Management of

Low Birth Weight

Babies

LOW BIRTH WEIGHT

Birth weight<2500 g

GRADING
Birth weight

Grade

2500 2000 gm

Low birth weight

2000 1000 gm

Very low birth weight

< 1000 gm

Extremely low birth

weight

LBW: Significance

Incidence

30% of neonates
in India
75% neonatal deaths and 50% infant
deaths occur among LBW infants

LBW babies are more prone to:

Malnutrition
Recurrent

infections
Neuro developmental delay

LBW babies have higher mortality and morbidity

Types of LBW
2 types based on the origin

Preterm

< 37 completed
weeks of gestation
Account for 1/3rd of
LBW

Small-for-date (SFD) /
intra uterine growth
retardation (IUGR)

< 10th centile for

gestational age
Account for 2/3rd of
LBW neonates

CAUSES of LBW
Low birth weight includes 2 groups
1) Preterm babies(<37
wks )
In nearly 50% of cases2)
ofIUGR
LBW the cause is not
known. In remaining 50%
the causes are grouped
into
a) medical

a) Medical causes
1. Maternal causes : all high risk mothers
except
Diabetics
2. Placental causes : Placenta previa ,
Congenital
defects of placenta etc,
3. Fetal causes
: Multiple gestation,
b) Social causes
Hydramnios,
intrauterine infections etc.
Poverty, Illiteracy,
Ignorance, Poor standard of
living,
lack of knowledge on family
planning, early marriages,

Causation: LBW
Etiology of prematurity

Low maternal weight, teenage / multiple

pregnancy
Previous preterm baby, cervical incompetence
Antepartum hemorrhage, acute systemic
disease
Induced premature delivery
Majority unknown

Causation: LBW
Etiology of SFD / IUGR

Poor nutritional status of mother

Hypertension, toxemia, anemia
Multiple pregnancy, post maturity
Chronic malaria, chronic illness
Tobacco use

LBW: Identification of types

Prematurity

Date of LMP
Physical features

Breast nodule
Genitalia
Sole creases
Ear cartilage / recoil

Identification: Preterm LBW

Breast nodule
Preterm

Preterm

Term

Term

Identification: Preterm LBW

Male genitalia

Preterm
Preterm

Term
Term

Identification: Preterm LBW

Female genitalia

Preterm

Term

Identification: Preterm LBW

Sole creases
Preterm

Term

Identification: Preterm LBW

Ear Cartilage

Preterm

Term

LBW: Identification of types

SFD / IUGR
Intrauterine growth chart
Physical characteristics

Emaciated look
Loose folds of skin
Lack of subcutaneous tissue
Head bigger than chest by >3cm

Intrauterine growth chart

90th percentile

Birth weight (grams)

LARGE FOR DATE

APPROPRIATE FOR DATE

10th percentile
SMALL FOR DATE

PRETERM

TERM

Gestation (weeks)

POST-TERM

Identification: SFD / IUGR

2.1 Kg - IUGR

3.2 Kg - AFD

LBW (Preterm) : Problems

Birth asphyxia

Hypothermia

Feeding difficulties

Infections

Hyperbilirubinemia
Respiratory
distress

Retinopathy of
prematurity

Apneic spells

Intraventricular
hemorrhage

Hypoglycemia

Metabolic acidosis

LBW (SFD) : Problems

Birth asphyxia
Meconium aspiration syndrome
Hypothermia
Hypoglycemia
Infections
Polycythemia

LBW: Issues in delivery

Transfer mother to a well-equipped

centre before delivery
Skilled person needed for effective
resuscitation
Prevention of hypothermia - topmost
priority

Care of LBW babies

Depends upon birth weight

2500 2000 gm
at

Requires special care

home

<2000 gm
at

Requires special care

hospital

<2000 gm &
>1800 gm & stableHemodynamically

Requires kangaroo mother ca

Special care at Home

Principles: Prevention of infections
Prevention of hypothermia
Correction of malnutrition
1.Prevention of infections
- Gentle and minimal handling
- Handling with clean hands

- Room must be warm, clean and dust

- Immunization at right time

2.Prevention of hypothermia

Avoid bath till baby attains 2500g weight

Cover baby with clean dry & warm cloth

Bottles filled with warm water & covered with thin clo

are kept on both sides (or) baby without blanket is ke

near 60 candle bulb burning.

