Low Birth Weight Baby

According to World Health Organization low birth weight is one whose birth weight is 2500gm or less irrespective of the gestational age.

Low birth weight are group into two category:

1.  Preterm:- The growth potential is normal and is appropriate for the gestational period.

2.  Small for gestational age:- the terms is to designate the newborn with birth weight less than 10th percentile or less than two standard deviation for their gestational age.

Preterm baby means a baby born before 37 completed weeks of gestation calculating from the first day of last menstrual period.

the weight is 2500gm or less and the length is usually less than 44cm.The head and abdomen are relatively large. The head circumference disproportionately exceeds that of the chest. The skin is thin, red and shiny, due  to lack of subcutaneous fat and covered by lanugo and vernix. The muscle tone is poor. The nails are not grown right upto the finger tips.


Care of preterm baby immediately after birth:

• To prevent pervolaemia and hyperbilirubinaemia  the cord is to be clampsed quickly.
   
• The cord length should be kept long in case exchange transfusion is required due to  hyperbilirubinaemia .
   
• The air passage should be cleared of mucus promptly and gently using mucus sucker. The stomach contents are also sucked out.
   
• Adequate oxygenation through mask or nasal catheter in concentration not exceeding 35% and interrupted therapy should be provided only when required.
   
• The baby should be wrapped in sterile towel and is laid on one side in the cot iwth the head slightly lowered.
   
• Aqueous solution of vitamin k1 mg is to be injected intramuscularly to prevent hemorrhagic manifestation.
   
• The baby should be handled with extreme gentleness all through. Bathing is not appropriate for a premature baby.
  
  
  For survival of babies ,because babies are functionally immature a special care is needed. Those requiring special care have inability to suckle the breast and to swallow and also incapacity to regulate the temperature within limited ranges from 96-99 F., inability to control the cardio-respiratory function without cyanotic attacks.
  
  Special care should be taken to maintain a relatively stable body temperature, adequate humidification to counter balance increased insensible water loss ,to prevent or to treat atelectasis, to prevent infection to maintain nutrition, adequate nursing care. It is not only to keep the environmental temperature and humidity as constant as possible, but a careful watch on the body temperature of the baby is mandatory.
  
  Smaller babies are best placed in the incubator where temperature and humidity can be better stabilized. The baby could be managed under radiant heater with protective plastic covers.

The most important things to protect baby from infection.

----- The visitors are to be restricted.

----- Nurses or doctors having any infection should not enter the nursery.

----- Each baby should have separate belonging.

----- The ward should be wet mopped daily using crude carbolic acid by sweeper using face masks.

----- The preparation, storage and administration of feeds should be maintained aseptically. The mother is advice to express the milk into a sterile container.

----- Any baby showing features suggestive of infection should be immediately isolated and treated.

Early feeding between 1-2 hours of birth is now widely recommended. It eliminates hypoglycemia, lower serum bilirubin .
Depending upon degree of prematurity, the interval of feeding ranges from hourly in extreme prematurity to 3 hourly feeds in babies born after 36 weeks. To meet the calorie requirement, the amount of milk to be given is slowly but progressively increased. The feed should be small and are to be given at shorter intervals.