This document provides information on the management of low birth weight (LBW) neonates and infants. It discusses delivery room management which focuses on maintaining thermoregulation, minimal handling, and use of nasal CPAP or intubation if needed. It also discusses providing kangaroo mother care for temperature regulation and breastfeeding initiation. Guidelines are provided for intravenous fluid administration in the first days and nutritional management including working towards full enteral nutrition through breastfeeding or other feeding methods depending on birth weight and gestation. Follow up protocols are outlined focusing on feeding, growth, development, and screening for common preterm complications.

1. ULFAT AMIN
M.Sc. CHN, DNA, RN

2. Delivery Room Management
 The delivery room management consists of an expert
resuscitation—maintaining good thermoregulation,
minimal handling, and use of nasal continuous positive
airway pressure (CPAP) and intubation when required for
preterm births.

3.  Low birth weight neonates who need care in a special
care unit include those with birth weight less than 1,800
g, gestation less than 34 weeks, any neonate who is
unable to feed from the breast and any sick neonate.

4.  Low birth weight babies are more prone to develop
hypothermia due to deficient heat regulatory mechanisms.
 Soon after delivery, the unclothed baby with the head and feet
covered should be placed in between the breasts of the mother
to have skin-to-skin contact position (Kangaroo mother care).
 It not only maintains the temperature of the baby but also
helps in the prompt initiation of breastfeeding.

5.  If a LBW needs fluids, then in the first 48 hours after
birth, neonates less than 1,250 g should be provided 5%
dextrose and those more than 1,250 g should receive
10% dextrose.

6. Day of life Birth weight 1000-1500g Birth weight >1500g
1 60ml 80ml
2 75ml 95ml
3 90ml 110ml
4 105ml 125ml
5 120ml 140ml
6 135ml 155ml
7 150ml 170ml

7.  The goal of nutritional management of the LBW infant
should be to achieve full enteral nutrition as soon as
possible. Breast milk is the best milk for the neonate and
the mother should be supported and counseled for the
maintenance of regular lactation and the need for
expression and its technique.

8. Birth
weight (g)
< 1,200 1,200–1,800 >1800
Gestation
Condition
<30 (weeks) 30-34 (weeks) >34 (weeks)
Initial Intravenous
fluids;
Try gavage feeds
if not sick
Gavage Breastfeeding; if
unsatisfactory,
give spoon or
paladai feeds
After 1–3
days
Gavage Spoon or
paladai feeds
Breastfeeding
Later (1–3
weeks)
Try spoon or
paladai feeding
Breastfeeding Breastfeeding
After (4–6
weeks)
Breastfeeding Breastfeeding Breastfeeding

9.  Monitoring for Feed Intolerance
 Vitamin and Mineral Supplementation:
Supplementation should be started as soon as the infant
is receiving at least 120–150 mL/kg of enteral feeds.
 Adequacy of Nutrition
 Immunization

10.  Follow-up Protocol :After discharge from the
hospital, babies should be regularly followed up and
screened for the following parameters:
• Feeding and nutrition
• Anemia and osteopenia
• Growth and development: Neurobehavioral
problems
• Immunization
• Retinopathy of prematurity, vision, strabismus and
hearing
• Problems resulting from previous morbidities, e.g.
bronchopulmonary dysplasia.

11.  A baby born with a gestational age of less than 37
complete weeks (or less than 295 days) is termed as
preterm baby.
 These babies are also termed as immature born, early or
premature.
 These babies are vulnerable to various physiological
handicapped conditions with high mortality rate due to
their anatomical functional immaturity.

12. A. Extremely preterm (less than 28 weeks
of gestation).
B. Very preterm (28-32 weeks of
gestation).
C. Moderate to late preterm (32-37 weeks
of gestation).

13. 1. APH, cervical incompetence and bicornuate uterus.
2. Chronic and systemic maternal diseases or infections.
3. Threatened abortion, acute emotional stress, physical exertion,
sexual activity and trauma.
4. Low maternal weight gain and poor socioeconomic condition.
5. Maternal malnutrition.
6. Cigarette smoking and drug addiction.
7. Multiple pregnancy
8. Very young and unmarried mother.
9. Too frequent child birth.

14. 1. Maternal diabetes mellitus and severe heart disease.
2. Placental dysfunction with unsatisfactory fetal growth.
3. Eclampsia, severe pre-eclampcia and hypertension.
4. Fetal hypoxia and fetal distress.
5. APH.
6. Severe Rh-isoimmunization.
7. Artificial rupture of membranes.

15.  Compared with the term infant, the preterm infant is tiny,
scrawny, and red.
 The extremities are thin, with little muscle or
subcutaneous fat.
 The head and abdomen are disproportionately large, and
the skin is thin, relatively translucent, and usually
wrinkled.

16.  Veins of the abdomen and scalp are more visible.
 Lanugo is plentiful over the extremities, back, and
shoulders.
 The ears have soft, minimal cartilage and thus are
extremely pliable.
 The soft bones of the skull tend to flatten on the sides,
and the ribs yield with each labored breath.

17. 1. Respiratory Distress Syndrome
2. Intraventricular Hemorrhage
3. Cold Stress
4. Retinopathy of Prematurity
5. Necrotizing Enterocolitis

18. 1. Improving Respiratory Function.
2. Maintaining Body Temperature
3. Preventing Infection
4. Maintaining Adequate Nutrition
5. Preserving Skin Integrity
6. Promoting Energy Conservation and Sensory Stimulation
7. Reducing Parental Anxiety

19. THANK YOU