1. NURSING
MANAGEMENT OF
LOW BIRTH
WEIGHT(LBW)
BABIES
By : Rosekumary VF
2nd yr msc n

2. DEFINITION :LOW-BIRTH-WEIGHT (LBW)
 Babies with a birth weight of less
than 2500 g, irrespective of the
period of their gestation are
classified as low birth weight babies.
.

3.  Very low-birth-weight infant :an infant whose
birth weight is less than 1500g.
 Extremely low birth weight infant: an infant
whose birth-weight is less than1000g

4.  According to birth weight and gestational age
LBW
SGA(small for
preterm gestational age)

5.  Preterm: the growth potential is normal and is
appropriate for the gestational period
 SGA:
Constitutionally small
IUGR by pathological process

6. CARE OF PRETERM BABIES
OPTIMAL MANAGEMENT AT BIRTH
 Attended by a senior pediatrician
 Air passage cleared of mucus
 Delayed clamping of cord helps in improving iron
store but lead to hypervolemia and
hyperbilirubinemia . So clamp the cord quickly
 Promptly dry, keep effectively covered and warm
 Vit K 0.5mg IM

7. MONITORING
 Vital signs monitoring
 Activity and behaviur
 Colour: pink, pale grey , blue , yellow
 Tissue perfusion :-
pink colour, capillary refill over upper chest <2sec,
warm and pink extremities, normal BP, urine output
>1.5 ml/kg/hr, absence of metabolic acidosis, lack
of disparity between PaO2 and SPO2

8. MONITORING
 monitor ABG and electrolyte
 Tolerance of feeds : vomiting, gastric residuals and
abdominal girth
 Look for development of apnic attack, sepsis
 Weight gain velocity

9. PROVIDE IN UTERUS MILIEU
 Create soft comfortable nestled and cushioned bed
 Avoid excessive light, sound, rough handling and
painful procedures. Use effective sedation and
analgesia for procedures
 Provide warmth and ensure asepsis
 Prevent evaporative skin losses by effectively
covering the baby, application of oil or liquid paraffin

10. PROVIDE IN UTERUS MILIEU
 Provide effective and safe oxygenation
 Provide parenteral nutrition partially and give
trophic feeds with EBM
 Provide tactile and kinesthetic stimulation- skin to
skin contact, interaction, music caressing and
cuddling

11. POSITION OF THE BABY
 Most love to lie in a prone position, cry less and
feels more comfortable
 Relieves abdominal discomfort by passage of flatus
and reduce risk of aspiration

12.  Increase ventilation, and increase dynamic lung
compliance and enhances arterial oxygenation
 Unsupervised prone positioning beyond neonatal
period recognized as a risk factor for SIDS

13. THERMAL COMFORT
 Prewarmed open care system or incubator should
be available
 care in a thermoneutral environment with a
servosensor geared to maintain skin temperature
of mid epigastric region at 36.50c
 Application of oil or liquid paraffin reduce
convective heat loss and evaporative water loss

14. THERMAL COMFORT
 Extremely low babies covered with a cellophane or
thin transparent plastic sheet to prevent convective
and evaporative losses from skin
 As soon as condition stabilises effectively clothe the
baby
 Partial kangaroo care to prevent hypothermia

15. OXYGEN THERAPY
 Oxygen should be administered with a head box
when saturation is less than 85% and withdrawn
gradually when > 90%

16. PHOTOTHERAPY
 Jaundice is common due to immaturity, hypoxia,
hypoglycemia, infections and hypothermia
 Due to immaturity of blood brain barrier,
hypoproteinemia and perinatal distress factors
bilirubin brain damage may occur at relatively lower
level
 Initiate phototherapy early

17. PREVENTION OF NOSOCOMIAL INFECTION
 Handling should be reduced to minimum
 Vigilance maintained on all procedures

18. FEEDING AND NUTRITION
Babies with weight <1200gm or gestational age <30
weeks and sick baby should be started on IV
dextrose solution
Wt>1000gm :- 10% dextrose
Wt<1000gm :- 5% dextrose
 Trophic feeds with EBM (1-2 ml 4 times a day)
through Ng tube can be started in all babies
irrespective of birth weight

