( spontaneous onset of labour following PROM) (induced labour or cesarean section before 37weeks)
Low birth weight
Postnatal care of the baby
Dr Utpal Sharma
Dept Of Community Medicine
Sikkim Manipal Institute of Medical
Infants (0-1year) constitutes about 2.92% of total population of
Of 136 million births every year 90% are in third world.
About 20-30% of the thee babies are underweight
About 40% of total infant mortality occurs in the 1st
month of the life
During weaning period about 25% children doesn’t receive quality
….making them susceptible to impaired health conditions
later in life
Many low cost measures like immunization, breast feeding etc.
are available to save these precious lives
Objectives of early
Establish and maintenance of cardio-respiratory
Maintenance of body temperature
Avoidance of infection
Establishment of suitable feeding regimen
Early detection and treatment of congenital and
Clearing the airway
The airway should be cleared of mucus and
For newborns already subjected to hypoxia
resuscitation requires more active measures
If the heart is not beating for 5 min, probably
the baby dead
Taken at 1min and again at 5min after birth
Requires immediate and careful observation of
Colour of the infant
Each sign is given a score of 0,1or 2
Perfect score is 9-10, of a total score of 10
A score of 0-3 indicates baby is severly
depressed, 4-6 indicate moderate depression
Score below demands prompt action
Low Apgar score at the end of 5 min is
….high risk of complication and
…..death during neonatal period
Care of cord
Cord should be cut only after cessation of pulsation
Stump should be kept dry with no application
Care of eyes
Should be cleaned before opening with sterile swabs
from inner to outer side
Any discharge from eyes is pathological
and demands immediate treatment
As a preventive measure maternal genital tract
infections should be treated beforehand
Care of skin
First bath/sponging may be delayed for 24 hrs after birth
Thereafter no need of bathing till discharged
Maintenance of body temperature
Normal body temperature of a newborn is 36.5º to 37.5º C
Most of the heat loss occurs trough evaporation of amniotic
fluid from the body of the wet child
About 75% of heat loss occurs from the head
It is important to dry the baby quickly with a
clean cloth and wrapped in warm clothing
A naked newborn exposed to an
environmental temperature of 230
suffers the same heat loss as a naked
adult in 0 0
Do you know…..?????
Initiated within 1/2 hour in case of a vaginal delivery
and within 4-6 hours in case of a C/S. (IYCF)
First milk called “colostrum” should be given to the
Exclusive breast feeding should be practiced for six
Baby should be breastfed ON DEMAND i.e. whenever
the baby cries for feeds.
Time interval between each feed is about 2 to 3 hours.
Frequency of feeds should be at least 8-10 times in 24
hours and compulsory night feeds
Ensure the delivery room is warm (25° C), with no draughts.
Dry the baby immediately; remove the wet cloth.
Wrap the baby with clean dry cloth.
Keep the baby close to the mother to stimulate early
Postpone bathing/sponging for 24 hours.
Keep the baby clothed and wrapped with the head covered.
Minimize bathing especially in cool weather or for small
Keep the baby close to the mother.
Use kangaroo care for stable LBW babies and for re-warming
stable bigger babies
Birth weight is the single most important determinant
of chances of child survival, healthy growth and
Low Birth Weight (LBW)babies are grouped as
Preterm (short gestation) and…
Small for Age/Date (SFA/D) term infants.
Countries with fewer incidence of LBW, preterm is
In countries like India, where the proportion of LBW
is high, majority of LBW is due to SFA.
By international agreement LBW is considered as
Low Birth Weight (LBW) :
Any neonate weighing less than 2500 gm at birth
irrespective of gestational age.
Very Low Birth Weight baby (VLBW) :
Any neonate weighing less than 1500 gm at birth
irrespective of gestational age.
Extremely Low Birth Weight baby (ELBW) :
Any neonate weighing less than 1000 gm at birth
irrespective of gestational age.
…when measured preferably within one hour of life
Besides this babies are also classified according to the
Pre-term Baby :
Babies born before 37 completed weeks (<259 days) of
gestation irrespective of the birth weight.
Term baby :
Babies born between 37 to 42 weeks of pregnancies
(259-294 days) irrespective of the birth weight.
Babies born at 42 completed week or thereafter (> 294
days of gestation)
A LBW is any infant with birth weight <2.5 kg
irrespective of gestation and includes….
