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  • 1. WELCOME
  • 3. DEFINITION Low-birth weight newborns are those born weighing less than 2,500 grams, either because they are premature (less than 37 weeks' gestational age) or growth retarded (birth weight less than the 10th percentile for gestational age).
  • 4. INCEDINCE Nearly 70 percent of all infant mortality is associated with low birth weight. Some minority women, especially African American women, have substantially higher rates of low-birth weight babies than white women.
  • 5. CAUSES Primary cause of low birth weight  Premature birth (being born before 37 weeks gestation). Being born early means a baby has less time in the mother's uterus to grow and gain weight. Much of a baby's weight is gained during the latter part of pregnancy.
  • 6. Another cause  Intrauterine growth restriction (IUGR).  Antepartum hemorrhage  Maternal malnutrition and anaemia  Too frequent child birth  Low maternal weight gain
  • 7. Factors that can also contribute to the risk of very low birth weight.  Race - African-American babies are two times more likely to have low birth weight than Caucasian babies.  Age - Teen mothers (especially those younger than 15 years old) have a much higher risk of having a baby with low birth weight.
  • 8.  Multiple birth - Multiple birth babies are at increased risk of low birth weight because they often are premature. Over half of twins and other multiples have low birth weight.  Mother's health - Babies of mothers who are exposed to illicit drugs, alcohol, and cigarettes are more likely to have low birth weight. Mothers of lower socioeconomic status are also more
  • 9. CLINICAL MANIFESTATIONS Physical characteristics  Babies with low birth weight look much smaller than other babies of normal birth weight.  A low birth weight baby's head may appear to be bigger than the rest of the body  General activity of the baby is poor  Eyes remains closed and protruded
  • 10.  Ears are soft  Skin is thin and shiny  Nipples and areola are flat  Nails are short and not grown up to the finger tip
  • 11. Physiological handicaps  Alteration of respiratory function :- respiration is rapid, shallow, irregular with apnoea and cyanosis.  Immaturity of nervous system :- babies are inactive, lethargic, and have poor cough reflex. Sucking and swallowing reflexes are incordinated.  Disturbances of circulatory function :- closure of ductus arteriosus may be delayed. Intracranial hemorrhage may occur. Hypofunction of bone marrow may cause hemorrhagic problems.  Impaired thermo regulation :- hypothermia due to poorly developed heat regulating centre.
  • 12.  Inefficient gastrointestinal and hepatic functions :- capacity of the stomach is poor. Abdominal distension and functional intestinal obstruction are found due to hypotonia. Hypoglycemia is common.  Metabolic disturbances :- they are prone to develop hypoglycemia, hypocalcemia, hypoxia,acidosis and hypoproteinemia.  Impaired renal function :- they may be dehydrated due to inability to conserve water. Urination may be delayed.  Drugs toxicity :- reduced renal clearance lead to toxic effects of drugs.
  • 13. DIAGNOSIS The height of the fundus Height can be measured from the pubic bone. This measurement in centimeters usually corresponds with the number of weeks of pregnancy after the 20th week. If the measurement is low for the number of weeks, the baby may be smaller than expected.
  • 14. Ultrasound It is a more accurate method of estimating fetal size. Measurements can be taken of the fetus' head and abdomen and compared with a growth chart to estimate fetal weight.
  • 15. MANAGEMENT Specific management for low birth weight will be determined by your baby's physician based on: i. Baby's gestational age, overall health, and medical history I. Baby's tolerance for specific medications, procedures, or therapies II. Opinion or preference
  • 16. 1) AT BIRTH Efficient resuscitation and prevention of hypothermia are important aspect of care at birth. Delayed cord clamping may improve the iron stores. Warmth should be maintained by heat source. Vitamin k 0.5mg should be administered intramuscularly.
  • 17. 2) CARE AT NICU NICU should be warm, free from excessive sound, and have soothing light. Aseptic measures and hand washing should be there. Rough handling and painful procedures should be avoided.
