LOW BIRTH WEIGHT BABY
INTRODUCTION
Identification
of high risk neonate is very important
responsibility of nursing personal at delivery room.
Between 6 and
7% of all babies born in the United
Kingdom
DEFINITION
World Health
Organization has defined low birth
weight “as one whose birth weight is less than 2500 gm irrespective of the
gestational age”.
Very low
birth weight infants weight 1500 gm or less and extremely low birth weight
infants weight 1000 gm or less
CLASSIFICATION
Low
Birth Weight Babies are again classified after co-relating both the birth
weight and gestational age into two groups:
Preterm:
The growth
potential is normal and appropriate for gestational period (10 to 90th
percentile)
Small
for Gestational Age (SGA):
The term is
to designate the new born with birth weight less than the 10th
percetile or less than two standard deviation for their gestational age. A
fetus of SGA may be constitutionally small or due to a pathologic process (Feta
Growth Restriction)
INCIDENCE
·
The incidence of low birth weight is generally
highest in those countries where the mean birth weight is low and as such
varies from about 5% to 4% of live birth
·
In India, about a third of the infants weight
less than 2500 gm
·
The factors influencing the low birth of baby,
a part from the short gestational period are
o
Socio-economic status
o
Nutritional and intrauterine environment
o
Ethinic background and genetic control are
also important
·
Thus, it is logical to correlate birth weight
and gestational age with risks of neonatal morbidity and mortality of the
individual countries or population groups.
PRETERM
BABY
Definition
“A baby born
before 37 completed weeks of gestation calculating from first day of last
menstrual period is arbitrarily denied as preterm baby”.
Incidence
·
Preterm baby constitutes two-thirds of two
births babies
·
The incidence of low birth weight baby is
about 30-40% in the developing countries
·
As such the incidence of preterm baby is about
20-25%
·
In affluent societies and in the developed
countries, the incidence of the former is less than 10%
Etiology
·
Idiopathic
·
Preveous history
·
Smoking
·
Maternal, fetal, placental complications
·
Low socioeconomy
Manifestations
of Prematurity
·
The weight is 2500 gm or less and length is
usually less than 44cm
·
The head and abdomen are relatively large
·
The skull bones are soft with wide sutures and
posterior fontanelle
·
The head circumference disproportionally
exceeds that of the chest
·
Pinnae of cars are soft and flat
·
The eyes kept closed
·
The skin is thin, red and shiny
·
Muscle tone is poor
·
Plantar creases are not visible before 34
weeks
·
Nails are not grown right upto the finger tips
Complications
·
Asphyxia
·
Hypothermia
·
Pulmonary syndrome
·
Cerebral haemorrhage
·
Fetal shock
·
Heart failure
·
Oliguria, anuria
·
Infections
·
Jaundice
·
Dehydration and acidamia
·
Anaemia
·
Retinopathy of prematurity
·
The pulmonary syndrome includes
o
Pulmonary oedema
o
Intra-alveolar haemorrhage
o
Indiopathic respiratory distruss syndrome
Management
·
Immediate management following birth
o
The cord is to be clamped quickly
o
The air passage should be cleared of mucus
o
Adequate oxygenation
o
The baby should be wrapped including head in a
sterile warm towel
o
Aqueous solution of vitamin k 1mg is to be
injected intramuscularly
·
Other management
o
To maintain body temperature
o
The smaller babies are best placed in the
incubator
o
Respiratory support
o
Infection
§
Main sites of infection are respiratory tract,
gastro-intestinal tract, skin and umbilicus
§
Every precaution should be taken to prevent or
minimize infection
o
Provide adequate nutrition
o
Early feeding between 1-2 hours of birth
Method
of Feeding of a Preterm Baby
·
Tube or Gavage
·
Pipette, dropper, katori and spoon
·
Bottle
·
Intravenous fluid therapy
Tube
or Gavage
A fine
polythene tube of about 0.5 mm internal diameter is used.
It should be
passed through the nose down to oesophagus expressed breast milk is started
with a small volume and gradually build up. It may be safely continued for
about 7 days calculated amount of fluid is injected with a syringe either by
gravitation or by pressure.
Pipette,
Dropper, Katori and Spoon
This is used
where the baby can swallow but fails to suck.
Bottle
It is used
when baby can sudt and swallow but cannot manage to express the milk out from
the breast.
Intravenous
Fluid Therapy
Neonate
within the incubator or under radiant heaters have increased fluid requirement
to counter balance the increase in sensible water loss.
