Low Birth Weight

Low birth weight is defined by the world health organization as birth weight of Live born
infant of 2499 gm or less, regardless of gestational age

Birth weight Grade

2500-2000 gm Low birth weight
2000-1000 gm Very low birth weight
<1ooo gm Extremely low birth weight

Type of low Birth Weight

Low birth weight are of two clinical types:

 Preterm babies born before 37 weeks of gestation

 Small for date/small for gestational age(babies having intra uterine growth retardation)

Incidence
 Globally more than 20 million infants born each year weight less than 2.5 kg accounting
for 17% of all births in developing world
 South Asian has highest incidence with 31% of all infants with low birth weight
 India has about 40 % of all infants with low birth weight babies in developing country
 In Nepal it is an important leading cause of neonatal death
 Prevalence low birth weight in Nepal is 27 %
 About 70% LBW babies are IUGR and 30% Preterm.

Causes
1. Mother related factors

• Very young mother

• Poor maternal health

• Excessive physical activity without rest

• Alcoholic and smoking

• Low maternal weight

• Low space between two pregnencies

2. Pregnancy and labor related factor

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  Previous low birth babies
 Smoking use of alcohol during pregnancy
 Severe anemia
 Pre term labor
 Early rupture of membrane
 Infections in mother during pregnancy
 Pre eclampsia
 Eclampsia
 hypertension

3. Fetus related factor

 Multiple gestation
 Infection in fetus
 Placenta related factors
 Infected placenta
 Premature separation of placenta

4. Socioeconomic factors

 low maternal education

 Low economic status

Low Birth weight: problem

 Birth asphyxia
 Hypoglycemia
 Hypothermia
 Feeding difficulties
 Infections
 Respiratory distress

Management
Maintain warmth

 After birth the baby is admitted to a high risk nursery or well equipped pediatric unit
 Covering with warm clothes
 Room should be warm
 Place under the warmer or incubator
 Keep baby`s head cover
 Skin to skin contact(kangaroo mother care0

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Maintain effective breathing

 Administer oxygen as needed

 Do stimulation resuscitation if required
o Infection prevention
 Follow strict and hand washing practice
 Isolation of infected baby
 Early detection and prompt treatment of infection
 Aseptic technique and avoid sick person away

Physical and emotional support

 Prompt kangaroo mother care

 Involve family in baby care
 Support the family
 Encourage bonding of infant and mother

Feeding and nutrition

 Initiate breast feeding soon after if there is no any difficulty in breast feeding
 Encourage exclusive breast feeding
 If baby can tolerate enteral feed this usual amount given in 1 day is 60-80 ml/kg
 Increased every day by 15 ml to reach a volume of 180-200/kg/day by 7th to 10th day
 Iv therapy if baby not able to suck breast milk
 Inj. NS Start with 70-80ml/kg on day 1 and gradually to 150 ml/kg/day
 Daily weight, urine output and serum urea , nitrogen, sodium level should be monitor
carefully to determine water balance and body fluids

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 Guidelines for modes of feeding
LBW babies
Age Categories of neonates
Birth weight <30 weeks 30-34 weeks >34 weeks
<1200gm 1200-1800 >1800 gm
gm
Initial Iv fluids and Gavage feed Breast feed
gavage feeds katori and
spoon feed
After 1-3 Gavage feed Katori spoon Breast feed
days feed
2-4 weeks Katori spoon Breast feed Breast feed
feed
4-6 weeks Breast feed Breast feed Breast feed

Nursing Management

Assessment
 Respiratory status
 Body temperature
 Breast feeding
 Infant condition
 Pain and discomfort
 Possibility of infection

Nursing Diagnosis

 Ineffective breathing pattern related to prematurity of respiratory system

 Altered thermoregulation related to immature temperature regulation center and
mechanism
 Imbalance nutrition related to unable suck or inadequate intake
 Risk for infection related to poor immunity
 Delayed growth and development related to preterm birth and its consequences

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  Pain related to various diagnostic and therapeutic procedure
 Altered family process and parent baby attachment

Implementation

1. Ineffective breathing pattern related to prematurity of respiratory system

 Place the baby in supine position with neck slightly extended(sniffing position) to prevent
narrowing airway
 Place baby in side lying position to prevent aspiration
 Observe the sign of respiratory problems such as cyanosis, grunting nasal flaring etc
 Do suction as per need
 Monitor oxygen saturation

