This document discusses the management of low birth weight babies. It begins by defining low birth weight as under 2500g and categorizes it into grades. It then discusses the significance, types, causes, identification, problems, care and feeding of low birth weight babies. Special care involves prevention of infections, hypothermia and malnutrition. Hospital care focuses on the same along with use of incubators. Kangaroo mother care is also described which involves skin-to-skin contact between the mother and baby.

1. Management of
Low Birth Weight
Babies

2. LOW BIRTH WEIGHT
Birth weight<2500 g
GRADING
Birth weight Grade
2500 – 2000 gm Low birth weight
2000 – 1000 gm Very low birth weight
< 1000 gm Extremely low birth
weight

3. LBW: Significance
 Incidence : 30% of neonates
in India
 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. 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

5. CAUSES of LBW
Low birth weight includes 2 groups
1) Preterm babies(<37 wks )
2) IUGR
In nearly 50% of cases of LBW
the cause is not known. In
remaining 50% the causes are
grouped into
a) medical
b) social

6. a) Medical causes
1. Maternal causes : all high risk mothers except
Diabetics
2. Placental causes : Placenta previa , Congenital
defects of placenta etc,
3. Fetal causes : Multiple gestation, Hydramnios,
intrauterine infections etc.
b) Social causes
Poverty, Illiteracy, Ignorance,
Poor standard of living,
lack of knowledge on family
planning, early marriages,
smoking etc

7. Causation: LBW
Etiology of prematurity
 Low maternal weight, teenage / multiple
pregnancy
 Previous preterm baby, cervical incompetence
 Antepartum hemorrhage, acute systemic
disease
 Induced premature delivery
 Majority unknown

8. Etiology of SFD / IUGR
 Poor nutritional status of mother
 Hypertension, toxemia, anemia
 Multiple pregnancy, post maturity
 Chronic malaria, chronic illness
 Tobacco use
Causation: LBW

9. LBW: Identification of types
Prematurity
 Date of LMP
 Physical features
 Breast nodule
 Genitalia
 Sole creases
 Ear cartilage / recoil

10. Identification: Preterm LBW
Breast nodule
Preterm Term
Preterm Term

11. Male genitalia
Identification: Preterm LBW
Preterm TermPreterm Term

12. Female genitalia
Identification: Preterm LBW
Preterm Term

13. Identification: Preterm LBW
Sole creases
Preterm
Term

14. Ear Cartilage
Identification: Preterm LBW
Preterm Term

15. SFD / IUGR
 Intrauterine growth chart
 Physical characteristics
 Emaciated look
 Loose folds of skin
 Lack of subcutaneous tissue
 Head bigger than chest by >3cm
LBW: Identification of types

16. Intrauterine growth chart
400
800
1200
1600
2000
2400
2800
3200
3600
4000
4400
31 33 35 37 39 42 44 45
PRETERM TERM POST-TERM
APPROPRIATE FOR DATE
SMALL FOR DATE
LARGE FOR DATE
90th
percentile
10th
percentile
Gestation (weeks)
Birthweight(grams

17. 2.1 Kg - IUGR 3.2 Kg - AFD
Identification: SFD / IUGR

18. LBW (Preterm) : Problems
 Birth asphyxia
 Hypothermia
 Feeding difficulties
 Infections
 Hyperbilirubinemia
 Respiratory
distress
 Retinopathy of
prematurity
 Apneic spells
 Intraventricular
hemorrhage
 Hypoglycemia
 Metabolic acidosis

19.  Birth asphyxia
 Meconium aspiration syndrome
 Hypothermia
 Hypoglycemia
 Infections
 Polycythemia
LBW (SFD) : Problems

20. LBW: Issues in delivery
 Transfer mother to a well-equipped
centre before delivery
 Skilled person needed for effective
resuscitation
 Prevention of hypothermia - topmost
priority