3.Correction of malnutrition

As LBW babies cannot suck milk actively , it

gets tired
faster. So frequent breast feeding must be
given almost

LBW: Keeping warm at home

Skin-to-skin contact
Convection
Radiation

Birth weight (Kg)

Room
temperature (0C)

1.0 1.5

34 35

1.5 2.0

32 34

2.0 2.5

30 32

> 2.5

28 - 30

Warm room, fire or heater

Evaporation

Conduction

Prevent heat losses

Baby warmly wrapped

Special care at Hospital

1.Prevention of infections
Prophylactic antibiotics to prevent septicemia.
Separate nurses for feeding and toilet attending.
Barrier nursing to prevent cross infections.

2.Prevention of hypothermia
Child is kept under incubator it maintains the
temperature , humidity and o2 supply , till
weight
increases
to 2000g.of O2
Careful
monitoring
supply:
low O2 hypoxia and
cerebral
palsy
high O2 retinopathy of
prematurity

3.Correction of malnutrition
The baby is already malnourished.
Further malnutrition should be prevented.
Tube feeding is done because baby is in incubator
and it
is too young to suck mothers milk.

Care of LBW babies

Depends upon birth weight

2500 2000 gm
at

Requires special care

home

<2000 gm
at

Requires special care

hospital

<2000 gm &
>1800 gm & stableHemodynamically

Requires kangaroo mother ca

Special care at Home

Principles: Prevention of infections
Prevention of hypothermia
Correction of malnutrition
1.Prevention of infections
- Gentle and minimal handling
- Handling with clean hands

- Room must be warm, clean and dust

- Immunization at right time

2.Prevention of hypothermia

Avoid bath till baby attains 2500g weight

Cover baby with clean dry & warm cloth

Bottles filled with warm water & covered with thin clo

are kept on both sides (or) baby without blanket is ke

near 60 candle bulb burning.

3.Correction of malnutrition

As LBW babies cannot suck milk actively , it

gets tired
faster. So frequent breast feeding must be
given almost

LBW: Keeping warm at home

Skin-to-skin contact
Convection
Radiation

Birth weight (Kg)

Room
temperature (0C)

1.0 1.5

34 35

1.5 2.0

32 34

2.0 2.5

30 32

> 2.5

28 - 30

Warm room, fire or heater

Evaporation

Conduction

Prevent heat losses

Baby warmly wrapped

Special care at Hospital

1.Prevention of infections
Prophylactic antibiotics to prevent septicemia.
Separate nurses for feeding and toilet attending.
Barrier nursing to prevent cross infections.

2.Prevention of hypothermia
Child is kept under incubator it maintains the
temperature , humidity and o2 supply , till
weight
increases
to 2000g.of O2
Careful
monitoring
supply:
low O2 hypoxia and
cerebral
palsy
high O2 retinopathy of
prematurity

3.Correction of malnutrition
The baby is already malnourished.
Further malnutrition should be prevented.
Tube feeding is done because baby is in incubator
and it
is too young to suck mothers milk.

LBW: Indications for

hospitalization

Birth weight <1800 g

Gestation <34 wks
Unable to feed*
Sick neonate*

* Irrespective of birth weight and gestation

LBW: Keeping warm at home

Skin-to-skin contact
Convection
Radiation

Birth weight (Kg)

Room
temperature (0C)

1.0 1.5

34 35

1.5 2.0

32 34

2.0 2.5

30 32

> 2.5

28 - 30

Warm room, fire or heater

Evaporation

Conduction

Prevent heat losses

Baby warmly wrapped

LBW: Keeping warm at home

Well covered newborn

LBW: Keeping warm in hospital

Skin-to skin method
Warm room, fire or
electric heater
Warmly wrapped

Radiant warmer

Heated water-filled mattress

Air-heated Incubator

LBW: Keeping warm in hospital

Overhead
Radiant warmer

LBW: Fluids and feeding

Weight <1200 g; Gestation <30 wks*

Start initial intravenous fluids

Introduce gavage feeds once stable
Shift to katori-spoon feeds over next few
days. Later on breast feeds

