Low birth weight Baby Low birthweight is when a baby is born weighing less than 5 pounds, 8 ounces or below

2500grams. About 1 in every 12 babies in the United States is born with low birthweight. Some low birthweight babies are healthy, even though theyre small. But being low birthweight can cause serious health problems for some babies. What causes a baby to be born with low birthweight? There are two main reasons why a baby may be born with low birthweight: 1. Premature birth. This is birth before 37 weeks of pregnancy. About 7 of 10 lowbirthweight babies are premature. The earlier a baby is born, the lower her birthweight may be. About 1 in 8 babies in the United States is born prematurely. Talk to your health provider about things you can do to help reduce your chances of having a premature baby. 2. Fetal growth restriction. This means a baby doesnt gain the weight she should before birth. You may hear the terms growth-restricted, small-for-gestational age or smallfor-date to describe these babies. They may have low birthweight simply because their parents are small. Others may have low birthweight because something slowed or stopped their growth in the womb. About 1 in 10 babies (10 percent) are growthrestricted. Your health care provider may think your baby isnt growing normally if your uterus (womb) isnt growing. He may use ultrasound and heart rate monitoring to check your babys growth. In some cases, a babys growth can be improved by treating health conditions in the mother, like high blood pressure. Can a mothers health condition lead to premature birth or fetal growth restricition? Yes. These conditions in the mother may lead to premature birth and/or fetal growth restriction: Preterm labor This is labor that starts too soon, before 37 weeks of pregnancy. Chronic health conditions These are health conditions that last for a long time or that happen again and again over a long period of time. Chronic health conditions need treatment from a health care provider. Conditions that may lead to low birthweight include high blood pressure, diabetes and heart, lung and kidney problems. Infections Certain infections, especially infections in the uterus, may increase your chances of having a premature baby. Problems with the placenta The placenta grows in your uterus and supplies your baby with food and oxygen through the umbilical cord. Some problems in the placenta can reduce the flow of blood and nutrients to your baby, which can limit your babys growth. In some cases, a baby may need to be born early to prevent serious complications for both mom and baby. Not gaining enough weight during pregnancy Women who dont gain enough weight during pregnancy are more likely to have a lowbirthweight baby than women who gain the right amount of weight. Smoking, drinking alcohol and using street drugs Pregnant women who smoke cigarettes are nearly twice as likely to have a low-birthweight baby than women who dont smoke. Smoking slows a babys growth and increases your chances of

having a premature birth. Using alcohol and street drugs during pregnancy can slow your babys growth in the womb and can cause birth defects. Some drugs, like cocaine, may increase your chances of having premature birth. Other conditions Youre more likely than other women to have a low-birthweight baby if you: Have low income Dont have a lot of education Are black Are younger than 17 or older than 35 Can a babys health condition lead to premature birth or fetal growth restricition? Yes. These conditions in the baby may lead to premature birth and/or fetal growth restriction: Birth defects These are health conditions that are present at birth. Birth defects change the shape or function of one or more parts of the body. They can cause problems in overall health, how the body develops, or in how the body works. They may limit a babys development in the womb, which may lead to low birthweight. Babies with birth defects are more likely than babies without birth defects to be born prematurely. Infections Certain infections in the baby can slow growth in the womb and cause birth defects. These include cytomegalovirus, rubella, chickenpox and toxoplasmosis. What medical problems can low birthweight cause for newborns? Low-birthweight babies are more likely than babies with normal weight to have health problems as a newborn. Some need special care in a hospitals newborn intensive care unit (NICU) to treat medical problems like: Respiratory distress syndrome (RDS). This breathing problem is common in babies born before 34 weeks of pregnancy. Babies with RDS dont have a protein called surfactant that keeps small air sacs in the lungs from collapsing. Treatment with surfactant helps these babies breathe more easily. Babies with RDS also may need oxygen and other breathing help to make their lungs work. Bleeding in the brain (called intraventricular hemorrhage or IVH). Bleeding in the brain can affect low-birthweight premature babies, usually in the first 3 days of life. Brain bleeds usually are diagnosed with an ultrasound. Most brain bleeds are mild and fix themselves with no or few lasting problems. More severe bleeds can cause pressure on the brain that can cause fluid to build up in the brain. This can cause brain damage. To reduce the fluid, your baby may be treated with medicine. In some cases, a surgeon may insert a tube into the babys brain to drain the fluid. Patent ductus arteriosus (PDA). PDA is a common heart problem for premature babies. Before birth, a large artery called the ductus arteriosus lets the babys blood bypass his lungs. This artery usually closes after birth so that blood can travel to the babys lungs and pick up oxygen. When the artery doesnt close properly, it can lead to heart failure. Providers use tests like ultrasound to check for PDA. Babies with PDA are treated with a drug that helps close the artery. If the drug doesnt work, a baby may need surgery.

