low birth weight
TRANSCRIPT
Postnatal care of the babyDr Utpal Sharma
Assistant ProfessorDept Of Community Medicine
Sikkim Manipal Institute of Medical Sciences
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
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
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
Apgar scoreTaken at 1min and again at 5min after birth
Requires immediate and careful observation ofHeart rate Respiration Muscle tone Reflex response Colour of the infant
Each sign is given a score of 0,1or 2Perfect 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
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
Cont…
Care of cordCord should be cut only after cessation of pulsation
Stump should be kept dry with no application
Care of eyesShould 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
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
A naked newborn exposed to an environmental temperature of 230C
suffers the same heat loss as a naked adult in 0 0 C
Do you know…..?????
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
Warm chainAt 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
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.
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
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)
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.
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
Causes of preterm birthPreterm births are classified into two groups
Spontaneous preterm birthProvider 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
Types of preterm births and risk factors involved
Spontaneous preterm births Provider initiated preterm births
Age at pregnancy and spacingMultiple pregnancyInfectionUnderlying chronic medical conditionLifecycle/ work relatedPsychological healthGenetic and other
Medical induction / Cesarean section for maternal or foetal indication
Other- Not medically indicated
Small for date babiesMay 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
Cont…
In developing nations 3 determining factors are associated with adverse prenatal and postnatal development of the childMalnutrition Infections Unregulated pregnancy
LBW
Factors associated with IUGRMaternal factors Placental cause Foetal causesMalnutrition Severe anemiaHeavy physical work during pregnancyHypertensionMalaria Toxemia SmokingLow socio-economic statusShort maternal statureVery young ageHigh parity and close spacingLow educational status
Placental insufficiencyPlacental abnormalities
Foetal abnormalitiesIntrauterine infections Chromosomal abnormalities Multiple gestation
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
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.
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
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
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.
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 kgsNeeds intensive care unit for a day or two
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 babiesAtelectesisMalformationPulmonary haemorrhage Intracranial haemorrhage, secondary to trauma or
anoxiaPneumonia and other infections
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
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