2. Altered thermoregulation regulation related to immature temperature regulation center

and mechanism

 Cover baby in cloths properly, cover head with cap and initiate breast feeding
 Place the baby in warmer or incubator or skin to skin contact to maintain temperature
 Monitor body temperature and temperature of incubator if in used
 Maintain nutrition through IV as prescribed
 Encourage the mother to feed baby frequently

3. Imbalance nutrition related to unable to suck or inadequate intake

 Provide breast feeding if sucking is good

 Assess for tolerance of feeding
 Measure weight, observe skin condition
 Monitor intake and output strictly

4. Risk for infection related to poor immunity

 Hand washing before caring baby

 Follow sterile technique isolate the infant who have infection
 Assess sign of infection
 Visitor should be restricted
 Maintain cleanliness of unit
 Administer antibiotic as prescribed

5. Delayed growth and development related to preterm birth and its consequences

 Provide optimum nutrition

 Promote rest and comfort

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6. Pain related to various diagnostic and therapeutic procedure

 Assess pain by facial expression

 Maintain comfort by changing diaper
 Keep the environment quite
 Altered family process and parent baby attachment
 Support parent and involve in care
 Answer questions of parents in simple language
 Provide teaching about care of baby at hospital and home

Respiratory distress syndrome

 It is also known as HYALINE MEMBRANE DISEASE
 Respiratory dysfunction in neonates primarily related to developmental delay in
maturation of lung or deficiency in surfactant synthesis.
 Surfactant production starts around 20 week of life and peak at 35 weeks
 Therefore any neonate <35 weeks is prone to develop RDS without surfactant infants are
unable to keep their lungs inflated and therefore exert a great deal of effort to expand the
alveoli with each breath

Incidence
 RDS common in preterm babies less than 34 weeks of gestation
 The overall incidence 10-15% but can high as 80% in neonate below 28 weeks of
gestation.

Causes
 Prematurity (more common)
 Maternal pre eclampsia
 Hypothermia
 Maternal anemia
 Asphyxia
 Meconium aspiration syndrome
 Delivery complication that reduce blood flow to the baby

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 Decreased
Decreased
pulmonary
surfactant
blood flow

Decreased Decreased
alveolar lung
ventilation compliance

Pathogenesis of RDS

Clinical features
The symptoms usually appear within minutes of birth although they may not be seen for
several hours. Symptoms may include:

 Cyanosis
 Apnea
 Grunting
 Rapid breathing
 Shortness of breath
 Chest indrawing
 Nasal flaring

Diagnosis
 History taking
 Gastric aspirate shake test is done to determine lung maturity
 Blood gas analysis
 Chest X ray

Management
 The baby should be placed in neonatal intensive care unit
 Monitoring baby`s conditions

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  Air passage cleared periodically through endo tracheal suction
 Maintain adequate ventilation and oxygenation by mask, hood and ventilators
 Minimal handing of baby
 Surfactant therapy: 100mg/kg body weight the route intra tracheal via ET tube
 NSAIDS such as indomethacin has been used for pharmacological closure of ductus
 IV antibiotic according to the result of culture

Nursing management
 Assess the sign of respiratory distress tachycardia, grunting , cyanosis
 Administer oxygen as per need
 Do en-do tracheal suctioning with strict aseptic techniques if baby ETT
 Infant should be position with head elevated to reduce the pressure on diaphragm
 Maintain temperature by placing baby in warmer or incubator
 Measure weight daily
 Proper recording and reporting of baby`s condition

Possible complications
Air gas may build up in

 The space surrounding the lungs(pneumothorax)

 The space between in the chest between two lungs (pneumo mediastinum)
 The area between the heart and the thin sac that surrounds the heart (pueumo
pericardium)

other complications

 Bleeding into the lungs

 Delayed mental development

References
 Uprety Kamala.Essential Of Child Health Nursing(1st Edition).Akshav Publication ,
Kathamandu

• Adhikari Tulshi . Essential Of Paediatric Nursing(2nd Edition). Vidyarthi Pustak

Bhandar. Bhotahity, Kathmandu

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