  • 18. 3) MAINTANANCE OF BREATHING Baby should be positioned with neck slightly extended and air passage to be cleared by gentle suctioning to remove the secretion. Oxygen therapy is administered whenever necessary. Respiration rate, rhythm, signs of distress, chest retraction, apnea, cyanosis, oxygen saturation, etc… to be monitored at regular intervals.
  • 19. 4) MAINTANANCE OF STABLE BODY TEMPERATURE. Baby should be received in a pre warmed radiant warmer or incubator. Environmental temperature should be maintained according to the baby’s weight and age. Kangaroo mother care can be provided. All measures to be taken to prevent heat loss.
  • 20. KANGAROO MOTHER CARE Kangaroo care is a technique practiced on newborn, usually preterm, infants wherein the infant is held, skin-toskin, with an adult. . Kangaroo care was initially developed to care for preterm infants in areas where incubators are either unavailable or unreliable.
  • 21. The kangaroo position provides ready access to nourishment. The parent's stable body temperature helps to regulate the neonate's temperature more smoothly than an incubator, and allows for readily accessible breastfeeding.
  • 22. It has proven successful in improving survival rates of premature and low birth weight newborns and in lowering the risks of nosocromial infection, severe illness, and lower respiratory tract disease. It also increased exclusive breast feeding and for a longer duration and improved maternal satisfaction and confidence.
  • 23. Typically in kangaroo care, the baby wears only a diaper and is tied in a headup position to the mother’s bare chest with a strip of cloth in a manner that extends the baby’s head and neck to prevent apnea.
  • 24. The mother wears a shirt or hospital gown with opening to the front. The cloth wraps around and under the baby’s bottom to create flexion. The tight bundling is enough for the mother’s breathing and chest movement to stimulate the baby’s breathing.
  • 25. Because of the close confines of being attached to its mother’s chest, the baby is enclosed in a high carbon dioxide environment which also stimulates breathing. Fathers can also use the skin-to-skin contact method.
  • 26. 5) MAINTANANCE OF NUTRITION AND HYDRATION After first 1-2 weeks of life most preterm babies require 120-150 Kcal/kg/day to maintain satisfactory growth. Feeding should be initiated early. Expressed milk can be given.
  • 27. Nasogastric tube feeding can be given with expressed breast milk to all babies with poor sucking reflex. IV dextrose solution can be given to babies weighing less than 1200 gm or sick babies.
  • 28. 6) PREVENTION OF INFECTION Nosocromial infections are to be prevented. Thorough hand washing, separate baby articles, wearing of shoes and sterile gown and mask by care giver, restriction of visitors can be done. Infected babies should be kept separate. Antiseptic cleaning of all instruments are necessary.
  • 29. 7) PREVENTION, EARLY DETECTION, AND PROMPT MANAGEMENT OF COMPLICATIONS Baby should be observed for respiration, skin colour, activity, passage of stool and urine, etc… weight should be recorded. Position should be changed every 2 hourly. Baby should placed on right side after feeding to prevent regurgitation and aspiration.
  • 30. 8) FAMILY SOPPORT, DISCHARGE PLANNING, FOLLOW UP AND HOME CARE. Baby’s condition and progress should be explained to the parents to reduce their anxiety. Parents should be informed about home care, need of warmth, cleanliness, infection prevention, immunization etc…a community health nurse should visit the family every week for a month and provide necessary guidance and support.
  • 31. Prevention Prenatal care It is a key factor in preventing preterm births and low birth weight babies. At prenatal visits, the health of both mother and fetus can be checked. Because maternal nutrition and weight gain are linked with fetal weight gain and birth weight, eating a healthy diet and gaining the proper amount of weight in pregnancy are essential.
  • 32. Mothers should also avoid alcohol, cigarettes, and illicit drugs, which can contribute to poor fetal growth, among other complications. Prenatal multivitamin supplements are associated with a significantly reduced risk of babies with a low birth weight compared with prenatal iron-folic acid supplementation.
  • 33. Questions???
  • 34. THANK YOU