PRESENTATION ON LOW BIRTH

WEIGHT BABIES

• SUBMITTED. TO
• RESP. HARJOT KAUR
• M.sc nursing

• SUBMITTED . ON – 23/7/2020

SUBMITTED . BY- PRABHJOT KAUR

Student of Msc 1st year
SGRD .college of pandher
 INTRODUCTION
A neonate with a birth weight of less than 2500 gm
irrespective of the gestational age are termed as low
birth weight baby(LBW).
• They include both preterm & small for dates (SFD)
babies.
• These two groups have different clinical problems &
prognosis.
• The LBW babies are more prone to malnutrition,
infections. They are more vulnerable to develop
hypertension, diabetes mellitus , coronary artery
disease in adult life.
 INCIDENCE

The magnitude of low birth weight infants in

developing countries is enormous .There are about
total 22 million such infants in the world out of
which India shares about 7 to 10 million . Low birth
constitutes 30% of live births india.
• High incidence of LBW babies in our country is due
to higher no. of babies with IUGR (small for dates)
rather than preterm babies.
 TERMINOLOGY

• Low birth weight babies:- A baby whose birth

weight is less than 2.5 kg (2500gm),regardless of
birth weight.
• Very low birth weight babies:- Babies with a birth
weight of less than 1500 gm .
• Extremely low birth weight babies:- Babies with a
birth weight of less than 1000 gm.
 CONTD….
• Small for dates babies:- Babies with a birth weight of less
than 10th percentile for their gestational age. They are also
termed as small for gestational age. Dysmaturity refers to
marasmic appearance of a baby indicating placental
dysfunction.
• Preterm baby:-A baby born with a gestational age of less
than 37 completed weeks is termed as preterm baby. These
babies are also known as premature, immature.
 CONTD….
• Intrauterine growth retardation:- Babies who do
not grow adequately in utero.
 TYPES OF LBW BABIES

Low birth weight babies are of two clinical

types:-
1.Preterm babies.
2.Small for gestational age.
 CONTD…..
1.Preterm babies:-Approximately 10 – 12 % of Indian
neonates are born before 37 completed weeks. These
babies are vulnerable to various physiological handicapped
conditions with high mortality rate due to their anatomical
& functional immaturity.
Causes of preterm birth:-
1) Spontaneous causes:- There may be spontaneous onset of
preterm labor leading to preterm birth. The causes may
be:-
 CONTD….
• APH, cervical incompetence, bicornuate uterus.
• Chronic & systematic maternal diseases or infections.
• Threatened abortion, acute emotional stress, physical
exertion, sexual activity , trauma.
• Low maternal weight gain, poor socio economic conditions.
• Maternal malnutrition & anemia.
• Cigarette smoking & drug intake during pregnancy.
 CONTD….
• Multiple pregnancy & congenital malformations
• Very young & unmarried mother.
• Too frequent child birth & history of previous
preterm delivery.
 CONTD….

2) Induced causes:-The preterm labor may be induced

to safeguard the interests of mother & fetus , when
there is impending danger for them .The conditions
are:-
• Maternal diabetes mellitus & severe heart diseases.

• Placental dysfunction with unsatisfactory fetal

growth.
• Eclampsia, severe preeclampsia & hypertension.
 CONTD….

• Fetal hypoxia & fetal distress.

• APH.
• Severe Rh – isoimmunization.
• Iatrogenic – improper diagnosis of maturity in elective
deliveries.
 CHARACTERISTICS OF PRETERM
INFANTS

Physical characteristics:-
• Size:- A preterm baby is small in size ,usually less than 47
cm & weight less than 2.5 kg.
• Posture:-The preterm infants lies in a “relaxed attitude”,
limbs are extended. General activity of the baby is poor
with incomplete neonatal reflexes such as moro, sucking &
swallowing reflex.
 CONTD….
• Head:-Head is larger than body , skull bones are soft
,sutures are widely separated & fontanelles are large.
• Face:-Face is small with small chin.
• Hair:-Scalp hairs are scanty, wooly with separate individual
hair fibers.
• Skin:- Skin of preterm is thin ,shiny .There is less
subcutaneous fat .Edema may present.
 CONTD….