19. FEEDING AND NUTRITION
 When stabilized enteral feeds are begun with EBM
starting with a volume of 30 ml/kg/day on day1
 Depending on tolerence feeds increased by 10-20
ml/kg/day every day and IVF are reduced

20. NUTRITIONAL SUPPLEMENTS
 When baby is stable, EBM can be fortified with
human milk fortifier(HMF) for additional calories and
protein.
 Multivitamin drops containing folic acid started at 2
weeks of age
 Iron supplements after 2-3 weeks
 Vitamin E which prevents powerful antioxidant and
prevent hemolytic anemia and edema

21. GENTLE RHYTHMIC STIMULATION
 Gentle touch, massage, cuddling, stroking and
flexing by the nurse or preferably by mother
 Soothing auditory stimuli can be given to preterm
baby in the form of family voices or music
 Visual input provided with the help of coloured
objects, diffuse light and eye tto eye contact

22. UTILITY OF CORTICOSTEROIDS
 Antenatal administartion of Betamethasone or
dexamethasone if labour starts before 34 weeks
 In infants who did not receive antenatal steroids a
single dose of dexamethasone 0.2 mg/kg iv at 4 hrs
of age is recommended in very LBW babies

23. WEIGHT RECORD
 Accurate weighing is a sensitive index of well being
 Most LBW babies loss weight during 1st 3 to 4 days
of life upto 10 to 15% of birth weight
The weight remains stationary for next 4 to 5 days
then starts to gain at a rate of 1.0 to 1.5 % of body
weight per day and regain birth weight by the end of
2nd week

24. IMMUNIZATION
 The dose is not reduced in preterm babies
 Administer 0 day vaccines on the day of discharge

25. FAMILY SUPPORT
 The frightened seen of NICU should be demystified
 Family should be constantly informed and involved
in care of baby

26.  Mother should be encouraged to touch and talk with
her baby and provide routine care under guidance
of nurses
 Assist to provide kangaroo care

27. TRANSFER FROM TO COT
 Baby who is feeding well, reasonably active with a
stable body temperature irrespective of wieght
qualifies for transfer to open cot
 The baby should be observed for another 12 hours
after putting incubator off

28. NURSING ASSESSMENT
 Infant is small
 Skin is thin , blood vessels can be easily
seen beneath the epidermis
 Skin wrinkled and red with an excess of
lanugo and little or no vernix
 No subcutaneous fat deposits
 Head is large in proportion to the body
 Eyes prominent but closed
 Ears are soft and chin recedes
 Thorax is less firm

29. NURSING ASSESSMENT
 Abdomen protruded
 Genitalia
male: few scrotal rugae, testes are not descended
female: labia and clitoris are prominent
 Exteremities: thin, muscle are small
 Nail: soft and short
 Palms and sole: minimal creases and appear
smooth
 Generally lies inactive with arms and legs extended
 Reflex activity not fully developed

30. NURSING DIAGNOSIS
 Risk for impaired parenting related to inadequate
bonding secondary to parent child separation
- participate in frank discussion with parents
about infant’s condition
- allow parents to express fear, guilt, anxiety
- assist parent with bonding by role modeling
and staying
- demonstrate how to proide basic care :
holding , diapering, turning

31. NURSING DIAGNOSIS
 Imbalanced nutrition less than body requirement
related to diminished sucking
-feed prescribed amount of breast milk
by NG/PO
- monitor blood glucose level
- Weigh baby daily
- maintain I/O chart
- place child in semi sitting
position for feeds
-position post feeds on right
side or prone position

32. NURSING DIAGNOSIS
 Risk for ineffective breathing pattern related to
effects of prematurity
-monitor pulse and respiration Q 2 H
- Assess respiratory distress, cyanosis,
grunting, nasal flaring.
- provide rest period between nursing care
- maintain oxygenation