low birth weight babies , LBW BABIES

3. NICU: stands for Neonatal Intensive Care
Unit. NICU is highly specialized area in the
hospital where critically ill or sick
Newborn/Neonatal cared to reduce mortality
and morbidity.

4. Neonatal care is defined as the management
of complex life threatening diseases
provision of intensive monitoring & initiation
of life sustaining therapies in and organized
manner to critically ill child in care unit.

6.  To improve the condition of critically
ill Neonate keeping in mind the
survival of Neonate so as to reduce
the mortality and morbidity rate.
 To maintain the functioning of
pulmonary, cardiovascular, Renal,
gastrointestinal and nervous system.

7.  To Provide continuing service and training
to medicine and nursing personnel in the
care of Newborn.
 To monitor Vital Signs.
 To measure the oxygen concentration of
the blood by oxygen analyzer.
 To administer the precise amount of fluids
and minutes concentration of drugs
through I.V infusion pump.

8.  Low birth weight baby (2000gm)
 Large babies (more than or equal to 4kg)
 Birth Asphyxia
 Meconium Aspiration Syndrome
 Sever Jaundice
 Infant of diabetic mother

9.  Neonatal sepsis/meningitis
 Neonatal convulsions/seizures
 Severe congenital malformation/ Cyanotic
congenital heart disease
 Oxygen therapy/ perinatal nutrition
 Cardiovascular Monitoring
 Exchange blood transfusion
 Mother of ‘Hepatitis B Carrier’
 Injured Neonate etc.

10.  Warm incubator (36°C)
 Adequate light supply
 Resuscitation and Treatment trolley stocked
 History , diet , treatment, problem
list/sheet and flow chart.
 Oxygen air and suction apparatus
 Oxygen air tubing or flow meter
 Vital sign monitoring apparatus
 Specific equipment as indicated by
diagnosis.

11.  Data should be collected within 24hours(if
possible much sooner)
 History and examination
1. Maternal history
2. Paternal history
3. Obstetrical history
4. Labour
5. Delivery
6. Apgar score
7. Vital Signs

12.  On admission
1. Notify the doctor and nurse in-charge.
2. Check infant identification Label.
3. Quickly examine/observe the infant head
to toe for obvious abnormalities
condition.
4. Resuscitate infant as necessary and
maintain warmth.

13. 5. Anthropometric examination
6. Transfer to normal environment as soon
as possible.
7. Commonest observations:
Temperature
Heart rate
Respiration
Color
Apgar score
Reflexes.

14.  Record keeping
1. Birth History (Done in labour room)
2. Ward History Contains
 Patient Registration Sheet
 Apgar score and examination sheet
 Feed chart and progress chart
 Treatment chart
 Growth chart

15. NURSING MANAGEMENT
OFLOWBIRTHWEIGHT(LBW)

16.  Babies with a birth weight of less than 2500
g, irrespective of the period of their
gestation are classified as low birth weight
babies.

17.  Very low-birth- Weight infant :an infant
whose birth weight is less than 1500g.
 Extremely low birth weight infant: An infant
whose birth-weight is less than1000g.

18.  According to birth weight and gestational
age
LBW
Preterm SGA(small for
gestational age)

19.  Preterm: the growth potential is normal and is
appropriate for the gestational period.
SGA
Constitutionally IUGR by
small pathological process

20. OPTIMAL MANAGEMENT AT BIRTH
 Attended by a senior
pediatrician.
 Air passage cleared of mucus.
 Delayed clamping of cord helps
in improving iron store but lead
to hypervolemia and
hyperbilirubinemia. So clamp the
cord quickly.
 Promptly dry, keep effectively
covered and warm
 Vitamin K 0.5mg IM

21. Φ Vital signs monitoring
Φ Activity and behavior
Φ Color: pink, pale grey, blue, yellow.
Φ Tissue perfusion: pink color, capillary
refill over upper chest <2sec, warm and
pink extremities, normal BP, urine
output >1.5 ml/kg/hr, absence of
metabolic acidosis, lack of disparity
between PaO2 and SPO2.

22. Φ Monitor ABG and electrolyte
Φ Tolerance of feeds: vomiting, gastric
residuals and abdominal girth.
Φ Look for development of apnic attack,
sepsis
Φ Weight gain.

23.  Create soft comfortable nestled and
cushioned bed .
 Avoid excessive light, sound, rough
handling and painful procedures. Use
effective sedation and analgesia for
procedures.
 Provide warmth and ensure asepsis.
 Prevent evaporative skin losses by
effectively covering the baby, application
of oil or liquid paraffin.

24.  Provide effective and safe oxygenation.
 Provide parenteral nutrition partially and
give trophic feeds (minimal volumes of
milk feeds (10–15 mL/kg/day) with EBM.
 Provide tactile and kinesthetic stimulation-
skin to skin contact, interaction, music
caressing and cuddling.

25.  Most love to lie in a prone position, cry less
and feels more comfortable
 Relieves abdominal discomfort by passage
of flatus and reduce risk of aspiration.

