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Low birth weight

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Low birth weight

  1. 1. Dr. Srinivas Rao 2nd year PG Community Medicine LOW BIRTH WEIGHT
  2. 2. Introduction Problem statement Causes of LBW Care of LBW baby KMC Prevention References
  3. 3. INTRODUCTION BIRTH WEIGHT 1ST weight of fetus or new born obtained after birth. Importance of birth weight  It is single most important determinant for survival, growth and development of infant.  Reflects health status of mother during adolescence and pregnancy and also quality of antenatal care.
  4. 4. LOW BIRTH WEIGHT Any infant with a birth weight of less than 2.5 kg with in 1 hr of birth regardless of gestational age. GRADING Birth weight Grade 2500 – 2000 gm Low birth weight 2000 – 1000 gm Very low birth weight < 1000 gm Extremely low birth weight
  5. 5. PROBLEM STATEMENT  More than 20 million infants worldwide, representing 15.5 % of all births are born with low birth weight.  As per WHO criteria, incidence of LBW in India is 33% each year.  Prematurity is the worlds single biggest cause of new born deaths and 2nd leading cause of all child deaths after pneumonia.
  6. 6. CAUSES of LBW Low birth weight includes 2 groups 1) Preterm babies(<37 wks ) 2) IUGR In nearly 50% of cases of LBW the cause is not known. In remaining 50% the causes are grouped into a) medical b) social
  7. 7. a) Medical causes 1. Maternal causes : all high risk mothers except Diabetics 2. Placental causes : Placenta previa , Congenital defects of placenta etc, 3. Fetal causes : Multiple gestation, Hydramnios, intrauterine infections etc. b) Social causes Poverty, Illiteracy, Ignorance, Poor standard of living, lack of knowledge on family planning, early marriages, smoking etc
  8. 8. LBW (Preterm) : Problems  Birth asphyxia  Hypothermia  Feeding difficulties  Infections  Hyperbilirubinemia  Respiratory distress  Retinopathy of prematurity  Apneic spells  Intraventricular hemorrhage  Hypoglycemia  Metabolic acidosis
  9. 9.  Birth asphyxia  Meconium aspiration syndrome  Hypothermia  Hypoglycemia  Infections  Polycythemia LBW (SFD) : Problems
  10. 10. 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 Hemodynamically - Requires kangaroo mother care
  11. 11. 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
  12. 12. 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. 3.Correction of malnutrition  As LBW babies cannot suck milk actively , it gets tired faster. So frequent breast feeding must be given almost
  13. 13. 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 Prevent heat losses Baby warmly wrapped Conduction Radiation Convection Evaporation
  14. 14. 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.
  15. 15. 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
  16. 16. 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.
  17. 17. 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.
  18. 18. PARAMETERS TO BE MONITORED DURING KMC  Temperature : Once in 6 hrs.  Respiration : For apnea.  Feeding : Once in 90-120 min. Well being : By educating mother about danger signs.  growth : Gain of 15-20 g /kg/day.  Compliance with kangaroo care.
  19. 19. 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. COMPONENTS OF KMC 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.
  20. 20.  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. PREPARATION OF KANGAROO BABY 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
  21. 21. 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.
  22. 22. 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.
  23. 23. 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.
  24. 24. 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.
  25. 25. 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.
  26. 26.  KMC saves materials like incubators, O2 cylinders.  Saves in man power in terms of nursing staff. 4. Benefits to Hospital 5. Benefits to Nation  KMC reduces neonatal mortality & thus infant mortality.  Healthy and intelligent children , adds to the nation’s health and wealth.
  27. 27. 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.
  28. 28. 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.
  29. 29. THANKS FOR CONCERN OVER ME
  30. 30. REFERENCES 1. Park . K. Text Book of Social and Preventive Medicine. 23rd Ed. Jabalpur: M/s Banarsidas Bhanot; 2015 2. Suryakantha . AH. Community Medicine with Recent Advances. 3rd Ed. Haryana: Jaypee Brothers Medical Publishers; 2014. 3. Ghai.O.P. Essential Pediatrics. 8th Ed. New Delhi: CBS Publishers & distributors; 2013. 4. United Nations Children’s Fund and World Health Organization, low birth weight : country , and global estimates. UNICEF, New York, 2004. 5. WHO : Kangaroo mother care : A practical guide
  31. 31. Problems in LBW babies

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