A PRSENTATION
ON CARE OF LOW BIRTH WEIGHT BABY
BY
Lt. Sarada .K (MNS) ,CH(SC)
PUNE .
Any neonate whose life or quality of existence is threatened to be in high risk category requires close supervision by professionals .Infant mortality rate is very high in India (73 /1000 live births).Of all the infant deaths takes place in first month of life .Low birth weight & prematurity are the major contributor to infant mortality in India .These small premature babies have major physiological handicaps and ,therefore are ill-equipped for normal life .Expert & skilled care becomes an essential part of the care .
In order to provide quality care nurse must have adequate knowledge & skill in relation to etiological factors ,physiological handicaps , specific nursing interventions etc. as follow,
Definition : According to W.H.O. babies with a birth weight of 2.5 kg. Or less irrespective of their gestation are called as low birth weight baby .
Incidence : In India 30 to 40 % Of live births .Approx. 7-8 millions / year.
Classification : 1) Preterm : These are the babies who are born before the end of 37 weeks of gestation & whose rate of intrauterine growth was normal .
2) Small for date : These are the babies whose rate of intrauterine growth was slowed & whose birth weight falls below 10th percentile on international growth curves .
Etiological factors :
Preterm
- Spontaneous premature onset of labour
3Antepartum hemorrhage
4Cervical incompetence
5Multiple pregnancy
6Congenital malformations
7Young unmarried mothers
8Maternal Diabetes mallitus
9Severe Rh – isoimmunisation / Small for date
!) Maternal malnutrition
2) Chronic maternal systemic illnesses
3)Placental dysfunction
4)Genetic & chromosomal disorders .
5)Intrauterine infections .
6)Multiple pregnancy
7)Addictions e.g. Tobacco chewing smoking .
Physiological Handicaps’
Respiratory system
- Inefficient Respiratory center
- Respiration will be rapid ,irregular ,apneic
- Weak cry
- Inefficient respiratory centre
- Poor expansion of lungs due to inadequate surfactant
- Poor cough reflex.
Alimentary system
- Poor sucking & swallowing reflex
- Small capacity of the stomach
- Underdeveloped cardiac sphincter
- Lack of digestive enzymes leading to poor absorption & malnutrition
Thermoregulation
- Immature heat regulation center
- Inadequate Brown fat
- Poor muscle tone
- Low food intake
Renal system
- Immature kidneys
- Deficiency in nephrons
Blood & blood vessels
- Weak & fragile
Neurological
- Poor reflexes
Immature liver
- Hyperbilirubenemia & exaggeration of physiological jaundice is common .
- Poor hepatic glycogen stores
PRINCIPLES OF MANAGEMENT
Care at birth :
Suitable place of delivery in utero transfer to a place with optimum facilities if a low birth weight baby is expected .
Prevention of hypothermia
Efficient resuscitation .
Appropriate place of care :
Birth weight > 1800 gm. Care at home if baby is stable
1500- 1800 gm. - care at secondary level newborn unit .
< 1500 gms Tertiary level new born care
Thermal protection
Delay bathing
Warm room
Use of external heat source
Kangaroo mother care
Fluids & feeds
Intravenous fluids for very small babies & those who are very sick
Expressed breast milk with gavage or katori , spoon .
Direct breast feeding .
Monitoring & early detection of complications
Weight & other clinical signs
Electronic monitoring
Biochemical monitoring
Appropriate management of specific complications .
GOALS FOR CARE :
Infant will exhibit adequate oxygenation
Maintain stable body temperature
Exhibit no evidence of nosocomial infection
Receive adequate hydration and nutrition
Maintain skin integrity
Will experience no pain or reduction of pain
Receives appropriate developmental care.
Family receives appropriate support including preparation for home care .
ASSESSMENT :
General : Height , weight , any apparent deformity
Signs of distress .
Respiratory: Rate , regularity , breath sounds , shape of the chest
Cry , oxygen saturation ,need for suction .
Cardiovascular :Heart rate , rhythm , B.P.
Color of the skin & nailbeds .
Gastrointestinal : Signs of regurgitation ,Amount of feeds ,abdominal
distention , bowel sounds .
Genitourinary : Observe for any abnormality
Amount ,color ,specific gravity of urine .
Cardiovascular : Heart rate, rhythm
Neuromuscular : Level of activity , position ,reflexes
Skin : Discoloration ,blisters ,abrasions ,rash .
NURSING DIAGNOSIS WITH INTERVENTIONS
1) Ineffective breathing pattern R/T pulmonary & neuromuscular immaturity , decreased energy & fatigue.
Position : supine with slight head elevation
Suction
Maintenance of neutral environment
Observation ,recording & reporting of vital signs at regular intervals .
Application & Management of equipment correctly .
2) Ineffective thermoregulation R/T immature temperature control & decreased subcutaneous fat
Care at labor room :
- Maintain temperature at 28 –300C
- Receive the baby on pre warm bedsheet
- Keep the baby under warmer
- Dry the baby immediately
Care at later period
Place baby in incubator or under warmer
- Monitor child for hypo or hyper thermia
- Avoid situations that might predispose the baby for hypothermia .
3)Altered nutrition less than body requirement R/T immaturity , poor sucking & swallowing reflex
Feed the baby as per the instructions
Monitor signs of intolerance to feed .
Asses readiness for breast feeding , especially ability to suck & swallow .
Assist mother with expressing breast milk to establish & maintain
lactation until infant can take breast feeding
4)High risk for infection R/T deficient immunological defenses .
Follow strict hand washing technique before & after performing any procedure for the baby .
Restrict visitors
Ensure that all equipment, articles coming in contact with the baby are sterile or clean
Prevent personnel with U.R.T.I. taking care of baby.
Isolate septic cases .
Ensure adequate feeding .
Administer antibiotics as per instructions .
Fumigation of the Unit as per the hospital policy.
5)High risk for impaired skin integrity R/T immature skin structure , immobility , invasive procedures .
Keep the baby clean & dry .
Apply moisturizer
Use of adhesive at minimum
Changing of position
Remove adhesive with use of warm wet swab
Check restraints regularly for it’s proper placement
Take due precautions when heaters are used to maintain environmental temperature
6)Pain R/T diagnostic procedures , treatment etc.
Recognise that infant regardless of gestational age feels pain.
Differentiate between signs of pain / stress / fatigue
Use nonpharmacological methods to minimise pain
Encourage parents to provide comfort measures whenever possible
Convey an attitude of sensitivity & compassion for infant’s discomfort
Administer analgesics if ordered .
7)Altered growth & development R/T preterm birth , unnatural N.I.C.U. environment , separation from parents .
Provide optimum nutrition to ensure weight gain & brain growth
Provide regular periods of undisturbed rest
Recognise signs of overstimulation e.g. Irritability ,yawning cry .
Promote parent – infant interactions.
8)Altered family processes R/T situational /maturational crisis / knowledge deficit .
Informed the parents about child’s condition regularly
Encourage parents to ask doubts about child’ status ,their own problems in relation to child care .
Be honest in all dealings .
Emphasize positive aspect of infant’s status
Encourage visit from siblings
Preparation of family for home care.
Assess readiness of family to care for infant in home setting .
Teach necessary infant care techniques & observations
Reinforce follow up medical care.
Encourage & facilitate involvement with parent support group
Evaluation :
The effectiveness of nursing interventions must be evaluated at the regular intervals and whatever changes are required must be implemented immediately.
In order to provide quality care nurse must update her knowledge & skill in relation to care of high risk neonate . She should show enthusiasm & willingness to become an efficient health team member.