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LBW

The document defines high risk newborns as those with a greater chance of morbidity or mortality due to conditions associated with birth. It classifies high risk newborns according to size (including low birth weight), gestational age (preterm or post-term), and mortality (live birth, fetal death, neonatal death). It identifies several maternal conditions that can affect the fetus such as preeclampsia. It also lists signs that can identify high risk newborns and describes care and management of low birth weight infants.

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JOSLIN
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549 views

LBW

The document defines high risk newborns as those with a greater chance of morbidity or mortality due to conditions associated with birth. It classifies high risk newborns according to size (including low birth weight), gestational age (preterm or post-term), and mortality (live birth, fetal death, neonatal death). It identifies several maternal conditions that can affect the fetus such as preeclampsia. It also lists signs that can identify high risk newborns and describes care and management of low birth weight infants.

Uploaded by

JOSLIN
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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HIGH RISK NEWBORN

Definition
• The high risk neonate can be defined as a
newborn, regardless of gestational age or birth
weight, who has a greater than average chance of
morbidity or mortality because of conditions or
circumstances associated with birth and the
adjustment to extrauterine existence.
• (Marilyn J Hockenberry & David
Wilson 2009).
Classification
• HIGH RISK NEW BORNS ARE CLASSIFIED
ACCORDING TO
SIZE

GESTAT
MORT
IONAL
ALITY AGE
1. ACCORDING TO SIZE
1 Low birth An infant whose birth weight is less
weight than 2500 gms regardless of
gestational age.
2 Very low birth An infant whose birth weight is less
weight than 1500gms
3 Extremely low An infant whose birth weight is less
birth weight than 1000gms
Size contd…
5 Small for An infant whose rate of intrauterine
dates or growth was slowed and whose birth
small for weight falls below the10th percentile
gestation on intra uterine growth curves
al age
Size Contd…….
6 Intra Found in infants whose intra uterine growth is
uterine restricted
growth SYMMETRIC IUGR
retardat Growth restriction in which the weight,
ion length, and head circumference are all
affected.
Size contd…..
ASYMMETRIC IUGR
Growth restriction in which the head
circumference remains within normal
parameters while the birth weight
falls below the 10th percentile
Size contd….
7 Large for An infant whose rate of
gestational age intrauterine growth was
infants more and whose birth
weight falls above the90th
percentile on intra uterine
growth charts
2. ACCORDING TO GESTATIONAL AGE

1 PRETERM OR An infant born before completion


PREMATURE of 37 weeks of gestation,
INFANT regardless of birth weight
2 POST An infant born after 42 weeks of
TERM(POST gestational age , regardless of
MATURE) birth weight.
INFANT
Gestational age contd…
3 NEAR TERM (LARGE- An infant born between
PRE TERM INFANT) 34 6/7 and 36 6/7
weeks of gestation
regardless of birth
weight
3. ACCORDING TO MORTALITY
1 LIVE Birth in which neonate manifests any
BIRTH heart beat, breaths, or displays voluntary
movement regardless of gestational age
2 FETAL Death of fetus after 20 weeks of
DEATH gestation and before delivery, with
absence of any signs of life after birth
MORTALITY contd…….

3 NEONATAL DEATH Death that occurs in the


first 27 days of life ; early
neonatal death occurs in
first week of life; late
neonatal death occurs at
7 to 27 days
High risk related to maternal conditions
• The health of the fetus and newborn may be affected
by a number of maternal conditions. It includes

• HELLP syndrome
• These conditions can cause preterm delivery,
intrauterine growth retardation, asphyxia and death if it
not detected early and appropriate interventions
implemented.

