MANAGEMENT OF

LOW BIRTH WEIGHT BABY

h

Nur Muhammad Artha

 Introduction

• Premature birth and low birth weight

(LBW) still a health problems in
newborn
• Morbidity and mortality still high
accordingly to the complication
• Medical and technology
development leads to increasing the
survival at high risk of LBW for
long term neurocognitive deficits .
 Introduction (2)
• The normal birth weight of is > 2500 to
3000 gm.
• Low birth weight or LBW :
birth weight of less than 2500 gm
regardless to gestational age
• Incidence : 15 – 30 %
• Neonatal deaths : 75 % due to LBW
• Infant deaths : 50 % caused by LBW
• Complication :
– Prone to malnutrition
– Recurrent infection
– Neurodevelopmental handicaps
 Penyebab
• Persalinan kurang bulan / prematur
• Bayi lahir kecil untuk masa kehamilan

Faktor predisposisi
• Faktor ibu
• Faktor plasenta
• Faktor janin
■ Umur ibu < 20 tahun atau > 35 tahun

■ Jarak kehamilan < 1 tahun

■ Ibu dengan keadaan:

■ Mempunyai BBLR sebelumnya

■ Melakukan pekerjaan fisik beberapa jam tanpa istirahat

■ Sangat miskin

■ Kurang gizi

■ Perokok, pengguna obat terlarang, alkohol

■ Ibu hamil dengan:

■ Anemia berat.

■ Pre eklampsia atau hipertensi

■ Infeksi selama kehamilan

■ Kehamilan ganda
■ Faktor Bayi

Bayi dengan:
■ Cacat bawaan

■ Infeksi selama dalam kandungan

Pemeriksaan fisik
• Berat lahir < 2500 gram
• Kurang Bulan
• Tanda prematuritas (+)
• Tulang rawan telinga belum terbentuk
• Masih terdapat lanugo
• Refleks refleks masih lemah
• Alat kelamin luar
Pemeriksaan fisik

• Kecil untuk Masa Kehamilan :

• Tanda prematuritas (-)
• Kulit keriput
• Kuku lebih panjang
BBLR prematur murni
 BBLR

Kecil untuk Masa Kehamilan (KMK)
 TANDA PREMATURITAS
Kehamilan 32
Kehamilan 36 minggu-matur: daun
minggu:peningkatan kartilago
telinga kaku, lengkung terbentuk baik
lengkung luar daun telinga
Kehamilan 28 minggu : Payudara
Tdk ada jaringan payudara

Areola samar

Kehamilan 32 minggu:

areola terlihat,

jaringan payudara kecil

36 weeks gestation :
Kehamilan 36 minggu:
well-defined areola,
breast nodule
areola terlihat baik,

nodul payudara
 Kehamilan 32 minggu: Kehamilan 36 minggu-matur:

Deposit lemak pada labia mayora hampir menutupi

labia mayora meningkat labia minora

atur Matur
 Genitalia Laki-laki

Kehamilan 28 minggu : Kehamilan 36 minggu-matur: testis

sudah turun, pigmentasi skrotum
Testis masih tinggi di meningkat
scrotum
 Telapak kaki
Kehamilan 36 minggu-matur:
Kehamilan 32 minggu : rajah pada hampir seluruh
Rajah < 1/3 anterior telapak kaki
 LBW: Indications
for hospitalization

❖ Birth weight <1800 g

❖ Gestation <34 wks

❖ Unable to feed*

❖ Sick neonate*

❖ Irrespective of birth weight and

gestation
 Danger signals
(Early detection and referral)
❖ Lethargy, refusal to feed

❖ Hypothermia

❖ Tachypnea, grunt, gasping, apnea

❖ Seizures, vacant stare

❖ Abdominal distension

❖ Bleeding, icterus over palms/soles

Management of Newborn
Illness
• Education of mothers to recognize danger
signals

• Working with families to develop complication

plan for newborns

• Early recognition and appropriate management

of newborn illness
Minimum Preparation for any Birth
The following should be available and in working
order:

• Heat source

• Mucus extractor

• Self-inflating bag of newborn size

• 2 masks (for normal and small newborns)

• 1 clock

• At least one person skilled in newborn

resuscitation present at birth
Care of the Low Birth Weight
Newborn

• Birth weight = Gestation duration +

intrauterine growth

– Most low birth weight newborns in

developing countries are term or near term
(Small for gestation age)

– Increased risk of hypothermia and poor

growth
 Delivery management
• LBW is prone to be asphyxiated

• Management at birth accordingly to

Guidelines of Resuscitation (AHA/AAP)

• Consider :

– Early intubation

– Early CPAP

– Prevent hypothermia

– Prevent hyperoxia
 Genetic Nutrition

LBW OPTIMAL G & D

Immunization

Proper
Psycho social
management

Stimulation
 OXYGEN DANGER
• ↑ free radial and contribute the incidence of :

– Chronic lung disease

– retinopathy of prematurity

– NEC

– periventricular leukomalacia

– Effect to growth and development

• Defense to free radial just developped in third

semester ! premarure baby prone to be
Principles of Management for
Low Birth Weight and Preterm
Newborns
• Warmth

