MANAGEMENT OF

HIGH RISK NEW BORN,

LOW BIRTH WEIGHT
- M. NISSIE
 INTRODUCTION

High Risk New Born Are Babies Who Are In Risk To Survive
For Life In Extra Uterine Environmental After The Birth.
These Babies Requires A Close, Continuous Monitoring And
Early Care By The Health Professionals . Their Life Can Be
Saved By Proper Care And By Applying The Need Based
Measurements. High Risk New Born And Their
Management Required A Adequate Knowledge And Up To
Date Skill Among Nursing Professionals And Other Health
Care Providers To Manage Them Efficiency.
 NURSING DIAGNOSIS FOR HIGH RISK BABIES
1. Ineffective breathing pattern related to pulmonary and neuromuscular
immaturity, decreased energy, and fatigue.
2. Ineffective thermoregulation related to immature temperature control and
decreased subcutaneous fat.
3. Risk for infection related to deficient immunologic defenses
4. Imbalance nutrition less than body requirement related to inability to ingest
nutrients because of immaturity
5. Risk for impaired skin integrity related to immature skin structure, decreased
nutritional state and immobility
6. Pain related to procedure, diagnosis, treatment and handling.
7. Delayed growth and development related to preterm birth, NICU,
environment, separation from parents.
 LOW BIRTH WEIGHT NEONATE

• LOW BIRTH WEIGHT NEONATE

Low birth weight newborn may be defined according to World Health
Organization ( WHO ) , babies with a birth weight of less than 2,500 gm. The term
very Low Birth Weight refers to birth weight less than 1500 gm. Extremely Low
Birth Weight ( ELBW ) refers birth weight less than 1000gm , the term
‘Micropreemie’ refers when birth weight below 500 gm.

INCIDENCE - The low birth weight infants in developing countries is enormous .

There are about total 22 millions such infants in the world out of which India
shares about 7 to 10 million. Low birth constitutes 30% of live births in India
• Low Birth Weight babies are broadly of two clinical types .

1) First are those born before 37 weeks of gestation period

( preterm ) . A preterm baby is expected to have less in weight.

2) Second category includes those babies who have intrauterine

growth retardation. These Babies are undernourished ( or small )
for a given gestation ( dates ) So they are also called Small for
Gestational Age ( SGA ) or Small for Dates ( SFD ) babies.
A ) Small for date babies ( small for gestational age, light for dates,
intrauterine growth retardation)

 DEFINITION : A baby whose birth weight falls below

10th percentile ( < 10 percentile ) for the period of gestation.
• TYPES ( Classification ) of small for date babies : There are three major types –

a) MALNOURISHED : These babies appears long, thin and alert , skin loosing its
normal elasticity, excess skin folds over the buttocks and thighs, difference in
head and chest circumference is more than 3cm. Internal organ with the
exception of brain commonest variety of small for date babies.
b) HYPOPLASTIC BABIES : These babies are small in all parameters including the
head size. Cell number is reduced, post natal physical and mental growth is
• C ) MIXED TYPE BABIES :- These babies have above both type of physical
characteristics . IN these babies there is reduction in cell number and in the cell size
both.
ETIOLOGY FOR SMALL FOR DATE / LBW BABIES :
• Maternal history
• Maternal malnutrition
• Intra uterine infection
• Placental dysfunction
• Twin pregnancy
• Maternal diseases
• Genetic / chromosomal disorders
• Miscellaneous causes
 CLINICAL MANIFESTATION :

low birth weight baby looks much smaller than normal

birth weight baby. the baby appears marasmic , thin
skin and skin losing its elasticity . hanging folds over
the buttocks and thigh . low birth weight baby’s head
may appear bigger than the body. body fat is very
little.
DIAGNOSIS :
Diagnosis can be confirmed by the close observation of the baby .Observe the
weight and compared with gestation age. Estimate the fetal head and body size
and compare it. Observe the clinical features.
RISKS / PROBLEMS among small for Date Babies:
- Aspiration of meconium, amniotic fluid.
- Asphyxia as a result of cerebral anoxia
- Fetal hypoxia
- Pulmonary haemorrhage
- Congenital malformations
- Poor temperature regulations
- Hyperbilirubinemia
- Difficulty in feeding and weight gaining
 MANAGEMENT OF LBW / SFD BABIES

• - Provide resuscitation to baby with aspiration

• - Provide early feeding which prevents the hypoglycemia and leads rapid weight
gain
• - Prophylaxis against intraventricular hemorrhage
• - Provide ventilatory support , and indomethacin at 6 to 12 hours.
• - Provide vitamin E , maternal administration of Vitamin K
• - Steroids and IV immunoglobulin or fetal platelet transfusion may also be
carried out.
 PREVENTION OF LBW / SFD BABIES -:

•1- Female literacy and formal education

•2- Maternal health status
•3- Antenatal care
•4- Maternal infections