• Eyes:-Eyes remain closed & protruding due to shallow orbits.

• Ear:-Ears are soft, flat & cartilage is not fully developed. Ear
may fold easily.
• Breast:-The breast nodule is absent or less than 5mm
.Nipples & areola are flat.
• Abdomen:- Abdomen is soft ,round & prominent veins.
• Nails:-Nails are short & not grown up to finger tips.
• Sole:-Deep creases over soles & palms are absent. The sole
have only fine wrinkles.
• Female genitalia:-Labia majora is poorly developed, labia
minora s exposed due to separated labia majora.
 CONTD….
• Male genitalia:- The scrotum is
undeveloped ,testes are undescended.

 
 PHYSIOLOGICAL HANDICAPS
Various hazards are found in preterm neonates due to
functional immaturity of different functions:-
Respiratory problems:-
• Hyaline membrane diseases.
• Broncho pulmonary dysplasia.
• Pneumo thorax.
• Pneumonia.
• Apnea.
 CONTD….
Cardiovascular problems:-
• Patent ductus arteriosus.
• Hypotension.
• Bradycardia.
Gastrointestinal problems:-
• Poor gastrointestinal functions.
• Necrotizing enterocolitis.
• Hyperbilirubinemia.
• Incompetent cardioesophageal sphincter leading to
regurgitation.
 CONTD….
Central nervous system problems:-
• Intraventricular hemorrhage.
• Seizures.
• Retinopathy of prematurity.
• Deafness.
• Hypotonia.
 CONTD…
Problems associated with renal system:-
-Hyponatremia.
-Hyperkalemia.
-Renal tubular acidosis.
-Renal glycosuria.
-Edema.
 CONTD….
Other problems:-
• Hypothermia.
• Nutritional deficiencies.
• Increased susceptibility to infections.
 CAUSES OF SMALL FOR DATE BABIES
IUGR may be fetal response to following factors:-
1) Fetal factors:-
• Chromosomal anomalies.
• Infections.
• Infarction.
• Multiple gestation.
• Pancreatic hypoplasia.
• Insulin deficiency.
 CONTD….
2) Placental factors:-
• Placental weight or cellularity.
• Infarction.
• Abruptio placenta.
• Infection of placenta.
 CONTD….
3) Maternal factors:-
• Toxemia of pregnancy.
• Hypertension or renal disease.
• Hypoxemia (cyanotic cardiac or pulmonary disease).
• Malnutrition.
• Short stature of mother.
• Primi or grand multipara.
• Young mother (below 20 yrs).
• Smoking, alcohol or drug abuse.
 MANAGEMENT OF PRETERM BABIES
Prevention of preterm birth is important by early detection
& management of high risk antenatal mothers.
• Expert nsg. Care is essential for better recovery from
various problems due to physiological handicaps.
1) Care of preterm babies at birth:-Efficient resuscitation
& prevention of hypothermia are important aspects of
care at birth. Continuous breathing support may be
necessary. Warmth should be maintained by heat
source, vit k 0.5 mg should be administered i/m. Then
baby should be transferred to NICU for special care with
all precautions.
 CONTD….
2) Care at NICU:-NICU should be provide as like as
intrauterine environment for the preterm neonates. The
NICU should be warm, free from excessive sound & have
smoothing light. Protection from infections should be
ensured by aseptic measures & effective hand washing.
Rough handling & painful procedures should be avoided.
• Baby can be place in prone position during care. Prone
posture makes the neonate comfortable, less cry & reduce
the chance of aspiration .This position relieves abdominal
discomfort , improve ventilation Unsupervised prone
position may cause sudden infant death syndrome(SIDS).
 CONTD…
3) Maintenance of breathing:-Respiratory distress is the
commonest problem in preterm babies. Baby should be
positioned with slightly neck extended & air passage to be
cleared by gentle suctioning to remove the secretion, if
needed.
• Oxygen therapy should be administered only when
indicated. Baby’s respiration rate , rhythm ,chest
retraction ,cyanosis, oxygen saturation to be monitored at
frequent intervals.
• Chest physiotherapy by percussion, vibration & postural
drainage may be needed to loose & remove respiratory
secretions.
 CONTD….
4) Maintenance of stable body temperature:-
Environment temp. should be maintained acc to
baby’s weight & age. Baby skin temp. should be
maintained 36.5 – 37.5degree c. Kmc provided
when baby’s condition is stabilizes. Constant
monitoring of temperature is essential with
thermometer. Bathing should be delayed. External
heat sources to be used for thermal protection.
 CONTD….

