Nursing management of low birth weight(lbw) babies


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Nursing management of low birth weight(lbw) babies

  2. 2. 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..
  3. 3.  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
  4. 4.  According to birth weight and gestational age LBW SGA(small for preterm gestational age)
  5. 5.  Preterm: the growth potential is normal and is appropriate for the gestational period SGA: Constitutionally small IUGR by pathological process
  6. 6. CARE OF PRETERM BABIESOPTIMAL MANAGEMENT AT BIRTH Attended by a senior pediatrician Air passage cleared of mucus Delayed clamping of cord helps in improving iron store but lead to hypervolemia and hyperbilirubinemia . So clamp the cord quickly Promptly dry, keep effectively covered and warm Vit K 0.5mg IM
  7. 7. MONITORING Vital signs monitoring Activity and behaviur Colour: pink, pale grey , blue , yellow Tissue perfusion :- pink colour, capillary refill over upper chest <2sec, warm and pink extremities, normal BP, urine output >1.5 ml/kg/hr, absence of metabolic acidosis, lack of disparity between PaO2 and SPO2
  8. 8. MONITORING monitor ABG and electrolyte Tolerance of feeds : vomiting, gastric residuals and abdominal girth Look for development of apnic attack, sepsis Weight gain velocity
  9. 9. PROVIDE IN UTERUS MILIEU Create soft comfortable nestled and cushioned bed Avoid excessive light, sound, rough handling and painful procedures. Use effective sedation and analgesia for procedures Provide warmth and ensure asepsis Prevent evaporative skin losses by effectively covering the baby, application of oil or liquid paraffin
  10. 10. PROVIDE IN UTERUS MILIEU Provide effective and safe oxygenation Provide parenteral nutrition partially and give trophic feeds with EBM Provide tactile and kinesthetic stimulation- skin to skin contact, interaction, music caressing and cuddling
  11. 11. POSITION OF THE BABY Most love to lie in a prone position, cry less and feels more comfortable Relieves abdominal discomfort by passage of flatus and reduce risk of aspiration
  12. 12.  Increase ventilation, and increase dynamic lung compliance and enhances arterial oxygenation Unsupervised prone positioning beyond neonatal period recognized as a risk factor for SIDS
  13. 13. THERMAL COMFORT Prewarmed open care system or incubator should be available care in a thermoneutral environment with a servosensor geared to maintain skin temperature of mid epigastric region at 36.50c Application of oil or liquid paraffin reduce convective heat loss and evaporative water loss
  14. 14. THERMAL COMFORT Extremely low babies covered with a cellophane or thin transparent plastic sheet to prevent convective and evaporative losses from skin As soon as condition stabilises effectively clothe the baby Partial kangaroo care to prevent hypothermia
  15. 15. OXYGEN THERAPY Oxygen should be administered with a head box when saturation is less than 85% and withdrawn gradually when > 90%
  16. 16. PHOTOTHERAPY Jaundice is common due to immaturity, hypoxia, hypoglycemia, infections and hypothermia Due to immaturity of blood brain barrier, hypoproteinemia and perinatal distress factors bilirubin brain damage may occur at relatively lower level Initiate phototherapy early
  17. 17. PREVENTION OF NOSOCOMIAL INFECTION Handling should be reduced to minimum Vigilance maintained on all procedures
  18. 18. FEEDING AND NUTRITIONBabies with weight <1200gm or gestational age <30 weeks and sick baby should be started on IV dextrose solutionWt>1000gm :- 10% dextroseWt<1000gm :- 5% dextrose Trophic feeds with EBM (1-2 ml 4 times a day) through Ng tube can be started in all babies irrespective of birth weight
  19. 19. FEEDING AND NUTRITION When stabilized enteral feeds are begun with EBM starting with a volume of 30 ml/kg/day on day1 Depending on tolerence feeds increased by 10-20 ml/kg/day every day and IVF are reduced
  20. 20. NUTRITIONAL SUPPLEMENTS When baby is stable, EBM can be fortified with human milk fortifier(HMF) for additional calories and protein. Multivitamin drops containing folic acid started at 2 weeks of age Iron supplements after 2-3 weeks Vitamin E which prevents powerful antioxidant and prevent hemolytic anemia and edema
  21. 21. GENTLE RHYTHMIC STIMULATION Gentle touch, massage, cuddling, stroking and flexing by the nurse or preferably by mother Soothing auditory stimuli can be given to preterm baby in the form of family voices or music Visual input provided with the help of coloured objects, diffuse light and eye tto eye contact
  22. 22. UTILITY OF CORTICOSTEROIDS Antenatal administartion of Betamethasone or dexamethasone if labour starts before 34 weeks In infants who did not receive antenatal steroids a single dose of dexamethasone 0.2 mg/kg iv at 4 hrs of age is recommended in very LBW babies
  23. 23. WEIGHT RECORD Accurate weighing is a sensitive index of well being Most LBW babies loss weight during 1st 3 to 4 days of life upto 10 to 15% of birth weightThe weight remains stationary for next 4 to 5 days then starts to gain at a rate of 1.0 to 1.5 % of body weight per day and regain birth weight by the end of 2nd week
  24. 24. IMMUNIZATION The dose is not reduced in preterm babies Administer 0 day vaccines on the day of discharge
  25. 25. FAMILY SUPPORT The frightened seen of NICU should be demystified Family should be constantly informed and involved in care of baby
  26. 26.  Mother should be encouraged to touch and talk with her baby and provide routine care under guidance of nurses Assist to provide kangaroo care
  27. 27. TRANSFER FROM TO COT Baby who is feeding well, reasonably active with a stable body temperature irrespective of wieght qualifies for transfer to open cot The baby should be observed for another 12 hours after putting incubator off
  28. 28. 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
  29. 29. NURSING ASSESSMENT Abdomen protruded Genitalia male: few scrotal rugae, testes are not descended female: labia and clitoris are prominent Exteremities: 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
  30. 30. NURSING DIAGNOSIS Risk for impaired parenting related to inadequate bonding secondary to parent child separation - participate in frank discussion with parents about infant’s condition - allow parents to express fear, guilt, anxiety - assist parent with bonding by role modeling and staying - demonstrate how to proide basic care : holding , diapering, turning
  31. 31. NURSING DIAGNOSIS Imbalanced nutrition less than body requirement related to diminished sucking -feed prescribed amount of breast milk by NG/PO - monitor blood glucose level - Weigh baby daily - maintain I/O chart - place child in semi sitting position for feeds -position post feeds on right side or prone position
  32. 32. NURSING DIAGNOSIS Risk for ineffective breathing pattern related to effects of prematurity -monitor pulse and respiration Q 2 H - Assess respiratory distress, cyanosis, grunting, nasal flaring. - provide rest period between nursing care - maintain oxygenation