* May try gavage feeds, if not sick

LBW: Fluids and feeding

Weight 1200-1800 g; Gestation 30-34 wks*

Start initial gavage feeds

Katori-spoon feeding after 1-3 days
Shift to breast feeds as soon as baby is
able to suck

* May need intravenous fluids, if sick

LBW: Fluids and feeding

Weight >1800 g; Gestation > 34 wks*

Breast feeding
Katori-spoon feeding, if sucking not
satisfactory on breast
Shift to breast feeds as soon as possible

LBW: Feeding schedule

Begin at 60 to 80ml/kg/day
Increase by 15ml/kg/day
Maximum of 180-200ml/kg/day

First feed at 2 hrs of age then every 2

hourly

LBW: Feeding
Gavage feeding

LBW: Feeding
Katori-spoon feeding

Guidelines for fluid requirements

First day 60-80 ml/kg/day

Daily increment 15 ml/kg till day 7
Add extra 20-30 ml/kg for infants under
radiant warmer and 15 ml/kg for those
receiving phototherapy

Fluid requirements (ml/kg)

LBW: Adequacy of nutrition

Weight pattern*

Loses 1 to 2% weight every day initially

Cumulative weight loss 10%; more in preterm
Regains birth weight by 10-14 days
Then gains weight up to 1 to 1.5% of birth
weight daily

Excessive loss or inadequate weight

Cold stress, anemia, poor intake, sepsis

* SFD - LBW term baby does not lose weight

LBW: Supplements

Vitamins

: IM Vit K 1.0 mg at birth

Vit A* 1000 I.U. per day
Vit D* 400 I.U. per day

Iron

: Oral 2 mg/kg per day from

8 weeks of age

*From 2 weeks of age

Danger signals (Early detection

and referral)

Lethargy, refusal to feed

Hypothermia
Tachypnea, grunt, gasping, apnea
Seizures, vacant stare
Abdominal distension
Bleeding, icterus over palms/soles

Transportation of LBW baby

Adequate warmth
Life support
With mother
Referral note

Prognosis

Mortality
Inversely

related to birth weight and gestation

Directly related to severity of complications

Long term
Depends

on birth weight, gestation and

severity of complications

KANGAROO MOTHER CARE

First suggested by Dr Edgar Ray in Colombia.

Refers to care of preterm or low birth weight infants b

placing the infant in skin-to-skin contact with the mot
or any other caregiver.

PARAMETERS TO BE MONITORED DURING KMC

Temperature : Once in 6 hrs.
Respiration : For apnea.
Feeding

: Once in 90-120 min.

Well being

: By educating mother about

danger signs.
growth

: Gain of 15-20 g /kg/day.

Compliance with kangaroo care.

COMPONENTS OF KMC
1.KANGAROO POSITION
Consists of specific frog like position of LBW new
born
with skin-to-skin contact with mother , in between
her
The provider must keep herself
breasts
in a vertical
position.
in
a semi-reclining
position
to
avoid gastric reflux in the infant.
Maintained 24 hrs a day , till it
gains at least 2000g.

PREPARATION OF KANGAROO BABY

Baby must be suitably dressed in a cap , soakproof
diaper , socks and with an open shirt to have
skin to skin
contact between mother and baby and placed in
aMechanism of prevention of hypothermia
kangaroo SYNCHRONY
bag.
THERMAL
If the temp of the baby decreases by 1c ,
correspondingly
the temp of mother increases by 2 c to warm up
the baby.
If the temp of the baby raises by 1c , the temp of

2.KANGAROO FEEDING POLICY

kangaroo position is ideal for breast feeding.
Exclusive breast feeding is the policy.
Feeding is done once in 90-120 min.
If the baby can suckle , it is promoted.
If baby cannot suckle , expressed breast milk
to be fed.
If the baby is unable to swallow , EBM is fed by
nasogastric tube.

3a.EARLY DISCHARGE
Criteria for discharge:
Wt gain of at least 40g a day for 5 consecutive
days.
Baby should feed well on breast milk.
Temp should be maintained.
There should not be any evidence of illness.
Successful in-hospital adaptation of the mother
and other
members of the family.

3b.FOLLOW-UP
After discharge , KMC is continued
at home.
Follow-up is done daily by the
health worker for one week
and ensured that baby is feeding
well and gaining about 40g weight daily.
Afterwards once a week till the baby reaches
40
weeks of post conceptional age.