Nursing Management for Low Birth Weight Babies

Nursing Management for Low Birth Weight Babies, includes:

Care at Neonatal Intensive Care Unit:

The NICU should be warm, free from excessive sound smoothing light.
Protection from infection should be ensured by aseptic measures and effective hand washing.
Rough handling and painful procedure should be avoided.
Baby should be placed on soft comfortable, “nestled” and cushioned bed.
Continuous monitoring of the baby’s clinical status are vital aspects of management which depends upon the gestational age of the baby.
Baby can be placed in prone position during care.

Maintenance of Breathing:

Baby should be positioned with neck slightly extended and air passage to be cleared by gentle suctioning to remove the secretion, if needed. Precaution should be taken to prevent aspiration of secretion and feeds.
Concentration of oxygen to be maintained to have saO2 between 90 and 95% and paO2 between 60 and 80 mm of Hg.
Baby’s respiration rate, rhythm, signs of distress, chest retraction, nasal flaring, apnea, cyanosis, oxygen, saturation, etc. to be monitored at frequent interval.
Tackling stimulation by sole flaring can be provided to stimulate respiratory effort.
Chest physiotherapy by percussion, vibration and postural drainage may be needed to loosen and remove respiratory secretion.
Desirable level of arterial blood gas values should be I) Pao2 55-65 mm Hg .ii) PaCO2 35-45 mmHg and iii) PH 7.35-7.45.

Maintenance of Stable Body Temperature :

Baby should be received in a prewarmed radiant warmer or incubator. Environmental temperature should be maintained according to baby’s weight and age.
Baby’s skin temperature should be maintained 36.5 to 37.5 degree celcious.
Baby birth weight of less than 1200gm should be cared in the NICU incubator with 60 to 70 % humidity, oxygen and thermonutral environment for better thermal control and prevent heat loss.
Alternatively the baby should be managed under radiant warmer with protective plastic cover.
The baby as to be placed naked. If it I possible maintain temperature of the entire room.
The baby cot should be kept warm. Rubber hot water bottle may be usable for the purpose. The bottle should be filled with hot but not boiled water. Those should be covered with cloths.
The temperature of the cot should be checked so as to maintain it up to 85’F.
Kangaroo mother care can be provided when the baby’s condition stabilized. Baby should be clothed with frock, cap, socks, and mittens while giving kangaroo care.
Bathing should be delayed.

Maintenance of Nutrition and Hydration:

Caloric needs of non-growing LBW babies during first week of life are 60 kcal/ kg/ day on 7th is to be stepped up gradually to 100 on 14th day and about 120-150 on 21st day, to maintain satisfactory growth.
Human milk is the first choice of nutrition for all LBW babies. Colostrums, hind milk, foremilk, and preterm milk help faster growth of baby.
If breast milk is not available cows milk in proportion of 1:1 (milk: water) for 1st month and 2:1 during second month is an alternative substitute. One teaspoon glucose should be added to 50ml of milk prepared for the first 10 days and there after reduced to 1 teaspoon to 100ml milk.
Those babies who have good sucking and swallowing reflexes should start breastfeeding as early as possible.
Expressed breast milk can be given through spoon and bowl at 2 hour’s interval. Katoris-spoon or palady can also be used for feeding the preterm babys.
Gavages or nasogastric tube feeding can be given with EBM to all babies with poor sucking reflex.
Intravenous dextrose less than 1200 gm or sick babies.
Starvation to be avoided and early enteral feeding should be started as soon as the baby is stable.

Commencement: early feeding between 1-2 hours of birth is now widely recommended, the interval of feeding ranges from hourly in extreme prematurity to 3 hourly feeds in babies born after 36 weeks. The baby when kept in the cot, should be placed on one side with the head raised a little to prevent regurgitation.

Additional suplimentation: supplement of minerals and vitamin after 2 weeks should be started.

Vitamin-A-25000IU
Vitamin-D- 600IU
Vitamiv-C- 50mg.
Vitamin-B1- 0.5mg.
Folic acid- 65mg.
Calcium and phosphorus supplementation also essential. a liquid preparation of iron 1-2mg/kg/day should be given in the second or 3ed week.
IV gamma globulin therapy (400mg/kg/dose) may be given to prevent infection in selected case
Very LBW babies ( less than 1500gm, less than 32 weeks gestation) need vitamin-E.

Fluid requirement for LBW babies.

The first day the fluid requirement ranges from 60 to 100ml/kg ( the difference from each categories being 20ml/kg each)
The daily increment in all group is around 10 to 15 ml per kg till day 9.
Need extra requirement in case of phototherapy (20-40ml/kg/day) and radiant warmer (40-80ml/kg/day)

Gentle and early stimulation, prevention, early detection and prompt management of complication:

The baby should be observed for respiration, skin temperature, heart rate and skin color, activity feeding bahaviour, passage of meconium or stool and urine, condition of umbilical cord, eyes and oral cavity and Any abnormal signs like edema, bleeding, vomiting, etc. biochemical and electronic monitoring should be done if needed.
Weight recording should be done daily in sick babies or at alternative days. Position should be checked at every 2 hours. Baby should be placed in right side after feeding to prevent regurgitation and aspiration.
Mother should be allowed to take care of baby whenever condition permits.

Vaccinization of LBW:

If the LBW baby is not sick, the vaccination schedule is the same as for the normal babies. BCG, OPV, and HBV vaccine should be given at the time of discharge.

Transport o sick LBW babies:

It is essential to provide warmth during transport cold injury.
The baby should be clothed and placed in a pre warmed basket or box. But a transport incubator is ideal.
Hot water rubber bottle may be used as heat source. However make sure to cap them tightly and wrap 2 layers of towel to avoid direct contact with the baby.
Mother of the baby should also be transferred to the hospital along with the baby as for as possible. This will allay her anxiety and ensure breast milk feeding of the baby.

Family support discharge, follow- up and home care:

Baby’s condition and progress to be explained to the parent’s to reduce their anxiety. Treatment plan should be discussed.
Parents should be informed about the care of baby, after discharge at home. Need for warmth, breast feeding, general cleanliness, infection prevention measures, environmental hygiene, and follow-up plan. Immunization etc. should be explained to the parents.
Mostly healthy infant with a birth weight of 1800gm or more and gestational maturity of 3weeks or more can be managed at home. Mother should be prepared mentally and trained to provide essential care to the preterm baby at home.
At the discharge the baby should have daily steady weight gain with good vigor and able to suck and maintain warmth.
Ultimate survival of the baby depends upon continuity of care. The community health nurse should visit the family every week for a month and provide necessary guidance and support.