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LOW BIRTH WEIGHT & PREMATURITY

LOW BIRTH WEIGHT & PREMATURITY
LOW BIRTH WEIGHT & PREMATURITY
 Birth weight < 2500 g, gestational age is not taken into account. LBW could be

Birth weight < 2500 g, gestational age is not taken into account.

LBW could be :

Term Preterm Postterm

 Based on BW :  Low birth weight (LBW) : BW 1500 - < 2500

Based on BW:

Low birth weight (LBW) : BW

1500 - < 2500 g

Very Low Birth Weight (VLBW): BW 1000 g - <1500 g Extremely LBW (ELBW) : BW < 1000 g

Based on GA:

Preterm baby Appropriate for gestational age (AGA) Small for gestational age (SGA)

PRETERM BABY

PRETERM BABY

Preterm baby born before 37 weeks gestation

Have more problems than term babies who are small ( less than 2,5 kg at birth)

The more preterm the baby is, the more likely the baby is to have problem

Preterm baby may have a problem that is specific jaundice of prematurity, but may have any other problem that a full-size, term baby can have( jaundice associated with sepsis)

 Feeding difficulty  Abnormal body temperature  Breathing difficulty  Necrotizing enterocolitis  Jaundice 

Feeding difficulty Abnormal body temperature Breathing difficulty Necrotizing enterocolitis Jaundice Intraventricular bleeding Anaemia Low blood glucose Retinopathy of prematurity Apnea of Prematurity

Retinopathy of prematurity Apnea of Prematurity Bronchopulmonary dysplasia Osteopenia of Prematurity

Regardless of what other problems they may have all preterm babies require special considerations for feeding, fluid management and maintenance of normal body temperature (ideally using kangaroo mother care)

 Ensure the baby is fed as soon as possible after birth (within one hour if

Ensure the baby is fed as soon as possible after birth (within one hour if possible)

Encourage the mother to breastfed the baby or to give expressed breast milk

Total daily feed and fluid volumes for babies from birth

Day of life

1

2

3

4

5

6

7+

ml/kg body weight of

60

80

100

120

140

150

160

feed and/or fluid

+

General principles of feeding preterm babies  Difficulty feeding  the babies are not mature enough

General principles of feeding preterm babies

Difficulty feeding the babies are not mature enough to feed well.

Good feeding established by 34 – 35 weeks post- menstrual age.

Provide special support & attention to the mother during this difficult period

 Her breast milk is the best food for the baby  Breastfeeding is especially important

Her breast milk is the best food for the baby Breastfeeding is especially important for preterm baby. It is usually normal if the baby :

Tires easily & suckles weakly at first Suckles for shorter periods of time before resting Falls asleep during feeding Pause for long periods between suckling

It may take longer for a preterm baby to establish breastfeeding

Assure the mother that breastfeeding will become easier once the baby becomes bigger.

The mother follow the general principles of exclusive breastfeeding

 Encourage early and exclusive breastfeeding whenever  possible Explain to the mother and her family

Encourage early and exclusive breastfeeding whenever

possible Explain to the mother and her family the benefits of early and exclusive breastfeeding :

Breast milk contains the exact nutrients the baby needs and promotes the baby’s growth Easily digested and efficiently used by the baby’s body Protects the baby from infection Used as a contraceptive method

Encourage mother to breastfed the baby on demand (eight or more times in 24 hours) for as long as the baby wants

Advise the mother that she should not :

Force the baby to feed Interrupt a feed before the baby is done Use artificial teats or pacifiers Give the baby any other food or drink

Include the mother’s family

Ensure the mother eats nutritious food and has enough to drink

Avoid washing or wiping her nipples before breastfeeding

If the mother is too ill or she chooses not to breastfed a breast milk substitute

Signs of correct attachment Baby’s chin touches the breast

Baby’s mouth is wide open with the lower lips curled out

More of the areola is visible above than below the mouth

Baby suckles with slow, deep sucks and pauses sometimes

CALM

Signs of correct attachment  Baby’s chin touches the breast  Baby’s mouth is wide open
 Established an IV line  Reassess the baby after 12 hours :  If the

Established an IV line Reassess the baby after 12 hours :

If the baby’s condition is improving restart feeds, observing carefully If the baby’s condition is not improving IV fluid at maintenance volume for another 12 hours

 Preterm babies  require different feed and fluid volumes based on their condition and weight

Preterm babies require different feed and fluid volumes based on their condition and weight Babies without major illness 1,75 – 2,5 kg

Allow the baby to begin breastfeeding.

If the baby cannot be breastfed expressed breast milk using an alternative feeding method

Table Volumes of breast milk for a by weighing 1,5-1,748 kg without major illness Day of

Table Volumes of breast milk for a by weighing 1,5-1,748 kg without major illness

   

Day of life

 
 

1

2

3

4

5

6

7

Feed volume every 3 hours (ml/feed)

12

18

22

26

30

33

35

  • If the baby weighs 1,25 – 1,5 kg at least 8 times in 24 hours

  • If the baby weighs less than 1,25 kg at least 12 times in 24 hours

  • Ensure the baby is receiving enough milk by assessing the baby’s growth

Table Volumes of breast milk for a by weighing 1,25-1,49 kg without major illness

 

Day of life

 
 

1

2

3

4

5

6

7

Feed volume every 3 hours (ml/feed)

10

15

18

22

26

28

30