Care of Low Birth Weight Babies(LBW)

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Care of Low Birth Weight Babies(LBW)

  1. 1. Care of Low Birth Weight(LBW) Babies Dr.Rajkumar Patil Asstt.Prof.,Dept. of Community Medicine A V Medical College,Pondicherry
  2. 2. Low birth weight (LBW ) <ul><li>Gestational age </li></ul><ul><li>Pre-term </li></ul><ul><li>Term </li></ul><ul><li>Post term </li></ul><ul><li>LBW classification </li></ul><ul><li>Pre-term babies </li></ul><ul><li>Small for date(SFD) babies: </li></ul><ul><ul><li><10 th percentile for the gestational age </li></ul></ul><ul><ul><li>higher risk </li></ul></ul>
  3. 3. SFD
  4. 5. Problem statement Global 17% of live births India 30% of live births (but 5% less than 2 kg)
  5. 6. <ul><li>Risk factors for LBW </li></ul><ul><li>Malnutrition </li></ul><ul><li>Severe anaemia </li></ul><ul><li>Infection </li></ul><ul><li>Unregulated fertility </li></ul><ul><li>Age(<16 yr) </li></ul><ul><li>Hard physical work during pregnancy </li></ul><ul><li>Smoking </li></ul>
  6. 7. <ul><li>Prevention and control of LBW </li></ul><ul><li>Dietary improvements </li></ul><ul><li>IFA tablets </li></ul><ul><li>Controlling infections </li></ul><ul><li>Early detection and treatment of disorders </li></ul><ul><li>Family planning </li></ul>
  7. 8. <ul><li>Management of LBW babies </li></ul><ul><li>Intensive care </li></ul><ul><li>Feeding </li></ul><ul><li>Antibiotics </li></ul><ul><li>Weight <1.5 kg </li></ul><ul><li>Incubatory care(Temp.,Humidity,Oxygen) </li></ul><ul><li>Kangaroo Mother Care(>1.5 kg,normal) </li></ul><ul><li>Weight >1.5 kg </li></ul><ul><li>Incubatory care(Temp.,Humidity,Oxygen) </li></ul><ul><li>Radiant warmer </li></ul><ul><li>Kangaroo Mother Care </li></ul>
  8. 9. NICU
  9. 11. Kangaroo mother care (KMC)
  10. 13. Infant Feeding Bottle feeding Breast feeding
  11. 17. <ul><li>Global Recommendations for </li></ul><ul><li>Infant and Young Child Feeding (IYCF) </li></ul><ul><li>Exclusive breastfeeding for 6 months </li></ul><ul><li>Continue breastfeeding for up to 2 years or more </li></ul><ul><li>Introduce nutritionally adequate and safe </li></ul><ul><li>complementary foods after the age of 6 months </li></ul>
  12. 18. Colostrum <ul><li>Importance </li></ul><ul><li>Antibody -protects from infection and allergy </li></ul><ul><li>White cells - protects from infection </li></ul><ul><li>Purgative - clears meconium; helps prevent jaundice </li></ul><ul><li>Growth factors - helps intestine mature; </li></ul><ul><li>prevents allergy </li></ul><ul><li>Vitamin A -reduces severity of infections; </li></ul><ul><li>prevents eye diseases </li></ul>Nature’s way of coating the baby’s intestines with antibodies even before he starts taking anything else
  13. 19. <ul><li>Breastfeed on demand </li></ul><ul><li>Show mothers how to breastfeed </li></ul><ul><li>Tell her how to maintain lactation </li></ul><ul><li>if she is separated from the infant </li></ul><ul><li>8-10 times or more in 24 hours </li></ul><ul><li>Breastfeed at night also </li></ul><ul><li>No restrictions on length/numbers of breastfeeds </li></ul>
  14. 20. <ul><li>ABCD of benefits by breast feeding </li></ul><ul><li>Available easily </li></ul><ul><li>Allergic condition reduced </li></ul><ul><li>Anti-microbial factors </li></ul><ul><li>Best food for infant </li></ul><ul><li>Bonding between mother and child </li></ul><ul><li>Body shape returns quickly back to pre-pregnancy level </li></ul><ul><li>Breast cancer risk reduced </li></ul><ul><li>Bleeding reduced </li></ul><ul><li>Biochemical advantages (Prevents hypocalcaemia & hypomagnesaemia) </li></ul><ul><li>Clean </li></ul><ul><li>Cheap </li></ul><ul><li>Development of IQ, jaw, mouth </li></ul><ul><li>Digested easily </li></ul>
  15. 21. Human milk and cow’s milk Constituent Human milk (gm/l) Cow’s milk (gm/l) Proteins 11 33 1. Casein 4 28 2. Soluble proteins (lactalbumin, lactotransferrin,lysozyme) 7 5 Non-protein Nitrogenous substances 0.32 0.32 Lipids 35 35 Carbohydrates 70 (lactose 62) 50 Minerals 2 8 Vitamin C 60 mg 20 mg Vitamin D 50IU 25IU Energy 640-720 kC 650 kC