26.  Increase ventilation, and increase dynamic
lung compliance and enhances arterial
oxygenation.
 Unsupervised prone positioning beyond
neonatal period recognized as a risk factor
for SIDS(Sudden Infant Death Syndrome).

27.  Pre-warmed open care system or incubator
should be available.
 Care in a thermo neutral environment with a
servo sensor geared to maintain skin
temperature of mid epigastria region at
36.5c
 Application of oil or liquid paraffin reduce
convective heat loss and evaporative water
loss.

28.  Extremely low babies covered with a
cellophane or thin transparent plastic sheet
to prevent convective and evaporative
losses from skin.
 As soon as condition stabilizes effectively
clothe the baby.
 Partial kangaroo care to prevent
hypothermia.

29.  Oxygen should be administered with a head
box when saturation is less than 85% and
withdrawn gradually when > 90%

30.  Jaundice is common due to immaturity,
hypoxia, hypoglycemia, infections and
hypothermia.
 Due to immaturity of blood brain barrier,
hypoproteinemia and perinatal distress
factors bilirubin brain damage may occur at
relatively lower level.
 Initiate phototherapy early.

31.  Handling should be reduced to minimum.
 Vigilance maintained on all procedures

32.  Babies with weight <1200gm
or gestational age <30 weeks
and sick baby should be
started on IV dextrose
solution Wt.>1000gm:- 10%
dextrose
Wt<1000gm :- 5% dextrose.
 Trophic feeds with EBM (1-2
ml 4 times a day) through Ng
tube can be started in all
babies irrespective of birth
weight

33.  When stabilized enteral feeds are begun
with EBM starting with a volume of 30
ml/kg/day on day1.
 Depending on tolerance feeds increased by
10-20 ml/kg/day every day and IVF are
reduced

34.  When baby is stable, EBM can be fortified
with human milk fortifier(HMF) for
additional calories and protein.
 Multivitamin drops containing folic acid
started at 2 weeks of age.
 Iron supplements after 2-3 weeks.
 Vitamin E which prevents powerful
antioxidant and prevent hemolytic anemia
and edema.

35.  Gentle touch, massage, cuddling, stroking
and flexing by the nurse or preferably by
mother.
 Soothing auditory stimuli can be given to
preterm baby in the form of family voices or
music.
 Visual input provided with the help of
coloured objects, diffuse light and eye to
eye contact.

36.  Antenatal administration of Betamethasone
or dexamethasone if labor starts before 34
weeks.
 In infants who did not receive antenatal
steroids a single dose of dexamethasone
0.2 mg/kg iv at 4 hrs of age is
recommended in very LBW babies.

37.  Accurate weighing is a sensitive index of
well being.
 Most LBW babies loss weight during 1st 3 to
4 days of life up to 10 to 15% of birth
weight.
 The weight remains stationary for next 4 to
5 days then starts to gain at a rate of 1.0 to
1.5 % of body weight per day and regain
birth weight by the end of 2nd week.

38.  The dose is not reduced in preterm babies.
 Administer 0 day vaccines on the day of
discharge

39.  Family should be constantly informed and
involved in care of baby
 Mother should be encouraged to touch and
talk with her baby and provide routine care
under guidance of nurses.
 Assist to provide kangaroo care.

40.  Baby who is feeding well, reasonably active
with a stable body temperature irrespective
of weight qualifies for transfer to open cot.
 The baby should be observed for another
12 hours after putting incubator off.

41.  Infant is small
 Skin is thin , blood vessels can be easily
seen beneath the epidermis.
 Skin wrinkled and red with an excess of
lanugo and little or no vernix.
 No subcutaneous fat deposits.
 Head is large in proportion to the body.
 Eyes prominent but closed.
 Ears are soft and chin recedes.
 Thorax is less firm.

42.  Abdomen protruded
 Genitalia
 Male: few scrotal rugae, testes are not
descended
 Female: labia and clitoris are prominent.
 Extremities: thin, muscle are small.
 Nail: soft and short
 Palms and sole: minimal creases and appear
smooth
 Generally lies inactive with arms and legs
extended
 Reflex activity not fully developed.

43.  Risk for impaired parenting related to
inadequate bonding secondary to parent
child separation.
Participate in frank discussion with
parents about infant’s condition.
Allow parents to express fear, guilt,
anxiety- assist parent with bonding by
role modeling and staying.
Demonstrate how to provide basic care:
holding , diapering, turning.

44.  Imbalanced nutrition less than body
requirement related to diminished sucking
 Feed prescribed amount of breast milk
by NG/PO
 Monitor blood glucose level
 Weigh baby daily
 Maintain I/O chart
 Place child in semi sitting position for
feeds
 Position post feeds on right side or
prone position.

