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MANAGEMENT OF LOW BIRTH WEIGHT BABY

FOR OPTIMAL GROWTH AND DEVELOPMENT

M. Sholeh Kosim Perinatology Sub Division

Pediatrics Department Medical Faculty Diponegoro

University- Dr. Kariadi Hospital Semarang

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Introduction • Premature birth and low birth weight

(LBW) still a health problems in newborn

• Morbidity and mortality still high accordingly to the complication

• Medical and technology development leads to increasing the survival at high risk of LBW for long term neurocognitive deficits .

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Introduction (2)

• The normal birth weight of is > 2500 to 3000 gm. • Low birth weight or LBW :

birth weight of less than 2500 gm regardless to gestational age

• Incidence : 15 – 30 % • Neonatal deaths : 75 % due to LBW • Infant deaths : 50 % caused by LBW • Complication :

– Prone to malnutrition – Recurrent infection – Neurodevelopmental handicaps

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LBW: Indications for hospitalization

Birth weight <1800 g Gestation <34 wks Unable to feed* Sick neonate* Irrespective of birth weight

and gestation

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Danger signals (Early detection and referral)

Lethargy, refusal to feed Hypothermia Tachypnea, grunt, gasping, apnea Seizures, vacant stare Abdominal distension Bleeding, icterus over palms/soles

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Management of Newborn Illness

• Education of mothers to recognize danger signals

• Working with families to develop complication plan for newborns

• Early recognition and appropriate management of newborn illness

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Minimum Preparation for any BirthThe following should be available and in

working order:• Heat source • Mucus extractor• Self-inflating bag of newborn size • 2 masks (for normal and small

newborns) • 1 clock• At least one person skilled in newborn

resuscitation present at birth

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Care of the Low Birth Weight Newborn

• Birth weight = Gestation duration + intrauterine growth– Most low birth weight newborns in

developing countries are term or near term (Small for gestation age)

– Increased risk of hypothermia and poor growth

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Delivery management

• LBW is prone to be asphyxiated • Management at birth accordingly

to Guidelines of Resuscitation (AHA/AAP)

• Consider : – Early intubation – Early CPAP – Prevent hypothermia– Prevent hyperoxia

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LBW OPTIMAL G & D

Proper management

Genetic Nutrition

Immunization

Psycho social

Stimulation

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OXYGEN DANGER

• ↑ free radial and contribute the incidence of :– Chronic lung disease– retinopathy of prematurity– NEC– periventricular leukomalacia– Effect to growth and development

• Defense to free radial just developped in third semester premarure baby prone to be

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Principles of Management for Low Birth Weight and Preterm Newborns

• Warmth• Feeding• Detection and management of

complications (e.g., resuscitation, assisted respiration, infection )

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Warmth

As for all newborns:• Lay newborn on mother’s abdomen or

other warm surface• Dry newborn with clean (warm) cloth

or towel• Remove wet towel and wrap/cover

with a second dry towel• Bathe after temperature is stable

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Definition of Kangaroo Mother Care

• Early, prolonged and continuous skin-to-skin contact between a mother and her newborn

• Could be in hospital or after early discharge

25Kangaroo Mother Care

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How to Use Kangaroo Mother Care• Newborn’s position:

– Held upright (or diagonally) and prone against skin of mother, between her breasts

– Head is on its side under mother’s chin, and head, neck and trunk are well extended to avoid obstruction to airways

• Newborn’s clothing:– Usually naked except for nappy and cap– May be dressed in light clothing– Mother covers newborn with her own

clothes and added blanket or shawl

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• Newborn should be:– Breastfed on demand– Supervised closely and temperature

monitored regularly• Mother needs lots of support because

kangaroo care:– Is very tiring for her– Restricts her freedom– Requires commitment to continue

How to Use Kangaroo Mother Care (2)

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Effectiveness of Kangaroo Mother Care

• Randomized controlled trial• Conducted in three tertiary and teaching

hospitals in Ethiopia, Indonesia and Mexico• Study effectiveness, feasibility, acceptability

and cost of kangaroo mother care when compared to conventional methods of care

Cattaneo et al 1998.

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Benefits of Kangaroo Mother Care (1)• Is efficient way of keeping newborn warm• Helps breathing of newborn to be more

regular; reduce frequency of apneic spells• Promotes breastfeeding, growth and extra-

uterine adaptation• Increases the mother’s confidence, ability

and involvement in the care of her small newborn

• Seems to be acceptable in different cultures and environments

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• Contributes to containment of cost— salaries, running costs (electricity, etc.) Increases the mother’s confidence, ability and involvement in the care of her small newborn

• Seems to be acceptable in different cultures and environments

• Contributes to containment of cost— salaries, running costs (electricity, etc.)

deLeeuw et al 1991; Karlsson 1996; Lamb 1983; Ludington-Hoe et al 1993; Ross 1980.

Benefits of Kangaroo Mother Care (2)

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Feeding

• Early and exclusive breastfeeding– Breastmilk = best nourishment– Already warm temperature– Facilitated by kangaroo care

• If Breast milk is not availble, consider milk formula : Preterm formula --- until 2000 gm then change to After Discharged Formula

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START ANTIBIOTIC ADMINISTRATION EVEN WITHOUTH ANY SYMPTOMS

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LBW: Supplements

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RESPIRATORY DISTRESS PROBLEM

• Usually due to Hyaline Membrane Disease ( HMD ) • Assess : Antenatal steroids ???

• Surfactant • CPAP : BUBBLE CPAP

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INFECTION :

• ANTIBIOTICS • SUPPORTING TREATMENT :

• NUTRITION • OXYGENATION • WARMTH

• IMMUNOTHERAPY ; IF IT IS NEEDED

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HYPERBILIRUBINEMIA

• Accordingly to Level of Serum Total Bilirubin

• Foto therapy • Feeding : Breast milk • Fluid therapy • Antibiotics according to condition of infection

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RETINOPATHY OF PREMATURITY

• Worse complication is blindness • Due to : prematurity and toxic oxygen• Awarness to : baby with Ventilator and

high flow/consentration of O2 • Opthalmologic examination :

• < 32 weeks of gestation • < 1500 grams • Done : 1 months of age

• Lasik surgery

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APNEIC SPELL : APNEA OF PREMATURITY

• Very often : < 1500 grams • Complication : Hypoxemia Oxygenation and breathing stimulation :

Aminophylline or Theophylline Mechanical Ventilator

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HYPOGLYCAEMIA

• Awarness of symptoms , sometime asymptomatic • Blood Glucose level • Hypoglycemia : < 45 mg/dL • Dextrose infusion • Glucose Infusion Rate ( G I R )

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INTRAVENTRICULAR HEMORRHAGE

• Due to weakness of blood brain barrier and hypoxemia • Decreasing of consicousness , deficit

neurologics, seizure • USG or CT scan • Consult to Pediatric Neurology Division

and Neurosurgery

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METABOLIC ACIDOSIS

• Due to hypothermia, hypoxemia and infection

• Confirmed by clinically and laboratory• Shoulde corrected by considering

anion gap • Administration of bicarbonate : awarness of false route

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SUMMARY • Premature birth and low birth weight (LBW) still a health

problem with high Morbidity and mortality • The survival at high risk of LBW for long term

neurocognitive deficits • Two types of LBW : premature and IUGR • Problems accordingly to the type • Management consist of : warmth, feeding, management

of complication• Breast feeding is prioritized, in case of breastmilk is not

available, consider milk formula

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THANK YOU