LOW BIRTH WEIGHT AND PRETERM INFANT

Definitions

  • Low birth weight: Weight less than 2,500g at birth.
  • Very low birth weight: Weight below 1,500g at birth.
  • Extremely low birth weight: Weight below 1,000g at birth.
  • Preterm: An infant who has not finished 37 weeks of intrauterine life at birth.

Problems Associated with Prematurity

  • Poor thermal regulation, hypothermia
  • Respiratory problems: RDS, apnoeic attacks, aspiration
  • Feeding problems leading to hypoglycaemia
  • Infections
  • Hyperbilirubinaemia
  • Anaemia of prematurity
  • Congenital malformations

General Management

  • Babies with weight 2,000–2,499g can be cared for as normal weight babies. Some of them may have feeding difficulties. Observe for a day or two before discharging from maternity ward.
  • Babies of weight 1,750–1,999g need extra care. Kangaroo Mother care will provide enough warmth unless the baby has another problem. They should be able to breastfeed adequately, but some may tire quickly and may need tube or
    cup feeding.
  • Babies with weight below 1,750g are at increased risk of respiratory distress, infection, apnoea, and hypothermia, and are usually not able to feed especially if very low birth weight. They need to be admitted to a specialized area that will
    cater for their needs. For these babies treat any intercurrent problem and when they stabilize, start Kangaroo Mother care.

Thermal environment

  • Keep baby dry and well wrapped and nurse away from open windows
  • Avoid unnecessary exposure
  • Keep the room warm (at least 25oC)
  • Kangaroo Mother care
  • Incubators

Note:

Incubators are extremely expensive and thus not always available but useful for care of very sick babies needing oxygen and IV fluids. Kangaroo Mother care (KMC) is cheap and easy to carry out in many facilities. Use KMC when you have a stable LBW baby irrespective of weight

Kangaroo Mother Care (KMC)

KMC consists of:

  • Kangaroo position – Skin to skin contact between mother’s breasts or those of any other adult female.
  • Breastfeeding.
  • Follow up to ensure adequate growth and development.

Procedure for KMC

  • Mother wears a dress that opens at the front.
  • Baby wears nappy/diaper, cap, and socks.
  • Let the mother sit comfortably on a chair.
  • Mother opens the dress .
  • Place the naked baby in frog like posture on mother’s chest between her breasts.
  • Secure baby firmly but not too tight with a cloth round mother and baby.
  • Breastfeed frequently. Top up with cup if baby is not able to suck adequately.
  • Mother in recliner position during rest and sleep.
  • Monitor growth at least 3 times per week.

Fluid and Feed Management

  • Encourage mother to breastfeed frequently if baby is able. Check positioning and attachment.
  • Ensure adequate intake by calculating the requirement per day.
  • Record all intake (oral and IV) and check every 6 hrs to see if the desired intake is achieved.
  • Feeding should be done within the first hour of birth to avoid hypoglycaemia.
  • Introduce feeds as soon as possible; preferably no later than 24 hours after birth. Begin with 3ml for infants <1,500g and 6ml for those >1,500g. Increase by the same volume until the required volume for the day is reached. For
    infants on IV fluids, reduce gradually so that the total intake per day does not exceed daily requirements.
  • Calculation of feeds/fluids: Start with 60ml/kg/day on day 1. Increase by 20– 30ml per day to a maximum of 180–200ml/kg/day if using breast milk. For formula or IV fluid do not exceed 180ml/kg. Refer to Table 26.2 for amounts.
  • Give micronutrients:
    • Multivitamins a preparation containing 400IU of vitamin D as soon as enteral feeding is established.
    • Iron supplement 6mg/kg/day after age of 4 weeks.
  • Monitor weight at least 3 times a week. Weight gain after the first week is 15g/kg/day.