Necrotizing enterocolitis (NEC). This is a problem in a babys intestines. The intestines are long tubes below the stomach that help digest food. NEC can develop up 2 to 3 weeks after birth. It can be dangerous for a baby. It can lead to feeding problems, swelling in the belly and other complications. Babies with NEC are treated with antibiotics and fed intravenously (through a vein) instead of by mouth while the intestine heals. In some cases, a baby may need surgery to remove damaged parts of intestine. Retinopathy of prematurity (ROP). ROP is condition that affects blood vessels in the eye. It mostly affects babies born before 32 weeks of pregnancy. Most cases heal themselves with little or no vision loss. Some babies need treatment, though, to prevent vision loss.

What medical problems can low birthweight cause later in life? Babies born with low birthweight may be more likely than babies born at a normal weight to have certain medical conditions later in life. These include high blood pressure, diabetes and heart disease. Talk to your babys health care provider about what you can do to help your baby be healthy. As your child grows, make sure she eats healthy food, stays active and goes to all her health care checkups. Getting regular checkups throughout childhood can help your provider spot health conditions that may cause problems as your baby grows older. These checkups also help make sure that your child gets all the vaccinations she needs to stay protected from certain harmful diseases. What can you do to reduce your chances of having a low-birthweight baby? Learn what you can do to get healthy before and during pregnancy to help reduce your risk of having a low-birthweight baby and improve your chances of having a healthy pregnancy and a healthy baby. Preterm birth Four different pathways have been identified that can result in preterm birth and have considerable evidence: precocious fetal endocrine activation, uterine overdistension, decidual bleeding, and intrauterine inflammation/infection.[3] From a practical point a number of factors have been identified that are associated with preterm birth, however, an association does not establish causality. Being small for gestational age Being small for gestational age can be constitutional, that is, without an underlying pathological cause, or it can be secondary to intrauterine growth restriction, which, in turn, can be secondary to many possible factors. For example, babies with congenital anomalies or chromosomal abnormalities are often associated with LBW. Problems with the placenta can prevent it from providing adequate oxygen and nutrients to the fetus. Infections during pregnancy that affect the fetus, such as rubella, cytomegalovirus, toxoplasmosis, and syphilis, may also affect the baby's weight. Treatment for low birthweight: Specific management for low birthweight will be determined by your baby's physician based on:

your baby's gestational age, overall health, and medical history your baby's tolerance for specific medications, procedures, or therapies your opinion or preference

Care for low birthweight babies often includes:

care in the NICU temperature controlled beds special feedings, sometimes with a tube into the stomach if a baby cannot suck other treatments for complications