Extremely preterm (<28 weeks of gestation)
Very preterm (28-32 weeks of gestation)
Moderate to low preterm (32-37 weeks of gestation)
Even though born early their intrauterine growth
may be normal according to the gestation
Given good care, these babies catch up good
growth and by 2-3 years of age will be of normal
size and performance.
In 2010, an estimated 15 million babies were born
prematurely and about more than 1 million of these died
Prematurity is now the leading cause of deaths amongst
under-5 year children…..
..…and single most important cause of death in the
first month of life.
The survivors may face a lifetime with significant
Causes of preterm birth
Preterm births are classified into two groups
Spontaneous preterm birth
Provider initiated preterm birth
Prematurity is an important risk factor for developing
NCDs (HTN, DM) in later life for these babies
This creates a intergenerational cycle of risk
So the link between prematurity and NCDs adds a
very important dimension in public health aspect…
…..when increasing trend of both are
Types of preterm births and risk
Spontaneous preterm births Provider initiated preterm
Age at pregnancy and
Underlying chronic medical
Lifecycle/ work related
Genetic and other
Medical induction /
Cesarean section for maternal
or foetal indication
Other- Not medically
Small for date babies
May be born at term or preterm
Weighs less than 10th
for the gestational age
Results due to intrauterine growth retardation
These babies have high mortality rate not only in
neonatal period but during infancy as well
Hence inflate the perinatal and infant mortality rates
They are frequent victims of PEM and infections
In developing nations 3 determining factors
are associated with adverse prenatal and
postnatal development of the child
Factors associated with IUGR
Maternal factors Placental cause Foetal causes
Heavy physical work
Short maternal stature
Very young age
High parity and close
Association with mental retardation
High risk of perinatal and infant mortality
Human wastage and suffering
Very high cost of special care
Association with socioeconomic underdevelopment
Infant mortality is 20 times higher in LBW babies
Serves as an important guide for level of care to the children
Indicates the malnutrition and ill health of the mother
High percentage of LBW warrants need of improved care of
What Problems Do Low Birth
Weight Babies Have?
Breathing problems at birth and later.
Low body temperature because there is little fat on the body
and the newborn’s temperature regulating system is immature.
Low blood sugar because there is very little stored energy.
Feeding problems because of their small size, lack of energy,
small stomach and inability to suck.
Infections because the infection fighting system is not mature.
Jaundice (high bilirubin) because the liver is not mature.
Bleeding problems due to immature clotting ability at birth.
Other clinical Problems
related to prematurity
Despite of all efforts rate of LBW can’t be
lowered more than 10% around the world.
This is due to multiplicity of causes
Intervention have to be cause specific
Attention must be given to good prenatal care
and intervention programme…….
…..rather than “treatment” of
the LBW babies born later
Identifying “at risk” pregnant ladies by using mother health
…..primarily by the grass root level health care
A small increase in food intake, even in the last trimester
results in considerable improvement in weight of the infant
Other interventions consists of supplementary nutrition, IFA
tablets, food fortification etc.
Infections affecting foetal growth should be detected and
Other medical disorders like HTN, toxemias and diabetes
should be detected and treated early
Avoidance of excessive smoking
Improved sanitation measures
Measures to improve health and nutrition of young girls
In addition improved socioeconomic and environmental
conditions with distribution of health and social
….. guarantees long lasting effect
Government support in form of maternity leave and child
For treating LBW babies, the are classified
into 2 groups
Those under 2 kgs
Requires first class modern neonatal care in
intensive care unit until gains weight >2.5 kg
Those between 2-2.5 kgs
Needs intensive care unit for a day or two
Intensive care includes
Incubatory care comprising adjustment of
temperature, humidity and oxygen supply
Feeding of baby with breast milk if possible by
Prevention of infections
Leading causes of death in LBW babies
Intracranial haemorrhage, secondary to trauma or
Pneumonia and other infections
Introduced first in Colombia in 1979
by Dr. Hector Martinez and Dr Edzar Rey
Intervention to combat high infection and
mortality rate owing to overcrowding in
Now adopted across the developing world and
considered as essential element in continuum in
Four components of KMC are
Skin to skin positioning of baby on mother’s
Adequate nutrition through breast-feeding
Ambulatory care as a result of earlier discharge from
Support for the mother and her family in caring for the
For improved management of newborn in facilities,
newer initiatives has been designed
Newborn care corner
Newborn stabilizing unit
Special newborn care unit