Feeding and fluid electrolyte management of LBW

1. Feeding and fluid
electrolyte management of
newborn
Dr Jyoti Prajapati
Assistant Professor Paediatrics

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WHO recommends that all LBW infants, irrespective of their gestation be fed
breast milk.
Breast milk is the ideal feed for all infants, including LBW infants
The best milk for LBW infants is mother’s milk.
All else is inferior.

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LBW infants need optimal nutrition during the neonatal
period for proper growth and development.
Appropriate feeding of LBW and VLBW infants improves their
chances of survival
normal birth wt 2800-3000gm
LBW ( Low birth weight) <2500gm
VLBW ( very low birth weight) <1500gm
ELBW ( extremely low birth wt) < 1000gm

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LBW: Significance
○ 75% neonatal deaths and 50% infant
deaths occur among LBW infants
○ LBW babies are more prone to:
● Malnutrition
● respriatory distress
● apnea episodes
● gastrointestinal problems
● Recurrent infections
● Neuro developmental delay
LBW babies have higher mortality and morbidity

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Types of LBW
Preterm
○ < 37 completed weeks
of gestation
○ Account for 1/3rd of
LBW
Small-for-date (SFD) /
intra uterine growth
retardation (IUGR)
○ < 10th centile for
gestational age
○ Account for 2/3rd of
LBW neonates
2 types based on the origin

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The goal is to enable every LBW infant to receive feeding directly
and exclusively from her/his mother’s breast at the earliest.
preterm infants have feeding difficulties initially
-Inability to coordinate suck, swallow and breathing (<34wk)
-Immature and sluggish gut
-Systemic illness( hypothermia, sepsis, hyopglycemia, respiratory
problems etc.)

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Full term SGA infants may also experience.
Poor attachment and sucking effort on the breast
Poor swallowing
Easy tiredness (and hence poor intake)
Vomiting, regurgitation or abdominal distension
Lower the birth weight, greater is the likelihood of
feeding difficulties.

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Initiation of successful breast
feeding
Every effort should be made to provide breast milk to LBW infants. This would require:
1. stable infants
a.Placing infant in skin to skin contact with the mother immediately after delivery
b. Initiating breastfeeding within one hour
c.Initiating and providing Kangaroo Mother Care (KMC)
d. Offering breastfeeding frequently every two hours, and on demand
e.Ensuring continued frequent feeding at night
f.Ensuring proper positioning and attachment
g. Managing breast/nipple problems such as retracted or cracked nipple, and
breast engorgement

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2. For unstable infants (with cardio-respiratory problems, temperature instability,
abdominal distension or acute serious illness such as asphyxia or sepsis; on life
support)
a.Offering expressed breast milk by alternate methods
b.As the infant improves, putting her on the breast to stimulate lactation
c.Initiating Kangaroo Mother Care (KMC) once the infant stabilizes

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LBW: Feeding schedule
○ Begin at 60 to 80ml/kg/day
○ Increase by 15ml/kg/day
○ Maximum of 180-200ml/kg/day
○ early initiation and then every 2 hourly

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Weight >1800 g; Gestation > 34 wks*
○ Breast feeding
○ Katori-spoon feeding, if sucking not
satisfactory on breast
○ Shift to breast feeds as soon as possible
LBW: Fluids and feeding

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Weight 1200-1800 g; Gestation 30-34 wks*
○ Start initial gavage feeds
○ Katori-spoon feeding after 1-3 days
○ Shift to breast feeds as soon as baby is able
to suck
* May need intravenous fluids, if sick
LBW: Fluids and feeding

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LBW: Fluids and feeding
Weight <1200 g; Gestation <30 wks*
○ Start initial intravenous fluids
○ Introduce gavage feeds once stable
○ Shift to katori-spoon feeds over next few
days. Later on breast feeds
* May try gavage feeds, if not sick

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SPECIAL CONSIDERATIONS FOR INFANTS BELOW
1200 GRAMS
have many problems - breathing difficulty, hypothermia, and
hypoglycaemia.
-Maintenance of temperature,
-Prevention of infections (asepsis and hand washing)
-Require constant monitoring .
-Strict aseptic precautions should be observed while giving iv fluids
-Monitoring for fluid overload

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Even while on intravenous fluids, they can be administered small amounts of milk feeds
called minimal enteral nutrition (MEN) or trophic feeds.
It helps in the growth and maturation of the gastrointestinal tract.
started as 12 - 24 ml/kg/day divided into 4 - 6 feeds given via the intragastric route.
As the infant stabilises, breast milk feeding is gradually advanced to full
requirements

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Assisted feeding

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LBW: Feeding
Gavage feeding/ OG feeding

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Paladi feeding
LBW: Feeding

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KMC

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LBW: Adequacy of nutrition
expected changes in Weight pattern*
○ Loses 1 to 2% weight every day initially
○ Cumulative weight loss 10%;
○ more in preterm (10-15%)
○ Regains birth weight by 10-14 days
○ adequacy of feeding
○ frequency of urine (8-12 times for day)
○ weight gain (15-20 grams per day)

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Excessive loss or inadequate weight
—check the amount of intake, frequency, night feeds
—assess attachment (breastfeeding),
—spillage (if on paladai / cup / spoon feeds).
—Nipple and breast problems
—cold stress, sepsis, oral thrush, anaemia and late
metabolic acidosis

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LBW: Supplements
○ Vitamins : IM Vit K 1.0 mg at birth
Vit A 1000 I.U. per day
Vit D 400 I.U. per day
○ Iron : Oral 2 mg/kg per day from
8 weeks of age

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FLUID AND ELECROLYTE MANAGEMENT
○ Newborns are born with an excess of total
body water (TBW)
○ fetus 90%
○ at birth 75- 80%
○ adult 60%
○ this excess TBW is normally lost by
diuresis during 1st week of life

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WATER LOSS
SENSIBLE—
kidney and GIT( kidneys have limited capacity to dilute urine initially owing to low GFR)
INSENSIBLE -
skin 70% and respiratory system 30%
IWL PRETERM > TERM
fever , tachypnea, radiant warmer ,phototherapy increases IWL

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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 phototherapy

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Fluid requirements (ml/kg)

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initial 2 days, iv fluids consist of D10% only.
After that, sodium (2-4 mEq/kg/day) and
potassium (2-3 mEq/kg/day) is added to dextrose.
Maintenance fluid since 3rd day if baby is passing
urine =N/5 saline (four parts of D10% + one part of
NS)

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monitoring in iv fluid therapy
small volume infusion set should be used.
Too rapid an infusion may result in ccf and even death in a
small baby.
Adequacy of fluid therapy is indicated by weight
pattern in the expected range

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○ THANKS