5) Maintenance of nutrition & hydration:-

Requirements of all nutrients should be maintained
with adequate feeding. Nutritional supplementation
should be given.
• Feeding should be initiated early. Babies who have
good sucking & swallowing reflexes should start
breastfeeding as early as possible.EBM can be given
with spoon at 2 hrs interval. Early entral feeding
should be started as soon as baby is stable.
 Fluid requirement of LBW infants
DAY <1000g 1000-1500g >1500g

1st & 2nd 100-120 80-100 60-80

3rd & 4th 130-140 110-120 90-100

5th & 6th 150-160 130-140 110-120

7th & 8th 170-180 150-160 130-140

9th onwards 190-200 170-180 150-160

 CONTD….
6) Prevention of infections:-Measures to be taken to prevent
nosocomial infections. Thorough hand washing ,separate
baby care articles, changing of shoes & wearing of sterile
gown & mask by the care giver ,restriction of visitors should
be followed. Strict aseptic technique to be followed for all
invasive procedures.
 CONTD….
7) Gentle rhythmic stimulation:-Sensory stimulation to be
provided to the preterm babies by talking, singing, gentle
touching during care. Visual & auditory stimulation can also
be provided.
8) Prevention, early detection & prompt management of
complications:-The baby should be observed for vital signs,
skin color, activity, cry, feeding behavior, passage of stool &
urine, eyes, oral cavity, any abnormal signs like edema,
bleeding ,vomiting
 CONTD….
• Weight should be recorded daily. Position to be changed
frequently at 2 hrs interval. Any problem identified should
be managed immediately.
9) Family support discharge planning, follow up & home
care:-Parents should be informed about care of baby after
discharge at home.
 
 CONTD….
2)Small for dates:-A baby whose birth weight falls below the
10th percentile on intrauterine growth curves is known as
small for date .
CLASSIFICATION FOR SFD:-
1) Malnourished small for date babies (asymmetric IUGR):-
They appear long, thin, marasmic & alert .They have less
subcutaneous fat ,poor muscle mass & excess skin folds on
the buttocks & thighs. Back of hands & feet are wrinkled.
 CONTD….
• HC is generally more than 3cm than CC . Internal organs are
shrunken (liver, lungs).The growth retardation is due to
reduction in the size of cells but not the cell number .
2) Hypoplastic SFD babies (symmetric IUGR):- These babies
are small in all parameters including head size. Growth
retardation in early part of pregnancy leads to reduction in
no. of body cells.
 CONTD…
3) Mixed group:-There is reduction in both cell size & cell no.
These babies are the outcome of adverse factors of early or
mid pregnancy.
 CONTD….
Common problems of small for date babies:-The
clinical problems & prognosis are different in SFD
babies as compared to preterm babies. The clinical
problems may be found in these babies are:-
• Fetal hypoxia & intrapartum death due to placental
dysfunction.
• Severe birth asphyxia, meconium aspiration
syndrome.
• Congenital malformation.
 CONTD…
• Symptomatic hypoglycemia & hypocalcemia.
• Inappropriate thermoregulation.
• Hyperbilirubinemia.
• Pulmonary hemorrhage , polycythemia due to
unknown cause.
• Increased risk of infections.
• Poor growth potential.
• Development of DM, hypertension, coronary artery
disease in adult life.
 COND….
• Management:-Although the preterm & SFD babies have
physiological differences, the principles of management
of all LBW babies are common. Appropriate place of
care for these babies are as follows;-
• Birth weight more than1500gm – Home care, if the
baby is well.
• Birth weight 1500-1800gm:-Secondary level neonatal
care unit (level-2).
• Birth weight less than 1500gm:-Tertiary level newborn
care unit.
PRINCIPLES OF MANAGEMENT OF LBW BABIES