21. Care of LBW babies
Depends upon birth weight
2500 – 2000 gm - Requires special care at
home
<2000 gm - Requires special care at
hospital
<2000 gm &
>1800 gm & stable
Hemodynamically
- Requires kangaroo mother care

22. Special care at Home
Principles: Prevention of infections
Prevention of hypothermia
Correction of malnutrition
1.Prevention of infections
- Gentle and minimal handling
- Handling with clean hands
- Room must be warm, clean and dust-free
- Immunization at right time

23. 2.Prevention of hypothermia
 Avoid bath till baby attains 2500g weight
 Cover baby with clean dry & warm cloth
 Bottles filled with warm water & covered with thin cloth
are kept on both sides (or) baby without blanket is kept
near 60 candle bulb burning.
3.Correction of malnutrition
 As LBW babies cannot suck milk actively , it gets tired
faster. So frequent breast feeding must be given almost

24. LBW: Keeping warm at home
Birth weight (Kg) Room
temperature (0
C)
1.0 – 1.5 34 – 35
1.5 – 2.0 32 – 34
2.0 – 2.5 30 – 32
> 2.5 28 - 30
Skin-to-skin contact Warm room, fire or heater
Prevent heat losses Baby warmly wrapped
Conduction
Radiation
Convection
Evaporation

25. Special care at Hospital
1.Prevention of infections
 Prophylactic antibiotics to prevent septicemia.
 Separate nurses for feeding and toilet attending.
 Barrier nursing to prevent cross infections.

26. 2.Prevention of hypothermia
 Child is kept under incubator – it maintains the
temperature , humidity and o2 supply , till weight
increases to 2000g.
 Careful monitoring of O2
supply:
low O2 – hypoxia and cerebral
palsy
high O2 – retinopathy of
prematurity

27. 3.Correction of malnutrition
 The baby is already malnourished.
 Further malnutrition should be prevented.
 Tube feeding is done because baby is in incubator and it
is too young to suck mothers milk.

28. Care of LBW babies
Depends upon birth weight
2500 – 2000 gm - Requires special care at
home
<2000 gm - Requires special care at
hospital
<2000 gm &
>1800 gm & stable
Hemodynamically
- Requires kangaroo mother care

29. Special care at Home
Principles: Prevention of infections
Prevention of hypothermia
Correction of malnutrition
1.Prevention of infections
- Gentle and minimal handling
- Handling with clean hands
- Room must be warm, clean and dust-free
- Immunization at right time

30. 2.Prevention of hypothermia
 Avoid bath till baby attains 2500g weight
 Cover baby with clean dry & warm cloth
 Bottles filled with warm water & covered with thin cloth
are kept on both sides (or) baby without blanket is kept
near 60 candle bulb burning.
3.Correction of malnutrition
 As LBW babies cannot suck milk actively , it gets tired
faster. So frequent breast feeding must be given almost

31. LBW: Keeping warm at home
Birth weight (Kg) Room
temperature (0
C)
1.0 – 1.5 34 – 35
1.5 – 2.0 32 – 34
2.0 – 2.5 30 – 32
> 2.5 28 - 30
Skin-to-skin contact Warm room, fire or heater
Prevent heat losses Baby warmly wrapped
Conduction
Radiation
Convection
Evaporation

32. Special care at Hospital
1.Prevention of infections
 Prophylactic antibiotics to prevent septicemia.
 Separate nurses for feeding and toilet attending.
 Barrier nursing to prevent cross infections.

33. 2.Prevention of hypothermia
 Child is kept under incubator – it maintains the
temperature , humidity and o2 supply , till weight
increases to 2000g.
 Careful monitoring of O2
supply:
low O2 – hypoxia and cerebral
palsy
high O2 – retinopathy of
prematurity

34. 3.Correction of malnutrition
 The baby is already malnourished.
 Further malnutrition should be prevented.
 Tube feeding is done because baby is in incubator and it
is too young to suck mothers milk.