45.  Risk for ineffective breathing pattern
related to effects of prematurity
Monitor pulse and respiration Q 2 H
Assess respiratory distress, cyanosis,
grunting, nasal flaring.
Provide rest period between nursing
care
Maintain oxygenation

46. InfectionControlin
NeonatalIntensiveCareUnit

47.  Newborn babies who need intensive medical
attention are often admitted into a special
area of the hospital called the Neonatal
Intensive Care Unit (NICU).

48.  The NICU combines advanced technology and
trained health care professionals to provide
specialized care for the tiniest patients.
 NICUs may also have intermediate or
continuing care areas for babies who are not
as sick but do need specialized nursing care.
 Some newborn babies will require care in a
NICU, and giving birth to a sick or premature
baby can be quite unexpected for any

49.  4. Host risk factors for infection in newborns
include Low birth weigh- Acuity of underlying
illness- Immature immune system-
Permeable skin-
 5. Some studies have shown, type of infection
in newborn 1- Bacterial infection **Gram
positive infections Staphylococcus aureus-
Strepto pyogenes- **Gram negative
infections E.coli- Pseudomonas- Neisseria
meningitides-

50.  6. 2-Viral infections - Hepatitis HIV- Herpes- 3-
Fungal infections: Candidiasis- 4-Parasitic
infections -Toxoplasmosis
 7. According to provincial infectious diseases
advisory committee (PIDAC) The types of
infection transmission are: 1-contact
transmission *Direct contact: occurs through
touching the patient ex, colonized or infected
microorganism from staff. *Indirect contact:
occurs when microorganism transferred from
patient to patient via contaminated objects or the
contaminated hands of health care provider.

51.  8. 2-Droplet transmission wborns known or
suspected of having an infection that can
mitted by large respiratory droplets such as
cough or sneez travels for up to two meters
le of microorganisms transmitted by droplet
transmission in atory tract viruses (e.g.
Adenovirus, influenza and Para influ ses,
rhinovirus, RSV), rubella, mumps and
Bordetella pertu

52.  9. 3-Airborne transmission Airborne
transmission occurs when airborne particles
remain suspended in the air, travel on air
currents and are then inhaled by others who
are nearby or who may be some distance
away from newborns or if there have been
insufficient air exchange. The only
microorganisms transmitted by the airborne
rout are Mycobacterium tuberculosis (TB),
varicella virus (chickenpox virus) and measles
virus.

53.  10. Aims This paper is aimed to: - Control
and prevention nosocomial infection in
neonatal intensive care unit (NICU). -Provide
and identify hospital and health care facilities
policy information.

54.  11. infection control precaution
*staff precaution: 1-Hand hygiene: Removal
of visible soil and microorganism. Five
moments for hand hygiene: - before touching
the patient. - before clean/aseptic procedure.
- after body fluid exposure risk. - after
touching the patient. - after touching the
patient surroundings.

55.  12. *Impediments to effective hand hygiene:
- Accessories - long nail - nail polish -
artificial nail

56. 2- Personal protective equipment "PPE" -
gloves - gowns - facial protection - caps -
boots Personal protective equipment (PPE) is
worn to prevent transmission of
microorganisms from patient to patient and
from patient to staff or from staff to patient.
To protect newborns health unit care staff
should take necessary vaccinations that effect
them (measles ,mumps ,rubella, pertussis
,varicella , hepatitis B and influenza vaccine).

57. Environmental precautions: Observe
cleaning in unit care environment is
important to newborns safety ,staff and
visitors. Daily cleaning and disinfection the
environment surface should be in frequent
period.

58. Equipment precautions: The
medical equipment should be clean and
sterilized. The cleaning and disinfection of
the equipment on consistent basis following
with cleaning methods and instructions for
equipment.

59. visitor precautions: For safe visit to the newborns
and spending time or checking on them should
occur depending on some considerations:
- Limiting number of visitors.
- - visitors or family members should not visit if
they have signs and symptoms of being ill or
unwell, such as: •Fever •cough or influenza
•runny nose •vomiting or diarrhea •rash
•conjunctivitis. - hand hygiene before and after
visiting.
- - the visitor should be wearing personal
protective

60. Patient precautions: - neonatal skin care :
Bathing - management of central venous
catheters - management of peripheral
arterial catheters - management of umbilical
artery and vein catheters - prevention of
ventilator associated pneumonia

61. To provide a clean and safe neonatal intensive
care unit Along with hospital infection control
policy reviewed for newborn babies this paper
recommended that:
for staff: Staff have infection illness should be
excluded from work.
Hand hygiene including : hand washing , hand
rub.
Personal protective equipment including :
gloves, gowns, boots, caps,- masks.

62. For Environment: - clean neonatal intensive
care unit at least twice per day and additionally
as required. - clean isolettes / warmers
according to schedule and additionally as
required. - terminally clean neonatal intensive
care unit isolette / warmer and environment on
discharge of the newborn. - terminally clean
transport equipment after each newborn
transport. Frequent audits of practice should
be included as part of the

63. For equipment: Reusable medical equipment
must be cleanable and be to able to be
disinfected or sterilized. *for visitor: Family
members and others should not visit if they are
unwell.

64. THANK YOU