low birth weight

1. Postnatal care of the baby
Dr Utpal Sharma
Assistant Professor
Dept Of Community Medicine
Sikkim Manipal Institute of Medical
Sciences

2. Introduction
 Infants (0-1year) constitutes about 2.92% of total population of
India
 Of 136 million births every year 90% are in third world.
 About 20-30% of the thee babies are underweight
 About 40% of total infant mortality occurs in the 1st
month of the life
 During weaning period about 25% children doesn’t receive quality
nutrition…
….making them susceptible to impaired health conditions
later in life
 Many low cost measures like immunization, breast feeding etc.
are available to save these precious lives

3. Objectives of early
neonatal care
Establish and maintenance of cardio-respiratory
functions
Maintenance of body temperature
Avoidance of infection
Establishment of suitable feeding regimen
Early detection and treatment of congenital and
acquired disorders

4. Immediate care
Clearing the airway
The airway should be cleared of mucus and
other secretions
For newborns already subjected to hypoxia
resuscitation requires more active measures
If the heart is not beating for 5 min, probably
the baby dead

5. Apgar score
Taken at 1min and again at 5min after birth
Requires immediate and careful observation of
Heart rate
Respiration
Muscle tone
Reflex response
Colour of the infant
Each sign is given a score of 0,1or 2
Perfect score is 9-10, of a total score of 10
A score of 0-3 indicates baby is severly
depressed, 4-6 indicate moderate depression

6. Cont…
Score below demands prompt action
Low Apgar score at the end of 5 min is
associated with….
….high risk of complication and
…..death during neonatal period
Appearance
Pulse
Activity
Grimace
Respiration

7. Apgar score chart

8. Cont…
Care of cord
Cord should be cut only after cessation of pulsation
Stump should be kept dry with no application
Care of eyes
Should be cleaned before opening with sterile swabs
from inner to outer side
Any discharge from eyes is pathological
and demands immediate treatment
As a preventive measure maternal genital tract
infections should be treated beforehand

9. Cont….
Care of skin
 First bath/sponging may be delayed for 24 hrs after birth
 Thereafter no need of bathing till discharged
Maintenance of body temperature
 Normal body temperature of a newborn is 36.5º to 37.5º C
 Most of the heat loss occurs trough evaporation of amniotic
fluid from the body of the wet child
 About 75% of heat loss occurs from the head
 It is important to dry the baby quickly with a
clean cloth and wrapped in warm clothing

10. A naked newborn exposed to an
environmental temperature of 230
C
suffers the same heat loss as a naked
adult in 0 0
C
Do you know…..?????

11. Cont….
Breast feeding
 Initiated within 1/2 hour in case of a vaginal delivery
and within 4-6 hours in case of a C/S. (IYCF)
 First milk called “colostrum” should be given to the
baby
 Exclusive breast feeding should be practiced for six
months
 Baby should be breastfed ON DEMAND i.e. whenever
the baby cries for feeds.
 Time interval between each feed is about 2 to 3 hours.
 Frequency of feeds should be at least 8-10 times in 24
hours and compulsory night feeds

12. Warm chain
At delivery:
 Ensure the delivery room is warm (25° C), with no draughts.
 Dry the baby immediately; remove the wet cloth.
 Wrap the baby with clean dry cloth.
 Keep the baby close to the mother to stimulate early
breastfeeding.
 Postpone bathing/sponging for 24 hours.
After delivery:
 Keep the baby clothed and wrapped with the head covered.
 Minimize bathing especially in cool weather or for small
babies.
 Keep the baby close to the mother.
 Use kangaroo care for stable LBW babies and for re-warming
stable bigger babies

13. Low birth weight babies

14. Introduction
Birth weight is the single most important determinant
of chances of child survival, healthy growth and
development.
Low Birth Weight (LBW)babies are grouped as
Preterm (short gestation) and…
Small for Age/Date (SFA/D) term infants.
Countries with fewer incidence of LBW, preterm is
the cause
In countries like India, where the proportion of LBW
is high, majority of LBW is due to SFA.

15. Cont…
 By international agreement LBW is considered as
Low Birth Weight (LBW) :
 Any neonate weighing less than 2500 gm at birth
irrespective of gestational age.
Very Low Birth Weight baby (VLBW) :
 Any neonate weighing less than 1500 gm at birth
irrespective of gestational age.
Extremely Low Birth Weight baby (ELBW) :
 Any neonate weighing less than 1000 gm at birth
irrespective of gestational age.
…when measured preferably within one hour of life

16. Cont…
 Besides this babies are also classified according to the
gestational age
Pre-term Baby :
 Babies born before 37 completed weeks (<259 days) of
gestation irrespective of the birth weight.
Term baby :
 Babies born between 37 to 42 weeks of pregnancies
(259-294 days) irrespective of the birth weight.
Post-term baby
 Babies born at 42 completed week or thereafter (> 294
days of gestation)

17. Cont…
A LBW is any infant with birth weight <2.5 kg
irrespective of gestation and includes….
Extremely preterm (<28 weeks of gestation)
Very preterm (28-32 weeks of gestation)
Moderate to low preterm (32-37 weeks of gestation)
Even though born early their intrauterine growth
may be normal according to the gestation
Given good care, these babies catch up good
growth and by 2-3 years of age will be of normal
size and performance.