35. LBW: Indications for
hospitalization
 Birth weight <1800 g
 Gestation <34 wks
 Unable to feed*
 Sick neonate*
* Irrespective of birth weight and gestation

36. LBW: Keeping warm at home
Birth weight (Kg) Room
temperature (0
C)
1.0 – 1.5 34 – 35
1.5 – 2.0 32 – 34
2.0 – 2.5 30 – 32
> 2.5 28 - 30
Skin-to-skin contact Warm room, fire or heater
Prevent heat losses Baby warmly wrapped
Conduction
Radiation
Convection
Evaporation

37. Well covered newborn
LBW: Keeping warm at home

38. LBW: Keeping warm in hospital
 Skin-to skin method
 Warm room, fire or
electric heater
 Warmly wrapped
Heated water-filled mattress Air-heated Incubator
Radiant warmer

39. Overhead
Radiant warmer
LBW: Keeping warm in hospital

40. 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

41. 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

42. 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

43. LBW: Feeding schedule
 Begin at 60 to 80ml/kg/day
 Increase by 15ml/kg/day
 Maximum of 180-200ml/kg/day
 First feed at 2 hrs of age then every 2
hourly

44. LBW: Feeding
Gavage feeding

45. Katori-spoon feeding
LBW: Feeding

46. 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

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

48. LBW: Adequacy of nutrition
Weight pattern*
 Loses 1 to 2% weight every day initially
 Cumulative weight loss 10%; more in preterm
 Regains birth weight by 10-14 days
 Then gains weight up to 1 to 1.5% of birth
weight daily
Excessive loss or inadequate weight
 Cold stress, anemia, poor intake, sepsis
* SFD - LBW term baby does not lose weight

49. 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
*From 2 weeks of age

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

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

52. 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

53. KANGAROO MOTHER CARE
First suggested by Dr Edgar Ray in Colombia.
Refers to care of preterm or low birth weight infants by
placing the infant in skin-to-skin contact with the mother
or any other caregiver.

54. PARAMETERS TO BE MONITORED DURING KMC
 Temperature : Once in 6 hrs.
 Respiration : For apnea.
 Feeding : Once in 90-120 min.
Well being : By educating mother about danger signs.
 growth : Gain of 15-20 g /kg/day.
 Compliance with kangaroo care.

55. 1.KANGAROO POSITION
Consists of specific frog like position of LBW new born
with skin-to-skin contact with mother , in between her
breasts in a vertical position.
COMPONENTS OF KMC
The provider must keep herself in a
semi-reclining position to avoid gastric
reflux in the infant.
Maintained 24 hrs a day , till it gains
at least 2000g.

56.  Baby must be suitably dressed in a cap , soak-proof
diaper , socks and with an open shirt to have skin to skin
contact between mother and baby and placed in a
kangaroo bag.
PREPARATION OF KANGAROO BABY
Mechanism of prevention of hypothermia
 THERMAL SYNCHRONY
 If the temp of the baby decreases by 1°c , correspondingly
the temp of mother increases by 2 °c to warm up the
baby.

57. 2.KANGAROO FEEDING POLICY
 kangaroo position is ideal for breast feeding.
 Exclusive breast feeding is the policy.
 Feeding is done once in 90-120 min.
 If the baby can suckle , it is promoted.
 If baby cannot suckle , expressed breast milk to be
fed.
 If the baby is unable to swallow , EBM is fed by
nasogastric tube.

58. 3a.EARLY DISCHARGE
Criteria for discharge:
 Wt gain of at least 40g a day for 5 consecutive days.
 Baby should feed well on breast milk.
 Temp should be maintained.
 There should not be any evidence of illness.
 Successful ‘in-hospital adaptation’ of the mother and other
members of the family.

59. 3b.FOLLOW-UP
 After discharge , KMC is continued
at home.
 Follow-up is done daily by the
health worker for one week
and ensured that baby is feeding
well and gaining about 40g weight daily.
 Afterwards once a week till the baby reaches 40
weeks of post conceptional age.