  16. 22. <ul><li>Some Contents of Human milk </li></ul><ul><li>Protein </li></ul><ul><li>More cysteine (essential for premature) </li></ul><ul><li>IgG,lysozymes </li></ul><ul><li>Fats </li></ul><ul><li>PUFA rich </li></ul><ul><li>Easier to digest </li></ul><ul><li>Carbohydrates </li></ul><ul><li>Lactose for brain </li></ul><ul><li>Lactobacillus growth in intestine beneficial </li></ul><ul><li>Vitamins and Minerals </li></ul><ul><li>Vitamin A,C and D </li></ul><ul><li>Low Iron better bioavailability </li></ul><ul><li>Less Ca but better absorbed </li></ul><ul><li>Less sodium,less load on kidney </li></ul>
  17. 23. <ul><li>Signs of correct attachment </li></ul><ul><li>mouth wide open </li></ul><ul><li>lower lip is turned outside </li></ul><ul><li>chin touching the breast </li></ul><ul><li>areola of breast not visible below the lower lip </li></ul><ul><li>areola of breast and nipple are inside baby’s mouth </li></ul><ul><li>tongue under the teat </li></ul>correct incorrect
  18. 24. <ul><li>Helping Mothers with Breast Problems </li></ul><ul><li>Fullness </li></ul><ul><li>Engorgement </li></ul><ul><li>Mastitis </li></ul><ul><li>Breast abscess </li></ul><ul><li>Cracked nipple </li></ul><ul><li>Sore nipple </li></ul><ul><li>Inverted nipple </li></ul>
  19. 25. <ul><li>Expression of breast milk </li></ul>
  20. 26. Expression of breast milk
  21. 27. Burping the child
  22. 28. <ul><li>Artificial Feeding </li></ul><ul><li>Not on human milk </li></ul><ul><li>Indications </li></ul><ul><li>Mother very ill/died/unavoidably absent </li></ul><ul><li>Failure of breast milk production </li></ul><ul><li>Mother rejects infant </li></ul>
  23. 29. Principles of artificial feeding 1.Think of infants requirements: Energy:100kC/kg Protein:2 g/kg Carbohydrate:10 g/kg 2.After 4 months diluted milk can be used 3.Feeding 6-8 times (during illness more feeds)
  24. 30. <ul><li>What can be used for artificial feeding? </li></ul><ul><li>1.Dried milk </li></ul><ul><li>Dried whole milk </li></ul><ul><li>Simple to reconstitute </li></ul><ul><li>Fortified with vitamins </li></ul><ul><li>Expensive </li></ul><ul><li>2.Cow’s milk </li></ul><ul><li>Cheap </li></ul><ul><li>Easily available </li></ul><ul><li>Dilute with water for <4 months infant </li></ul><ul><li>(25-33% water) </li></ul><ul><li>Add sugar (5-10 gm) </li></ul>
  25. 31. Risks of artificial feeding <ul><li>For child: </li></ul><ul><li>diarrhoea and respiratory infections </li></ul><ul><li>allergy and milk intolerance </li></ul><ul><li>infant mortality </li></ul><ul><li>malnutrition,Vitamin A deficiency </li></ul><ul><li>chronic diseases (DM,hypertension) </li></ul><ul><li>Lower IQ </li></ul><ul><li>For mother: </li></ul><ul><li>interferes with bonding </li></ul><ul><li>pregnancy sooner </li></ul><ul><li>overweight </li></ul><ul><li>anaemia </li></ul><ul><li>ovarian and breast cancer </li></ul>
  26. 32. Weaning Weaning is gradual process to introduce foods other than breast milk or infant formula at around 6 months Breast feeding should also be continued till 2 years
  27. 33. Baby Friendly Hospital Initiative (BFHI) <ul><li>Launched in 1991 by WHO and UNICEF </li></ul><ul><li>10 steps to be fulfilled by the hospitals </li></ul><ul><li>Have a written breastfeeding policy that is routinely communicated to all health care staff </li></ul><ul><li>Train all health care staff in skills necessary to implement </li></ul><ul><li>this policy </li></ul><ul><li>3. Inform all pregnant women about the benefits and management of breastfeeding </li></ul><ul><li>4. Help mothers initiate breastfeeding within a half an hour of birth </li></ul><ul><li>5. Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants </li></ul>
  28. 34. <ul><li>6 . Give newborn infants no food or drink other than breast milk, unless medically indicated </li></ul><ul><li>Practice rooming-in : allow mothers and infants to remain together 24 hours </li></ul><ul><li>Encourage breastfeeding on demand </li></ul><ul><li>Give no artificial teats or pacifiers </li></ul><ul><li>(dummies or soothers) to breastfeeding infants </li></ul><ul><li>Foster the establishment of breastfeeding support groups </li></ul><ul><li>and refer mothers to them on discharge from the hospital </li></ul>
  29. 35. Thank you...

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