<br />As for all newborns:<br /><ul><li>Lay newborn on mother’s abdomen or other warm surface
  61. 61. Dry newborn with clean (warm) cloth or towel
  62. 62. Remove wet towel and wrap/cover with a second dry towel
  63. 63. Bathe after temperature is stable</li></ul>19<br />
  64. 64. 20<br />
  65. 65. 21<br />
  66. 66. 22<br />
  67. 67. 23<br />
  68. 68. Definition of Kangaroo Mother Care<br /><ul><li>Early, prolonged and continuous skin-to-skin contact between a mother and her newborn
  69. 69. Could be in hospital or after early discharge</li></ul>24<br />
  70. 70. 25<br />Kangaroo Mother Care<br />
  71. 71. How to Use Kangaroo Mother Care<br /><ul><li>Newborn’s position:
  72. 72. Held upright (or diagonally) and prone against skin of mother, between her breasts
  73. 73. Head is on its side under mother’s chin, and head, neck and trunk are well extended to avoid obstruction to airways
  74. 74. Newborn’s clothing:
  75. 75. Usually naked except for nappy and cap
  76. 76. May be dressed in light clothing
  77. 77. Mother covers newborn with her own clothes and added blanket or shawl</li></ul>26<br />
  78. 78. How to Use Kangaroo Mother Care (2)<br /><ul><li>Newborn should be:
  79. 79. Breastfed on demand
  80. 80. Supervised closely and temperature monitored regularly
  81. 81. Mother needs lots of support because kangaroo care:
  82. 82. Is very tiring for her
  83. 83. Restricts her freedom
  84. 84. Requires commitment to continue</li></ul>27<br />
  85. 85. 28<br />Effectiveness of Kangaroo Mother Care<br />Randomized controlled trial<br />Conducted in three tertiary and teaching hospitals in Ethiopia, Indonesia and Mexico<br />Study effectiveness, feasibility, acceptability and cost of kangaroo mother care when compared to conventional methods of care<br />Cattaneo et al 1998.<br />
  86. 86. Benefits of Kangaroo Mother Care (1)<br /><ul><li>Is efficient way of keeping newborn warm
  87. 87. Helps breathing of newborn to be more regular; reduce frequency of apneic spells
  88. 88. Promotes breastfeeding, growth and extra-uterine adaptation
  89. 89. Increases the mother’s confidence, ability and involvement in the care of her small newborn
  90. 90. Seems to be acceptable in different cultures and environments</li></ul>29<br />
  91. 91. Benefits of Kangaroo Mother Care (2)<br /><ul><li>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
  92. 92. Seems to be acceptable in different cultures and environments
  93. 93. Contributes to containment of cost— salaries, running costs (electricity, etc.)</li></ul>deLeeuw et al 1991; Karlsson 1996; Lamb 1983; Ludington-Hoe et al 1993; Ross 1980.<br />30<br />
  94. 94. Feeding<br /><ul><li>Early and exclusive breastfeeding
  95. 95. Breastmilk = best nourishment
  96. 96. Already warm temperature
  97. 97. Facilitated by kangaroo care
  98. 98. If Breast milk is not availble, consider milk formula : Preterm formula --- until 2000 gm then change to After Discharged Formula</li></ul>31<br />
  99. 99. 32<br />START ANTIBIOTIC ADMINISTRATION EVEN WITHOUTH ANY SYMPTOMS <br />
  100. 100. 33<br />
  101. 101. 34<br />
  102. 102. 35<br />
  103. 103. 36<br />
  104. 104. 37<br />
  105. 105. 38<br />
  106. 106. 39<br />LBW: Supplements <br />
  107. 107. 40<br />
  108. 108. RESPIRATORY DISTRESS PROBLEM <br /><ul><li>Usually due to Hyaline Membrane Disease ( HMD )
  109. 109. Assess : Antenatal steroids ???
  110. 110. Surfactant
  111. 111. CPAP : BUBBLE CPAP </li></ul>41<br />
  112. 112. INFECTION : <br /><ul><li> ANTIBIOTICS
  113. 113. SUPPORTING TREATMENT :
  114. 114. NUTRITION
  115. 115. OXYGENATION
  116. 116. WARMTH
  117. 117. IMMUNOTHERAPY ; IF IT IS NEEDED </li></ul>42<br />
  118. 118. HYPERBILIRUBINEMIA <br /><ul><li> Accordingly to Level of Serum Total Bilirubin
  119. 119. Foto therapy
  120. 120. Feeding : Breast milk
  121. 121. Fluid therapy
  122. 122. Antibiotics according to condition of infection </li></ul>43<br />
  123. 123. RETINOPATHY OF PREMATURITY <br /><ul><li> Worse complication is blindness
  124. 124. Due to : prematurity and toxic oxygen
  125. 125. Awarness to : baby with Ventilator and high flow/consentration of O2
  126. 126. Opthalmologic examination :
  127. 127. < 32 weeks of gestation
  128. 128. < 1500 grams
  129. 129. Done : 1 months of age
  130. 130. Lasik surgery </li></ul>44<br />
  131. 131. APNEIC SPELL : APNEA OF PREMATURITY <br /><ul><li> Very often : < 1500 grams
  132. 132. Complication : Hypoxemia
  133. 133. Oxygenation and breathing stimulation : Aminophylline or Theophylline
  134. 134. Mechanical Ventilator</li></ul>45<br />
  135. 135. HYPOGLYCAEMIA <br /><ul><li> Awarness of symptoms , sometime asymptomatic
  136. 136. Blood Glucose level
  137. 137. Hypoglycemia : < 45 mg/dL
  138. 138. Dextrose infusion
  139. 139. Glucose Infusion Rate ( G I R ) </li></ul>46<br />
  140. 140. INTRAVENTRICULAR HEMORRHAGE <br /><ul><li> Due to weakness of blood brain barrier and hypoxemia
  141. 141. Decreasing of consicousness , deficit neurologics, seizure
  142. 142. USG or CT scan
  143. 143. Consult to Pediatric Neurology Division and Neurosurgery </li></ul>47<br />
  144. 144. METABOLIC ACIDOSIS<br /><ul><li> Due to hypothermia, hypoxemia and infection
  145. 145. Confirmed by clinically and laboratory
  146. 146. Shoulde corrected by considering anion gap
  147. 147. Administration of bicarbonate : awarness of false route </li></ul>48<br />
  148. 148. SUMMARY <br /><ul><li>Premature birth and low birth weight (LBW) still a health problem with high Morbidity and mortality
  149. 149. The survival at high risk of LBW for long term neurocognitive deficits
  150. 150. Two types of LBW : premature and IUGR
  151. 151. Problems accordingly to the type
  152. 152. Management consist of : warmth, feeding, management of complication
  153. 153. Breast feeding is prioritized, in case of breastmilk is not available, consider milk formula</li></ul>49<br />
  154. 154. THANK YOU <br />50<br />
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