To given education regarding the law. To give the information about weight. To reduce the chance of low birth weight Explain details about the low birth weight

1. NURSING
MANAGEMENT OF A
LOW BIRTH WEIGHT
BABIES

2. Low birth weight (LBW)
 Definition : Birth weight
<2500 g(2.5 kg)
30% of neonates
in India
 Incidence :

3. LBW: Significance
 75% neonatal deaths and 50% infant
deaths occur among LBW infants
 LBW babies are more prone to:
 Malnutrition
 Recurrent infections
 Neuro developmental delay
LBW babies have higher mortality and morbidity

4. CLASSIFICATION:
1. According to Size:
 LBW- < 2500 gm
 Moderately LBW- 1500-2500 gm
 Very LBW- <1500 gm
 Extremely LBW- <1000 gm

5. Cont..
2. According to gestational Age:
a. gestational Age with weight:
 AGA- wt falls bw 10th & 90th %
SGA- < 10th %
LGA- > 90th %
IUGR
b. gestational Age regardless of weight:
 Preterm : < 37 wks
Full Term : 38-42 wks
Post Term: > 42 wks

6. Intrauterine growth chart

7. Cont..
3. According to Mortality:
 Fetal Death: after 20 wk of gestational age,
before delivery
Neonatal death: Early & late
Perinatal Mortality
Postnatal Death

8. A. PRETERM INFANTS:
Infant Born before the 37 wk of gestation.

9. Characteristics: Preterm
FEATURES SPECIFICATION
Size Small <47 cm; wt <2.5 kg
Posture Relaxed attitude, Limbs are extended
Head Large, Sutures widely separated &
fontanels large
Hair Fine, Fuzzy & wooly
Skin Thin, Pinkish & appear shiny, Abundant
lanugo & little vernix caseosa
Scarf Sign Infant elbow easily brought across chest
Heel to ear
maneuver
Heel easily brought to the ear

10. Cont..
Breast nodule
Preterm Term
Preterm Term

11. Male genitalia
Cont..
Preterm Term
Preterm Term

12. Female genitalia
Cont…
Preterm Term

13. Cont..
Sole creases
Preterm
Term

14. Ear Cartilage
Cont..
Preterm Term

15. ETIOLOGY OF PRETERM BIRTH
1. Fetal Factors:
 Fetal Distress
 Multiple gestation
 Erythroblastosis Fetalis

16. Cont..
2. Placental factors:
 Placental dysfunction
Placenta Previa
Abruptio Placental

17. Cont..
3. Uterine Factors:
 Bicornuate Uterus
Incompetent Cervix

18. Cont..
4. Maternal Factors:
 Pre-eclampsia
Chronic medical illness
Infection
Drug Abuse

19. Cont..
5. Other Factors:
 PRM
Polyhydramnios
Trauma

20. PROBLEM ASSOCIATED WITH
PREMATURITY:
1. Respiratory Problems
2. Cardiovascular Problems
3. GI Problems
4. CNS Problems
5. Problem associated with renal system
6. Other Problems

21. B. SMALL FOR DATES/SFG AGE
BABIES
 A baby wt falls below the 10th percentile on
intrauterine growth curves- SFD/SGA.

22. CLASSIFICATION:
1. Malnourished SFD Infants:
 Growth arrest in later pregnancy
 Reduction in cell size but not cell number
 Baby look marasmic & less subcutaneous fat

23. Cont..
2. Hypoplastic SFD Babies:
 Growth retardation in early part of pregnancy
Reduction in number of body cell
Babies smaller in all parameters including head
size

24. Cont..
3. Mixed:
 Growth retardation in early & mid pregnancy
Reduction in both cell number & size

25. ETIOLOGY OF SFD BABY
1. Fetal Factors:
 Chromosomal anomalies
 Infection
 Multiple gestation
 Pancreatic hypoplasia
 Insulin deficiency

26. Cont..
2. Placental Factors:
 Placental weight
Abruptio Placenta
Infection of Placenta

27. Cont..
3. Maternal Factors:
 Toxemia of pregnancy
HTN
Hypoxemia
Malnutrition
Short status of mother
Primi/grand multipara
Young mother (<20 year)
Smoking, alcohol, drug abuse

28. PROBLEMS OF SFD BABIES:
 Birth asphyxia
Polycythemia & hyperviscosity of blood
Hypothermia
Congenital malformation

29. Principles of Management of
LBW babies:
1. Care at Birth:
 Suitable place for delivery
 If premature labour administer Betamethasone
(12mg IM, 2 dose at interval of 18 hrs)/
Hydrocortisone 100 mg to the mother-improve
in the lung maturity
 Delayed cord clamping
 Avoid sedatives to the mother
 Administer vit K 0.5 mg IM
 Prevent hypothermia

30. Cont..
2. Appropriate place of care:
 BW >1800 gm- home care
BW 1500-1800 gm – Secondary level care
BW <1500 gm – Tertiary Level care

31. Cont..
3. Thermal Protection
4. Nutrition
5. Monitoring & early detection of complications
6. Appropriate management of specific
complications especially infection

32. NURSING INTERVENTION:
1. Nursery Care:
 Clear airway
 Initiate breathing
 Care of umbilical cord
 Eye care
 Vit. K administraion

33. 2. Thermal control:
Skin-to-skin contact Warm room, fire or heater
Prevent heat losses Baby warmly wrapped
Conduction
Radiation
Convection
Evaporation
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

34. Well covered newborn
Cont..

35. Cont..
 Skin-to skin method
 Warm room, fire or
electric heater
 Warmly wrapped
Heated water-filled mattress Air-heated Incubator
Radiant warmer

36. Overhead
Radiant warmer
Cont..

37. 3. Guidelines for fluid
requirements
 First day 60-80 ml/kg/day
 Daily increment 15 ml/kg till day 7
 Add extra 20-30 ml/kg for infants under
radiant warmer and 15 ml/kg for those
receiving phototherapy

38. Fluid requirements (ml/kg)
Day of life Birth Weight
>1500 g 1000 – 1500g
1 60 80
2 75 95
3 90 110
4 105 125
5 120 140
6 135 155
7 onwards 150 170

39. 4. Feeding & Nutrition:
Age Categories of Neonates
Birth Weight <1200 gm
<30 weeks
1200-1800 gm
30-34 weeks
>1800 gm
>34 weeks
Initial IV Fluid & Try
Gavage feeding
Gavage Breast feed/
Katori spoon
After 1-3 days Gavage Katori spoon Breast feed
2-4 weeks Katori spoon Breast feed Breast feed
4-6 weeks Breast feed Breast feed Breast feed

40. LBW: Feeding
Gavage feeding

41. Katori-spoon feeding
LBW: Feeding

42. Cont..
5. Management of complications:
 Infection
Jaundice
Metabolic derangement
Hematological abnormality
Retinopathy of Prematurity

43. Danger signals (Early detection
and referral)
 Lethargy, refusal to feed
 Hypothermia
 Tachypnea, gasping, apnea
 Seizures
 Abdominal distension
 Bleeding, icterus over palms/soles

44. Transportation of LBW baby
 Adequate warmth
 Life support
 With mother
 Referral note

45. Prognosis
 Mortality
 Inversely related to birth weight and gestation
 Directly related to severity of complications
 Long term
 Depends on birth weight, gestation and
severity of complications

46. Strategies to reduce incidence
of LBW:
 Proper education for women
Optimal Nutrition
Health check up
Avoid early marriage & teenage pregnancy
Inter pregnancy interval at least 3 year
Caloric intake, Protein, iron & folic acid
supplementation
Avoid smoking, alcohol
Early detection of disease