This PPT will help the readers to understand the management of LBW Babies as per FIMNCI Module

1. MANAGEMENT OF LOW
BIRTH WEIGHT BABIES
B.SUDHA
PROFESSOR
VMCON

2. Learning Objectives
The students after completing this section
should be able to:-
1) Enumerate problems of Preterm & LBW.
2) Chart intravenous fluid requirements for a
sick LBW neonate as per the baby’s birth weight.
3) Enumerate modes of enteral feeding for a
LBW neonate as per the baby’s birthweight.

3. Type of LBW
Preterm, IUGR are the reasons
Problems of LBW neonates
Problems of pre-term
• Asphyxia
• Hypothermia
• Inability To Breast Feed
• Respiratory Distress Syndrome
• Apneic Spells.
• Intra-Ventricular Hemorrhage.
• Metabolic Problems like Hypoglycemia, Metabolic Acidosis
and Hyperblirubinemia.
• Infection
• Retinopathy of Prematurity.

4. Problems of Small for Date babies.
• Fetal Distress, Meconium Aspiration syndrome
• Asphyxia,
• Hypothermia.
• Hypoglycemia
• Sepsis
• Malformations

5. Management
Delivery of low birth weight babies
• Hospital
• Well trained professionals
• Neonatal resuscitation skills
The indications for hospitalization of a neonate
include the following.
(a) Birth weight less than 1800 gm
(b) Neonate who is unable to feed from the breast
or by katori-spoon
(c) A sick neonate

6. Management
• Keeping LBW babies warm – home and hospital
Nutrition and fluids
• Mode for providing fluids and feeds – Birth
weight, gestation, presence or absence of
sickness and individual feeding effort of the baby
determine the decision.
• DBM, EBM
• >1200gm- IV fluids initially , gavage feeding later
• 1200-1800gm – gavage, katori spoon, breast
feeds.

7. Enteral feeds
Amount and scheduling of enteral feeds –
measuring the tube, insertion, pre aspirate if
abd.distended
Age (days) Feed volume (ml/kg/day)
1 60
2 90
3 120
4 150
5 180
6 180

8. Cup-spoon feeds
• 30-32 weeks or more are in a position to
swallow the feeds satisfactorily.
• If the baby does not actively accept and
swallow the feed, try gentle stimulation. If he
is still sluggish, do not insist on this method. It
is better to switch back to gavage feeds till the
baby is ready.

9. Judging adequacy of nutrition
• It is desirable to weigh all LBW babies at 2 weeks
(to check regaining of the birth weight), 4 weeks
(to ascertain a weight gain of at least 200-300g)
and then every month. Hospitalized LBW babies
should be weighed every day on the same
weighing machine.
• Excessive weight loss, or inadequate weight gain
indicates inadequate feeding, cold stress,
excessive insensible water loss or systemic illness
(like anemia, sepsis, late metabolic acidosis etc).

10. Vitamin supplements
• All LBW babies should receive intramuscular vitamin K
at birth.
• All preterms < 2000g should receive oral vitamin and
mineral supplement in doses shown below:
• Multivitamin preparation 0.3-0.6 ml (5-10 drops) /day –
6months(which usually provides vitamin A of 1000 IU/day
and vitamin D 400 IU/day)
• Calcium 80-100 mg/kg/day
• Phosphorous 40-50 mg/kg/day
• Iron should be started at a dose of 1 mg/kg/day at 4
weeks of age and provided till 12 months of age.

11. • Vaccinations in LBW babies –after recovery
• Discharge and Follow up
LBW babies can be discharged when:
• They are feeding from breast or breast and
cup
• Gaining weight for 3 consecutive days
• No signs of illness
• Are able to maintain normal body
temperature when roomed-in with mother
• Mother is confident of taking care of the baby

12. Counselling at Discharge
• Providing exclusive breast milk to the baby
• How to keep baby warm at home
• Identifying ‘Danger signs” for seeking medical
help
• Scheduled visits for assessing growth, monitoring
illness and providing immunization. These visits
should be at weekly intervals till the infant reaches
2.5kg
• Mother must be informed about her nutrition and
health

13. Thank u