1)Care at birth:-
• Select a suitable place for delivery which has optimum
facilities for handling LBW baby.
• In case premature labor is indicated, administer
Betamethasone (12mg IM , 2 doses at interval of 18 hrs) or
Hydrocortisone 100 mg to the mother ,as they help in
improving lung maturity.
 CONTD….
• Avoid administer of sedatives to the mother, as they
can depress baby’s respiration.
• A good episiotomy should be given to prevent
intracranial birth injury.
• Delayed cord clamping to help improve iron stores
of baby & prevent anemia.
• Efficient resuscitation.
• Administer of vitamin k 0.5 mg IM to reduce
incidence of hemorrhage in baby.
• Prevent hypothermia.
 CONTD….
2) Thermal protection:-
• Delay bathing up to 48-72 hrs of birth or even more
till the baby is stable.
• Maternal skin to skin contact or KMC.
• Warm delivery room.
• External heat source.
 CONTD….
3) Nutrition:-
• I/V fluids for very small babies & those who are sick.
• Expressed breast milk with NG tube or katori & spoon.
• Direct breastfeeding, if possible for the baby to suck & swallow.
4) Monitoring & early detection of complications:-
• Weight & other clinical signs.
• Electronic monitoring like heart rate, temp., oxygen saturation.
• Biochemical monitoring like Hb ,serum bilirubin , blood sugar.
5) Appropriate management of specific complications especially
infections.
 Nursing interventions following these principles are as follows;-
….

1) Nursery care:-At birth, measures are needed to clear the

airway, initiate breathing, care of umbilical cord & eyes &
administer of vit k .Special care is required to maintain a
patent airway & oxygen saturation in blood.
 CONTD….
2) Thermal control:-Survival rate of LBW babies is higher
when they are cared for in thermoneutral env., incubators
or radiant warmers should be used to maintain normal
body temp. Also KMC is given to stable LBW.
 CONTD….
3) Fluid requirement:- Fluids needs of infants vary acc
to their gestational age, environmental conditions &
disease states. Assuming minimal water loss in stool
of stool of infants not receiving oral fluids , their
water needs are equal to insensible water loss &
excretion of renal solutes.
 CONTD….
4) Feeding & nutrition:-Preterm LBW babies have some
limitations that would make breastfeeding difficult. The
limitations include a) Inability to suck effectively b) Inability
to coordinate sucking & swallowing. Human milk is first
choice of enteral feed for all LBW babies.
5) Management of complications.
 DISCHARGE & FOLLOW UP

• Before discharge, the baby is evaluated for any

complications of prematurity.
• Nutritional supplements including multivitamins,
iron, calcium & vit D are started.
• Baby should be immunized with BCG , Hep B & OPV
at birth.
• Parents are instructed regarding regular feeding of
baby.
 CONTD….
• Mothers are instructed regarding routine care of baby
like prevention of hypothermia & infections ,proper
feeding ,maintenance of personal hygiene, growth
monitoring.
• All the danger signs (feeding difficulty, lethargy,
hypothermia or hyperthermia ,tachypnea ,chest
indrawing ,convulsions) are explained to the parents
in detail with information regarding whom to contact.
• Follow up should be planned within 3-7 days of
discharge to ensure that baby has adjusted in home
env.
STRATEGIES TO REDUCE INCIDENCE OF LBW

• Women should be educated, status is raised in

society.
• Provide optimal nutrition & health care to girl
children throughout their lifecycle.
• Avoid early marriage & teenage pregnancy.
• Provide pre pregnancy health checkups , general &
nutritional guidance & essential vaccines.
• Ensure inter pregnancy of interval at least 3 yrs.
 CONTD…..
• Provide optimal & good quality antenatal care to all
pregnant women.
• Avoid smoking ,tobacco chewing & substance abuse
especially during pregnancy.
 
 SUMMARIZATION
• INTRODUCTION.
• DEFINITION.
• TYPES.
• CHARACTERISTICS.
• CAUSES.
• MANAGEMENT.
BIBLIOGRAPHY