Teaching Aids: NNF

Management of
Low Birth Weight
Babies

LBW- 1

Incidence

Teaching Aids: NNF

Definition

30% of neonates
in India

Birth weight
<2500 g

Low birth weight (LBW)

LBW- 2

Teaching Aids: NNF

LBW- 3

LBW babies have higher mortality and morbidity

Malnutrition
Recurrent infections
Neuro developmental delay

75% neonatal deaths and 50% infant

deaths occur among LBW infants
LBW babies are more prone to:

LBW: Significance

Teaching Aids: NNF

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

Preterm

LBW- 4

< 10th centile for

gestational age
Account for 2/3rd of
LBW neonates

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

2 types based on the origin

Types of LBW

Teaching Aids: NNF

LBW- 5

Low maternal weight, teenage / multiple

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

Etiology of prematurity

Causation: LBW

Teaching Aids: NNF

Poor nutritional status of mother

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

Etiology of SFD / IUGR

Causation: LBW

LBW- 6

Teaching Aids: NNF

Breast nodule
Genitalia
Sole creases
Ear cartilage / recoil

Physical features

Date of LMP

Prematurity

LBW- 7

LBW: Identification of types

Term

Preterm

Teaching Aids: NNF

Term

Preterm

Breast nodule

LBW- 8

Identification: Preterm LBW

Teaching Aids: NNF

Preterm
Preterm

Male genitalia

Term
Term

LBW- 9

Identification: Preterm LBW

Teaching Aids: NNF

Preterm

Female genitalia

Term

LBW-10

Identification: Preterm LBW

Teaching Aids: NNF

Preterm

Sole creases
Term

LBW-11

Identification: Preterm LBW

Teaching Aids: NNF

Preterm

Ear Cartilage

Term
LBW-12

Identification: Preterm LBW

Teaching Aids: NNF

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

SFD / IUGR
Intrauterine growth chart
Physical characteristics

LBW-13

LBW: Identification of types

400

800

1200

1600

2000

2400

2800

3200

3600

4000

4400

31

33

37

39

TERM

Gestation (weeks)

35

PRETERM

42

44

POST-TERM

SMALL FOR DATE

45

LBW-14

10th percentile

APPROPRIATE FOR DATE

LARGE FOR DATE

90th percentile

Intrauterine growth chart

Teaching Aids: NNF

Birth weight (grams)

Teaching Aids: NNF

2.1 Kg - IUGR

3.2 Kg - AFD

Identification: SFD / IUGR

LBW-15

Teaching Aids: NNF

Hyperbilirubinemia
Respiratory
distress

Infections

Feeding difficulties

Hypothermia

Birth asphyxia

LBW-16

Metabolic acidosis

Hypoglycemia

Intraventricular
hemorrhage

Apneic spells

Retinopathy of
prematurity

LBW (Preterm) : Problems

Teaching Aids: NNF

Birth asphyxia
Meconium aspiration syndrome
Hypothermia
Hypoglycemia
Infections
Polycythemia

LBW (SFD) : Problems

LBW-17

Teaching Aids: NNF

Transfer mother to a well-equipped

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

LBW: Issues in delivery

LBW-18

Teaching Aids: NNF

* Irrespective of birth weight and gestation

Birth weight <1800 g

Gestation <34 wks
Unable to feed*
Sick neonate*

LBW: Indications for

hospitalization

LBW-19

Conduction

Evaporation

Teaching Aids: NNF

Prevent heat losses

Radiation

Convection

Skin-to-skin contact

34 35
32 34
30 32
28 - 30

1.0 1.5
1.5 2.0
2.0 2.5
> 2.5

LBW-20

Baby warmly wrapped

Warm room, fire or heater

Room
temperature (0C)

Birth weight (Kg)

LBW: Keeping warm at home

Teaching Aids: NNF

Well covered newborn

LBW: Keeping warm at home

LBW-21

Teaching Aids: NNF

Heated water-filled mattress

Skin-to skin method

Warm room, fire or
electric heater
Warmly wrapped

LBW-22

Air-heated Incubator

Radiant warmer

LBW: Keeping warm in hospital

Teaching Aids: NNF

Overhead
Radiant warmer

LBW-23

LBW: Keeping warm in hospital

Teaching Aids: NNF

* May try gavage feeds, if not sick

LBW-24

Introduce gavage feeds once stable

Shift to katori-spoon feeds over next few
days. Later on breast feeds

Start initial intravenous fluids

Weight <1200 g; Gestation <30 wks*

LBW: Fluids and feeding

Teaching Aids: NNF

* May need intravenous fluids, if sick

Katori-spoon feeding after 1-3 days

Shift to breast feeds as soon as baby is
able to suck

Start initial gavage feeds

LBW-25

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

LBW: Fluids and feeding

Teaching Aids: NNF

LBW-26

Katori-spoon feeding, if sucking not

satisfactory on breast
Shift to breast feeds as soon as possible

Breast feeding

Weight >1800 g; Gestation > 34 wks*

LBW: Fluids and feeding

Teaching Aids: NNF

First feed at 2 hrs of age then every 2

hourly

Increase by 15ml/kg/day
Maximum of 180-200ml/kg/day

Begin at 60 to 80ml/kg/day

LBW: Feeding schedule

LBW-27

Teaching Aids: NNF

Gavage feeding

LBW: Feeding

LBW-28

Teaching Aids: NNF

Katori-spoon feeding

LBW: Feeding

LBW-29

Teaching Aids: NNF

LBW-30

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

Guidelines for fluid requirements

Teaching Aids: NNF

1
2
3
4
5
6
7 onwards

Day of life

1000 1500g

80
95
110
125
140
155
170

>1500 g

60
75
90
105
120
135
150

Birth Weight

Fluid requirements (ml/kg)

LBW-31

Teaching Aids: NNF

* SFD - LBW term baby does not lose weight

Cold stress, anemia, poor intake, sepsis

Excessive loss or inadequate weight

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

Weight pattern*

LBW: Adequacy of nutrition

LBW-32

Teaching Aids: NNF

LBW-33

: Oral 2 mg/kg per day from

8 weeks of age

Iron

*From 2 weeks of age

: IM Vit K 1.0 mg at birth

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

Vitamins

LBW: Supplements

Teaching Aids: NNF

Lethargy, refusal to feed

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

Danger signals (Early detection

and referral)

LBW-34

Teaching Aids: NNF

Adequate warmth
Life support
With mother
Referral note

Transportation of LBW baby

LBW-35

Teaching Aids: NNF

Depends on birth weight, gestation and

severity of complications

Long term

LBW-36

Inversely related to birth weight and

gestation
Directly related to severity of complications

Mortality

Prognosis