• Gestational diabetes mellitus


Maternal conditions contd…
• Pregnancy induced hypertension -Pregnancy-Induced
Hypertension (PIH) is a condition characterized by high
blood pressure during pregnancy

• Hazardous habits of mother such as drug addiction


smoking and alcohol abuse

• Maternal infections such as TORCH. (T-Toxoplasmosis,


O-Other (eg. Hepatitis B,), R-Rubella, C-
Cytomegalovirus infection, H-Herpes simplex) HIV,
CHICKEN POX etc. may lead to fetal malformations
Identification of a high risk
1 Birth weight of less than or gestation less than 34
weeks
2 Delayed passage of Meconium (more than 24
hours) and urine more than 48 hours
3 Inability to suck or swallow
4 Reduced activity or excessive inconsolable crying
5 Marked changes in colour: pale blue or yellow
Identification of a high risk contd…

6 Cold or febrile baby


7 Rapid breathing (respiratory rate more than 60
per minute, chest retractions)
8 Superficial infections (purulent conjunctivitis,
thrush, umbilical sepsis, pyoderma, abscess)
9 Persistent vomiting or watery diarrhea
Identification of a high risk contd…
11 Abdominal distention
12 Bleeding from any site
13 Seizures
14 Delayed capillary refill time
15 Fontanel bulging or depressed
16 Sudden loss of weight
17 Presence of any congenital anomalies
LOW BIRTH WEIGHT

Any infant with a birth


weight
of less than 2.5 kg
with in
1 hr of birth
regardless
of gestational age.
GRADING
Birth weight Grade

2500 – 2000 gm Low birth weight

2000 – 1000 gm Very low birth weight

< 1000 gm Extremely low birth weight


PROBLEM STATEMENT
 More than 20 million infants worldwide,
representing 15.5 % of all births are born with low
birth weight.

 As per WHO criteria, incidence of LBW in India is


33% each year.

 Prematurity is the worlds single biggest cause of


new born deaths and 2nd leading cause of all child
deaths after pneumonia.
CAUSES of LBW

In nearly 50% of cases of LBW the cause is not known.


In remaining 50% the causes are grouped into
a) medical
b) social
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, Hydramnios,
intrauterine infections etc.
b) Social causes

• Poverty, Illiteracy, Ignorance, Poor standard


of living,
• lack of knowledge on family planning, early
marriages, smoking etc
LBW (Preterm) : Problems

 Birth asphyxia  Retinopathy of


prematurity
 Hypothermia
 Apneic spells
 Feeding difficulties
 Intraventricular
 Infections
hemorrhage
 Hyperbilirubinemia  Hypoglycemia
 Respiratory distress
 Metabolic acidosis
LBW (SFD) : Problems

 Birth asphyxia

 Meconium aspiration syndrome


 Hypoglycemia

 Infections
 Polycythemia
Care of LBW babies

Depends upon
birth weight

2500 – 2000 gm

<2000 gm

<2000 gm & >1800 gm


& stable
Hemodynamically
Special care at Home

1.Prevention of infections
- Gentle and minimal handling
- Handling with clean hands
- Room must be warm, clean
and dust-free
- 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 cloth are kept on both sides

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
3.Correction of malnutrition

• As LBW babies cannot suck milk actively , it


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

 Careful monitoring of O2supply:


low O2 – hypoxia and cerebral palsy
high O2 – retinopathy of prematurity
3.Correction of malnutrition
3.Correction of malnutrition
 The baby is already malnourished.
 The baby is already malnourished.
Further malnutrition
Further malnutrition should
should be prevented.
be prevented.
Tube
Tube feeding
feedingis done because
is done baby isbaby
because in incubator and it
is in incubator and
is too young to suck mothers milk.
it is too young to suck mothers milk.
PREVENTION OF LBW BABY
A . DIRECT INTERVENTION MEASURES

 Prevention of malnutrition - By nutritional education


and
supplementation under ICDS.
 Prevention of anemia - By distribution of IFA tablets
DIRECT INTERVENTION MEASURES
contd…

 Control of infections - By early diagnosis and


prompt treatment.
 Avoid strenuous exercise , smoking & alcohol
among pregnant mothers.
B . INDIRECT INTERVENTION MEASURES

These are mainly family welfare services such as

 Deciding age at marriage.


 Deciding age at first child.
 Birth spacing.
 Deciding no of children.
 Improvement of availability of health services to
women.
THANKS
FOR
CONCERN
OVER ME

THANK YOU

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