This document discusses providing care for neonates with low birth weight or preterm birth. It defines low birth weight as less than 2,500 grams and notes the increased mortality risk for these infants. Causes of low birth weight include maternal, obstetric, and fetal factors. Management involves careful care in labor and at birth, controlling temperature, maintaining respiration, preventing infection through hygiene, observation and record keeping, specialized feeding appropriate to the infant's weight and maturity, and ideally breastfeeding to aid nutrition and infection protection. The goal is providing the optimal environment and skilled care needed for preterm infant survival.

1. PROVIDING CARE FOR A NEONATE
WITH NEONATAL PROBLEMS
Eyayalem Melese
Jan 2021

2. 1. LOW BIRTH WEIGHT BABY

3. Definition:
• Low birth weight has been defined by the
WHO as weight at birth of less than 2,500
grams (5.5 pounds).
• This is based on epidemiological observations
that infants weighing less than 2,500 g are
approximately 20 times more likely to die than
heavier babies.

4. Definitions:
• LBW is less than 2500g .
• Very LBW is less than 1,500 g .
• Extremely LBW is less than 1,000 g .

5. The incidence of LBW:
• is defined as the percentage of live births that
weigh less than 2,500 g out of the total of live
births during the same time period.
• incidence rate therefore is=

6. Classifications of LBW
• Low birth weight babies are divided into two
groups
1. Per term : borne before 37 weeks of
gestational periode.
2. Light for dates (SGA): Born during gestational
period (between 37-42 weeks of GA),but BW is <
2.5 kgs.

7. Weight for Gestational age Graph

8. Causes of LBW
1. Maternal
• - Poor socioeconomic
condition
• . Malnutrition
• . Unmarried
• - Height less than 150 cm
• - Chronic ill health
2. Obstetric
• - Complication of pregnancy
• - Poor placental function
• - Smoking
• - Poor A/N care
3. Fetal
• - Multiple pregnancies
• - Congenital abnormalities
• - Slow intrauterine growth
• - Chromosomal abnormality

9. 1. Preterm
• A baby born before 37 completed weeks of
gestation.
• All his organs are immature or not well
developed at birth.

10. FEATURES OF THE PRE-TERM INFANT
• The preterm infant is small,
• under weight, with diminished subcutaneous fat.
• The head is relatively large with soft bones and
separated sutures.
• The abdomen is also relatively prominent.
The others are also:-
• Poor respiratory control
• Inadequate regulation of body temperature
• Impaired resistance to infection
• Tendency to hemorrhage
• Skin soft texture, pink

11. FEATURES OF THE PRE-TERM INFANT
• Lounge present
• Few plantar creases
• Flat nipples
• Very little cartilage in the pinna of the ear
• Prominent clitoris and labia minora in the female
• Scrotum empty with nor or few reggae in the male
• Inactive
• Feeds poorly

12. 2. Light - for – dates(Small - for gestational age)
• A baby whose weight is below the tenth percentile for
gestational age
Features of the small - for gestational age (small - for - dates) baby
– Wasted or thin appearance
– Skin cracked, dry and peeling, pale
– Mature new born genitalia and nipple with bud and areola
– Usually alert and active
– Feeds well
• A number low birth weight infant will, of course, be both pre-
term and small-for dates and liable to the problems of both
groups.

13. 2. Light - for – dates(Small - for gestational age)
Meconium aspiration is not un common in the
small for dates infant:-
This complication may give rise to problems
with respiratory infection when the infant is
preterm and small for dates. However, the
complication of RDS in these babies seems less
common than in the true pre-term infant

14. • The infant’s abilities to suckle, swallow, and
control respiration and temperature are of
course the most important features from a
management point of view.
• In practice most babies below 2000 gm. are in
need of special care.
• Incidence:- 2/3 of LBW babies are preterm
75% of all early neonatal death are seen in
the LBW babies.