Low birthweight babies typically "catch up" in physical growth if there are no other complications. Babies may be referred to special follow-up healthcare programs. Prevention of low birthweight: Because of the tremendous advances in care of sick and premature babies, more and more babies are surviving despite being born early and being born very small. However, prevention of preterm births is one of the best ways to prevent babies born with low birthweight. Prenatal care is a key factor in preventing preterm births and low birthweight babies. At prenatal visits, the health of both mother and fetus can be checked. Because maternal nutrition and weight gain are linked with fetal weight gain and birthweight, eating a healthy diet and gaining the proper amount of weight in pregnancy are essential. Mothers should also avoid alcohol, cigarettes, and illicit drugs, which can contribute to poor fetal growth, among other complications. Nursing care of low birth weight includes: 1. Care at neonatal intensive care unit, 2. Maintenance of breathing, 3. Maintenance of stable body temperature, 4. Maintenance of nutrition and hydration, 5. Gentle early stimulation, 6. Prevention, early detection and prompt management of complication, 7. vaccinization of LBW 8. Transport of sick LBW baby. 9. Family support discharge, follow- up and home care, Care at neonatal intensive care unit: 1. The NICU should be warm, free from excessive sound smoothing light. 2. Protection from infection should be ensured by aseptic measures and effective hand washing. 3. Rough handling and painful procedure should be avoided. 4. Baby should be placed on soft comfortable, nestled and cushioned bed.

4. Continuous monitoring of the babys clinical status are vital aspects of management which depends upon the gestational age of the baby. 5. Baby can be placed in prone position during care. 2. Maintenance of breathing: 1. Baby should be positioned with neck slightly extended and air passage to be cleared by gentle suctioning to remove the secretion, if needed. Precaution should be taken to prevent aspiration of secretion and feeds. 2. Concentration of oxygen to be maintained to have saO2 between 90 and 95% and paO2 between 60 and 80 mm of Hg. 3. Babys respiration rate, rhythm, signs of distress, chest retraction, nasal flaring, apnea, cyanosis, oxygen, saturation, etc. to be monitored at frequent interval. 2. 4. Tackling stimulation by sole flaring can be provided to stimulate respiratory effort. 3. 5. Chest physiotherapy by percussion, vibration and postural drainage may be needed to loosen and remove respiratory secretion. 4. 6. Desirable level of arterial blood gas values should be I) Pao2 55-65 mm Hg .ii) PaCO2 3545 mmHg and iii) PH 7.35-7.45. 3. Maintenance of stable body temperature. Baby should be received in a prewarmed radiant warmer or incubator. Environmental temperature should be maintained according to babys weight and age. Babys skin temperature should be maintained 36.5 to 37.5 degree celcious. Baby birth weight of less than 1200gm should be cared in the NICU incubator with 60 to 70 % humidity, oxygen and thermonutral environment for better thermal control and prevent heat loss. Alternatively the baby should be managed under radiant warmer with protective plastic cover. The baby as to be placed naked. If it I possible maintain temperature of the entire room. The baby cot should be kept warm. Rubber hot water bottle may be usable for the purpose. The bottle should be filled with hot but not boiled water. Those should be covered with cloths. The temperature of the cot should be checked so as to maintain it up to 85F. Kangaroo mother care can be provided when the babys condition stabilized. Baby should be clothed with frock, cap, socks, and mittens while giving kangaroo care. Bathing should be delayed. 4. Maintenance of nutrition and hydration: caloric needs of non-growing LBW babies during first week of life are 60 kcal/ kg/ day on 7th is to be stepped up gradually to 100 on 14th day and about 120-150 on 21st day, to maintain satisfactory growth. Human milk is the first choice of nutrition for all LBW babies. Colostrums, hind milk, foremilk, and preterm milk help faster growth of baby. if breast milk is not available cows milk in proportion of 1:1 (milk: water) for 1st month and 2:1 during second month is an alternative substitute. One teaspoon glucose should be added to 50ml of milk prepared for the first 10 days and there after reduced to 1 teaspoon to 100ml milk. Those babies who have good sucking and swallowing reflexes should start breastfeeding as early as possible.

