Management of Low Birth Weight Baby

Low Birth Weight Baby:

Low birth weight has been defined by WHO as weight at birth of <2500 grams (5.5 pounds). Low birth weight is caused by intrauterine growth restriction, prematurity or both. It contributes to a range of poor health outcomes; for example, it is closely associated with fetal and neonatal mortality and morbidity, inhibited growth and cognitive development, and NCDs later in life. Low birth weight infants are about 20 times more likely to die than heavier infants.

Management of Low Birth Weight Baby:

As a midwife I will manage a case of low birth weight baby by the below ways:

• Attended by a senior pediatrician’ Air passage cleared of mucus Delayed clamping of cord helps in improving iron store but lead to hypervolemia and hyperbilirubinemia. So, clamp the cord quickly’ Promptly dry, keep effectively covered and warm’ Vit K 0.5mg IM.
• Vital signs monitoring, activity and behavior, color: pink, pale grey blue, yellow, Tissue perfusion: – pink color, capillary refill over upper chest <2sec, warm and pink extremities, normal BP, urine output >1.5 ml/kg/hr, absence of metabolic acidosis, lack of disparity between PaO2 and SPO2.
• Monitor ABG and electrolyte Tolerance of feeds: vomiting, gastric residuals and abdominal girth’ Look for development of apnic attack, sepsis weight gain velocity.
• Create soft comfortable nestled and cushioned bed Avoid excessive light, sound, rough handling and painful procedures. Use effective sedation and analgesia for procedures, Provide warmth and ensure asepsis, Prevent evaporative skin losses by effectively covering the baby, application of oil or liquid paraffin.
• Provide effective and safe oxygenation Provide parenteral nutrition partially and give trophic feeds with EBM’ Provide tactile and kinesthetic stimulation- skin to skin contact, interaction, music caressing and cuddling.
• Most love to lie in a prone position, cry less and feels more comfortable Relieves abdominal discomfort by passage of flatus and reduce risk of aspiration.

You can read: How to Identify High Risk Newborn | Newborn Danger Signs

• Increase ventilation, and increase dynamic lung compliance and enhances arterial oxygenation, unsupervised prone positioning beyond neonatal period recognized as a risk factor for SIDS.
• Prewarmed open care system or incubator should be available care in a thermo neutral environment with a servo sensor geared to maintain skin temperature of mid epigastric region at 36.5c. Application of oil or liquid paraffin reduces convective heat loss and evaporative water loss.
• Extremely low babies covered with a cellophane or thin transparent plastic sheet to prevent convective and evaporative losses from skin’ As soon as condition stabilizes effectively clothe the baby Partial kangaroo care to prevent hypothermia.
• Oxygen should be administered with a head box when saturation is less than 85% and withdrawn gradually when > 90%.
• Jaundice is common due to immaturity, hypoxia, hypoglycemia, infections and hypothermia. Due to immaturity of blood brain barrier, hypoproteinemia and perinatal distress factors bilirubin brain damage may occur at relatively lower level’ Initiate phototherapy early.
• Handling should be reduced to minimum’ Vigilance maintained on all procedures.
• Babies with weight <1200gm or gestational age <30 weeks and sick baby should be started on IV dextrose solution W>1000gm :- 10% dextrose Wt<1000gm :- 5% dextrose’ Trophic feeds with EBM (1-2 ml 4 times a day) through Ng tube can be started in all babies irrespective of birth weight
• When stabilized enteral feeds are begun with EBM starting with a volume of 30 ml/kg/day on day1 ‘ Depending on tolerance feeds increased by 10-20 ml/kg/day every day and IVF are reduced.
• When baby is stable, EBM can be fortified with human milk fortifier (HMF) for additional calories and protein. Multivitamin drops containing folic acid started at 2 weeks of age’ Iron supplements after 2-3 weeks’ Vitamin E which prevents powerful antioxidant and prevent hemolytic anemia and edema.
• Gentle touch, massage, cuddling, stroking and flexing by the nurse or preferably by mother Soothing auditory stimuli can be given to preterm baby in the form of family voices or music’ Visual input provided with the help of colored objects, diffuse light and eye to eye contact.
• Antenatal administration of Betamethasone or dexamethasone if labor starts before 34 weeks In infants who did not receive antenatal steroids a single dose of dexamethasone 0.2 mg/kg iv at 4 hrs. of age is recommended in very LBW babies.
• Accurate weighing is a sensitive index of wellbeing ‘ Most LBW babies loss weight during lst 3 to 4 days of life up to 10 to 15% of birth weight The weight remains stationary for next 4 to 5 days then starts to gain at a rate of 1.0 to 1.5 % of body weight per day and regain birth weight by the end of 2nd week.
• The dose is not reduced in preterm babies. Administer 0-day vaccines on the day of discharge.
• The frightened seen of NICU should be demystified’ Family should be constantly informed and involved in care of baby.
• Mother should be encouraged to touch and talk with her baby and provide routine care under guidance of nurses’ Assist to provide kangaroo care.