18. Scenario
 In 2010, an estimated 15 million babies were born
prematurely and about more than 1 million of these died
globally.
 Prematurity is now the leading cause of deaths amongst
under-5 year children…..
..…and single most important cause of death in the
first month of life.
 The survivors may face a lifetime with significant
disability

19. Causes of preterm birth
Preterm births are classified into two groups
Spontaneous preterm birth
Provider initiated preterm birth
Prematurity is an important risk factor for developing
NCDs (HTN, DM) in later life for these babies
This creates a intergenerational cycle of risk
So the link between prematurity and NCDs adds a
very important dimension in public health aspect…
…..when increasing trend of both are
observed worldwide

20. Types of preterm births and risk
factors involved
Spontaneous preterm births Provider initiated preterm
births
Age at pregnancy and
spacing
Multiple pregnancy
Infection
Underlying chronic medical
condition
Lifecycle/ work related
Psychological health
Genetic and other
Medical induction /
Cesarean section for maternal
or foetal indication
Other- Not medically
indicated

21. Small for date babies
May be born at term or preterm
Weighs less than 10th
percentile
for the gestational age
Results due to intrauterine growth retardation
These babies have high mortality rate not only in
neonatal period but during infancy as well
Hence inflate the perinatal and infant mortality rates
They are frequent victims of PEM and infections

22. Cont…
In developing nations 3 determining factors
are associated with adverse prenatal and
postnatal development of the child
Malnutrition
Infections
Unregulated pregnancy
LB
W

23. Factors associated with IUGR
Maternal factors Placental cause Foetal causes
Malnutrition
Severe anemia
Heavy physical work
during pregnancy
Hypertension
Malaria
Toxemia
Smoking
Low socio-economic
status
Short maternal stature
Very young age
High parity and close
spacing
Low educational
status
Placental insufficiency
Placental
abnormalities
Foetal abnormalities
Intrauterine infections
Chromosomal
abnormalities
Multiple gestation

24. Importance
 High incidence
 Association with mental retardation
 High risk of perinatal and infant mortality
 Human wastage and suffering
 Very high cost of special care
 Association with socioeconomic underdevelopment
 Infant mortality is 20 times higher in LBW babies
 Serves as an important guide for level of care to the children
 Indicates the malnutrition and ill health of the mother
 High percentage of LBW warrants need of improved care of
newborn

25. What Problems Do Low Birth
Weight Babies Have?
 Breathing problems at birth and later.
 Low body temperature because there is little fat on the body
and the newborn’s temperature regulating system is immature.
 Low blood sugar because there is very little stored energy.
 Feeding problems because of their small size, lack of energy,
small stomach and inability to suck.
 Infections because the infection fighting system is not mature.
 Jaundice (high bilirubin) because the liver is not mature.
 Bleeding problems due to immature clotting ability at birth.

26. Other clinical Problems
related to prematurity
Apnea
IVH
RDS/HMD
NEC
Oxygen toxicity

27. Prevention
Despite of all efforts rate of LBW can’t be
lowered more than 10% around the world.
This is due to multiplicity of causes
Intervention have to be cause specific
Attention must be given to good prenatal care
and intervention programme…….
…..rather than “treatment” of
the LBW babies born later

28. Direct Interventions
 Identifying “at risk” pregnant ladies by using mother health
card….
…..primarily by the grass root level health care
workers
 A small increase in food intake, even in the last trimester
results in considerable improvement in weight of the infant
 Other interventions consists of supplementary nutrition, IFA
tablets, food fortification etc.
 Infections affecting foetal growth should be detected and
treated early
 Other medical disorders like HTN, toxemias and diabetes
should be detected and treated early

29. Indirect interventions
 Family planning
 Avoidance of excessive smoking
 Improved sanitation measures
 Measures to improve health and nutrition of young girls
 In addition improved socioeconomic and environmental
conditions with distribution of health and social
services…..
….. guarantees long lasting effect
 Government support in form of maternity leave and child
benefits.

30. Treatment
For treating LBW babies, the are classified
into 2 groups
Those under 2 kgs
Requires first class modern neonatal care in
intensive care unit until gains weight >2.5 kg
Those between 2-2.5 kgs
Needs intensive care unit for a day or two

31. Cont….
Intensive care includes
 Incubatory care comprising adjustment of
temperature, humidity and oxygen supply
 Feeding of baby with breast milk if possible by
nasal catheter.
 Prevention of infections
Leading causes of death in LBW babies
Atelectesis
Malformation
Pulmonary haemorrhage
Intracranial haemorrhage, secondary to trauma or
anoxia
Pneumonia and other infections

32. Kangaroo mother
care(KMC)
Introduced first in Colombia in 1979
by Dr. Hector Martinez and Dr Edzar Rey
Intervention to combat high infection and
mortality rate owing to overcrowding in
hospitals.
Now adopted across the developing world and
considered as essential element in continuum in
neonatal care

33. Cont…
 Four components of KMC are
 Skin to skin positioning of baby on mother’s
chest
 Adequate nutrition through breast-feeding
 Ambulatory care as a result of earlier discharge from
hospital
 Support for the mother and her family in caring for the
baby
 For improved management of newborn in facilities,
newer initiatives has been designed
 Newborn care corner
 Newborn stabilizing unit
 Special newborn care unit

34. Thank you
for listening
to my story