 Expressed breast milk can be given through spoon and bowl at 2 hours interval. Katorisspoon or palady can also be used for feeding the preterm babys. Gavages or nasogastric tube feeding can be given with EBM to all babies with poor sucking reflex. Intravenous dextrose less than 1200 gm or sick babies. Starvation to be avoided and early enteral feeding should be started as soon as the baby is stable. Commencement: early feeding between 1-2 hours of birth is now widely recommended, the interval of feeding ranges from hourly in extreme prematurity to 3 hourly feeds in babies born after 36 weeks. The baby when kept in the cot, should be placed on one side with the head raised a little to prevent regurgitation. Additional suplimentation: supplement of minerals and vitamin after 2 weeks should be started. 1. Vitamin-A-25000IU 2. vitamin-D- 600IU 3. vitamiv-C- 50mg. 4. Vitamin-B1- 0.5mg. 5. Folic acid- 65mg. 6. Calcium and phosphorus supplementation also essential. a liquid preparation of iron 12mg/kg/day should be given in the second or 3ed week. 7. IV gamma globulin therapy (400mg/kg/dose) may be given to prevent infection in selected cases. 8. Very LBW babies ( <1500gm, <32 weeks gestation) need vitamin-E. Fluid requirement for LBW babies. The first day the fluid requirement ranges from 60 to 100ml/kg ( the difference from each categories being 20ml/kg each) The daily increment in all group is around 10 to 15 ml per kg till day 9. Need extra requirement in case of phototherapy (20-40ml/kg/day) and radiant warmer (4080ml/kg/day) 5. gentle and early stimulation, Prevention, early detection and prompt management of complication: The baby should be observed for respiration, skin temperature, heart rate and skin color, activity feeding bahaviour, passage of meconium or stool and urine, condition of umbilical cord, eyes and oral cavity and Any abnormal signs like edema, bleeding, vomiting, etc. biochemical and electronic monitoring should be done if needed. Weight recording should be done daily in sick babies or at alternative days. Position should be checked at every 2 hours. Baby should be placed in right side after feeding to prevent regurgitation and aspiration. Mother should be allowed to take care of baby whenever condition permits. 6. vaccinization of LBW: If the LBW baby is not sick, the vaccination schedule is the same as for the normal babies. BCG, OPV, and HBV vaccine should be given at the time of discharge. 7. Transport o sick LBW babies:

 It is essential to provide warmth during transport cold injury. The baby should be clothed and placed in a pre warmed basket or box. But a transport incubator is ideal. Hot water rubber bottle may be used as heat source. However make sure to cap them tightly and wrap 2 layers of towel to avoid direct contact with the baby. Mother of the baby should also be transferred to the hospital along with the baby as for as possible. This will allay her anxiety and ensure breast milk feeding of the baby. 8. Family support discharge, follow- up and home care: Babys condition and progress to be explained to the parents to reduce their anxiety. Treatment plan should be discussed. Parents should be informed about the care of baby, after discharge at home. Need for warmth, breast feeding, general cleanliness, infection prevention measures, environmental hygiene, and follow-up plan. Immunization etc. should be explained to the parents. Mostly healthy infant with a birth weight of 1800gm or more and gestational maturity of 3weeks or more can be managed at home. Mother should be prepared mentally and trained to provide essential care to the preterm baby at home. At the discharge the baby should have daily steady weight gain with good vigor and able to suck and maintain warmth. Ultimate survival of the baby depends upon continuity of care. The community health nurse should visit the family every week for a month and provide necessary guidance and support.

Nursing diagnosis; 1. Altered breathing dyspnea related to poor lung maturity secondary to respiratory distress 2. Altered body temperature hypothermia related to immature thermoregulation centre secondary to less subcutaneous fat. 3. Altered nutrition less than body requirement related to poor sucking reflex. 4. Fluid volume deficit hypovolumia related to poor intake. 5. Parental fear and anxiety related to NICU procedures and child condition 6. High risk for complication like hypoglycemia related to poor feeding. 7. High risk for infection related to poor immunity. 8. Parental knowledge deficit regarding care of low birth weight babies related to lack of exposure.