15. PREVENTION OF LOW NEONATES
1. General good health of the mother
2. Good antenatal supervision of the mother includes
a. Health education in the value of good nutrition
b. Extra rest and less work for mothers in multiple
pregnancies
c. Treat early signs of pre-eclampsia
d. Admit the mother with APH on the 1st bleeding
e. VDRL for all pregnant women and complete
treatment if possible

16. MANAGEMENT
A. CARE IN LABOUR
– Deliver the mother in a consultant unit
with special care baby unit.
–Avoid giving the mother drugs, which will
depress the fetal respiratory center at birth.
– Do episiotomy to shorten 2nd stage some
obstetrician recommend elective forceps to
reduce the risk of cranial injury
– C/S may be performed in obstetrics.
Complications (breech press)

17. MANAGEMENT
B. CARE AT BIRTH
–Establishment ofair way & respiration
–Warms
–Mother and baby relationship

18. MANAGEMENT
C. The care given to the preterm baby is
of vital importance as his survival depends on
the quality of care he receive.
1 - CONTROL OF BABY TEMPERATURE
• Put the baby = in an incubator on an apnea warn,
the baby has at about 30 0c.
• But the incubator temperature should be
adjusted according to the weight of the child,
3kg-32.20c , 2kg-34 oc 1 kg -35oc

19. MANAGEMENT
2. MATNTENANCE OF RESPIRATION
– Nurse the baby on an apnea mattress which sets
off an alarm when the baby has not breathed.
– Resuscitative measures can be carried out
prompt.
– Humidified O2, if the baby is cyanosed while the
caring of very small premature babies in high
oxygen tensions is known to result in the
development of detrimental fibroplasias
(retinopathy or prematurity)

20. MANAGEMENT
3. HYGIEN AND PREVENTION OF INFECTION
– Daily toilet should be carried prior to a feed
– Washing the face and hands with sterile swabs
– Cleansing the skin folds with antiseptic lotion on cotton
wool swabs
– Napkin area needs special attention
– Observe for sign of infection
– Clean the nurseries, damp dusting for the surfaces
– All staff should be free from contamination and infection.
– Hand washing carried out before and after handling each
baby
– Clean the incubator with antiseptic daily

21. MANAGEMENT
• 4. OBSERVATION AND RECORDING
– Body temperature:-checked hourly, then after is reached
36.8 0C can be done less frequently
– Respiration:- Rate.
– Apex beat:- should range 120 and 160 beats/nine.
– Color pallor, cyanosis or jaundice
– Activity and muscle tone
– Passage or urine and me conium
– Umbilical cord inspected for bleeding
– Baby should be carefully examined daily for sign of infection
– weight -weighed soon after birth

22. MANAGEMENT
• THE PRINCIPLES OF MANAGEMENT AREA AS FOLLOWS
1. A separate unit where this is possible with adequate
facilities and trained staff
2. The mother should be nearby so that she can participate
in the care of their babies and provide the necessary
breast milk.
3. Provision of optimal environmental temperature.
4. Skilled nursing. The skilled manpower must be avilable
to the best advantage organizing, supervising, and
constantly training the less skilled in procedure
like resuscitation, prevention of infection and feeding.

23. MANAGEMENT
5. Control of infection. There should be strict
adherence to aseptic techniques both in the
handling of the infant and the preparation of food.
Breast feeding, besides all its their advantages.
Diminished the chance of infection.

24. MANAGEMENT
FEEDING
• Breast feeding is of the atmost importance, not only for the
proper nourishment but also for the protection against infection
which provides for the low birth weight baby.
• Those unable to suck and swallow efficiently are tube fed.
Mothers should be helped to express milk for their babies. Early
feeding is advocated to prevent hypoglycemia and hydration.
• Feed with in 2 hours of birth, there after frequent regular
intervals. Only when breast milk is not available should a
powdered low solute cow’s milk to use. Method of feeding
depends on the size, maturity, and condition of the baby.
• Weight 2000 - 2500 g. may be ready to suck may breast or bottle
feed
• Weight under 2000 g. has poor sucking reflex and thus tube
feeding is necessary

25. MANAGEMENT
• The daily volumes required
are approximately as follows.
1. Under 2000 gm.
 60 ml/ kg. 1st day
 90 ml/kg. 2nd day
 120 ml/kg. 3rd day
 150 ml/kg. 4th day
 180 ml/kg. 5th day
 If necessary the quantity is
increased to 200ml/kg.
per day by the 10th day
•
2. Under 1500g.
• 60ml/kg. per day
increasing daily by 30 -
60ml/kg. depending on the
baby's tolerance to 200 -
250 ml/kg per day
3. Small - for dates babies
 100ml/kg. 1st and 2nd day
 120ml/kg. 3rd day
 150ml/kg. 4th day
 increasing until 180 - 200
ml./kg. is reached.
FEEDING