Fluid
Requirement
Fluid
requirement varies from 60-80 ml/kg/day of 10% dextrose water on first day and
increase by 15ml/kg/day. Amount should be more, if photo therapy is used.
Monitoring of fluid is done by measuring body weight, urine output, its
specific gravity and serum sodium.
Caloric
Requirement
·
The calorie intake of 60 calories per kg per
day on 7th day is be stepped up gradually to 100 on 14th
day about 120-150 on 21st day
·
To meet the calories requirement, the amount
of milk to be given is slowly but progressively increased until the baby is
receiving 200ml per kg body weight per day
Prevention
·
Avoidance of continuous O2
therapy specially in premature neonates
in concentration beyond 40%
·
To keep the arterial PO2 pressure
of the blood the critical level of 160mm Hg normal PO2 level is
about 100mm Hg
Nurses
Role
·
The most important single factor is high
standard of nursing and one trained nurse can adequately take care of two or
three infants
o
The temperature should be taken twice daily
and the baby should be weighed daily to know whether over or un dehydrated
o
Constant supervision specially during the
crucial first 48 hours is imperative
o
Mother should be allowed to her baby in the
nursery
o
Mother is thought for the general care of baby
and manual expression of breast milk by pressing over the areola and nipple
·
Intelligent observation, prompt recognition of
the abnormality and adequate measure to rectify the detect can be saving in
many an occasion.
SMALL
FORGESTATIONAL AGE/IUGR
·
In past, the term IUGR and SGA were used inter
changeably. Although related they are not synomymous
·
IUGR is a failure of normal growth caused by
multiple diverse effect on the fetus whereas SGA describes a baby whose weight
is lower than population norms
·
SGA babies are defined as having a birth
weight below the 10th centile for gestional age or <2 standard
deviations below the mean (the 50th centile) for the gestational age
·
Thus all IUGR babies may not be SGA and al SGA
babies may not be small as result of growth restriction
Incidence
·
Dysmaturity
comprises about one third of low birth weight babies
·
In developed countries, its overall incidence
is about 2-8%
·
The incidence among the term babies is about
5% and among the post term babies is about 15%
Etiology
·
Maternal Factor
o
Pregnancy induced hypertension, pre-eclampsia
o
Chronic hypertension
o
Diabetes mellitus
o
Under-nutrition
o
Smoking, alcohol misuse
o
Drugs – the rapeutic and addictive
o
Irradiation
o
Young and elderly mothers
o
Poor obstetric history
o
Underweight mother
·
Fetal Factors
o
Multiple gestation
o
Chromosomal/genetic abnormality including in
born errors of metabolism dw art syndrome
·
Placental Factor
o
Abuptioplacenta
o
Placental praevia
o
Chriomnionities
o
Abnormal cord insertion
Types
Symmetrical
Asymmetrical
·
Symmetrical (20 percent)
o
The fetus is affected from the noxius effect
very early in the phase of cellular hyperplasia
o
The total cell member is less
o
This form of growth retardation is most often
caused by structural or chromosomal abnormalities or congential infection
o
The pathologic process is intrinsic to the
fetus and involves all the organs including head
·
Asymmetrical (80 percent)
o
The fetus is affected in later months during
the phase of cellular hypertrophy
o
The total cell number remains the same but
size is smaller than normal
o
The pathogenic process that too often result
in asymmetric growth retardation are maternal diseases extrinsic to the fetus
Complications
·
Asphyxia and RDS
·
Hypoglycaemia
·
Meconium aspiration syndrome
·
Hypothermia
·
Pulmonary haemorrhage
·
Polycyhaemia
·
Hyperviscosity syndrome
·
Necrotizing entrocolitis
BENEFITS AND LIMITATIONS OF CARING FOR HEALTHY LOW BIRTH
WEIGHT BABIES ON POSTNATAL WORDS
·
Benefits of Mother
o
No separation of mother and baby
o
No need mother to visit NICU
o
Effective communication and understanding
o
More practice at mother skills
o
More opportunity for support form peer on ward
·
Limitation
o
The mother may not have any choice but to
return soon after birth
o
The mother may feel ambivalence towards the
birth event and her baby
o
The mother may feel that the NICU is best
place for her baby
o
The mother may be ill and not able to care for
her baby
CONCLUSION
Low birth
weight babies are more vulnerable to illness compared with appropriately grown
term babies and extra monitoring may be necessary caring for healthy LBW babies
on a postnatal ward is though to be advantageous because it removes them from
greater hard of infection that occurs in neonatal units prevents separation of
mother and baby.
BIBLIOGRAPHY
·
Myles Text Book of Midwifery
14th Edition
Page No.781-781
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