• Feeding

• Detection and management of complications

(e.g., resuscitation, assisted respiration,
infection )
 Manajemen Umum
• Stabilisasi suhu, Jaga jalan napas

• Nilai segera kondisi bayi

• Kelola kondisi spesifik /

komplikasinya
 Warmth

As for all newborns:

• Lay newborn on mother’s abdomen or other

warm surface

• Dry newborn with clean (warm) cloth or towel

• Remove wet towel and wrap/cover with a

second dry towel

• Bathe after temperature is stable

Temperatur tubuh neonatus

37.5 C
Kisaran normal

36.5 C Stres dingin ! hati-hati

36.0 C
Hipotermi sedang ! hangatkan
bayi
32.0 C
Hipotermi berat ! hampir meninggal
Perawatan segera oleh tenaga terlatih
Upaya Menurunkan Risiko Hipotermi

• Suhu optimal untuk ruangan bersalin/OK dan ruang perawatan

• Suhu ruangan bayi ideal 24 – 26o C

• Alas tidur, handuk pembungkus hangat dan topi

• Inkubator transpor hangat

• Saat melakukan tindakan, pastikan bayi hangat

• Pintu inkubator jangan sering dibuka

• Bila sudah stabil ! metode kanguru

37
Untuk kasus khusus

40
 Definition of Kangaroo Mother
Care
• Early, prolonged and continuous skin-to-skin
contact between a mother and her newborn

• Could be in hospital or after early discharge

Kangaroo Mother Care
How to Use Kangaroo Mother Care
• Newborn’s position:

– Held upright (or diagonally) and prone against skin of mother,

between her breasts

– Head is on its side under mother’s chin, and head, neck and
trunk are well extended to avoid obstruction to airways

• Newborn’s clothing:

– Usually naked except for nappy and cap

– May be dressed in light clothing

– Mother covers newborn with her own clothes and added

blanket or shawl
How to Use Kangaroo Mother Care (2
• Newborn should be:

– Breastfed on demand

– Supervised closely and temperature monitored regularly

• Mother needs lots of support because kangaroo care:

– Is very tiring for her

– Restricts her freedom

– Requires commitment to continue

 Effectiveness of Kangaroo
Mother Care

• Randomized controlled trial

• Conducted in three tertiary and teaching hospitals in Ethiopia,

Indonesia and Mexico

• Study effectiveness, feasibility, acceptability and cost of kangaroo

mother care when compared to conventional methods of care

Cattaneo et al 1998.
 Benefits of Kangaroo Mother Care (1)
• Is efficient way of keeping newborn warm

• Helps breathing of newborn to be more regular; reduce

frequency of apneic spells

• Promotes breastfeeding, growth and extra-uterine

adaptation

• Increases the mother’s confidence, ability and involvement

in the care of her small newborn

• Seems to be acceptable in different cultures and

environments
 Benefits of Kangaroo Mother Care (2)

• Contributes to containment of cost— salaries, running

costs (electricity, etc.) Increases the mother’s
confidence, ability and involvement in the care of her
small newborn

• Seems to be acceptable in different cultures and

environments

• Contributes to containment of cost— salaries, running

costs (electricity, etc.)

deLeeuw et al 1991; Karlsson 1996; Lamb 1983; Ludington-Hoe et al 1993;

Ross 1980.
 Feeding

• Early and exclusive breastfeeding

– Breastmilk = best nourishment

– Already warm temperature

– Facilitated by kangaroo care

• If Breast milk is not availble, consider milk formula : Preterm formula --- until
2000 gm then change to After Discharged Formula
START ANTIBIOTIC ADMINISTRATION EVEN
WITHOUTH ANY SYMPTOMS
LBW: Supplements
 RESPIRATORY DISTRESS
PROBLEM
• Usually due to Hyaline Membrane Disease
( HMD )

• Assess : Antenatal steroids ???

• Surfactant

• CPAP : BUBBLE CPAP

 INFECTION
• ANTIBIOTICS

• SUPPORTING TREATMENT :

• NUTRITION

• OXYGENATION

• WARMTH

• IMMUNOTHERAPY ; IF IT IS NEEDED
 HYPERBILIRUBINEMIA
• Accordingly to Level of Serum
Total Bilirubin

• Foto therapy

• Feeding : Breast milk

• Fluid therapy

• Antibiotics according to
condition of infection
 RETINOPATHY OF PREMATURITY

• Worse complication is blindness

• Due to : prematurity and toxic oxygen

• Awarness to : baby with Ventilator and high flow/

consentration of O2

• Opthalmologic examination :

• < 32 weeks of gestation

• < 1500 grams

• Done : 1 months of age

• Lasik surgery
APNEIC SPELL : APNEA OF
PREMATURITY

• Very often : < 1500 grams

• Complication : Hypoxemia

❖ Oxygenation and breathing stimulation :

Aminophylline or Theophylline

❖ Mechanical Ventilator
 HYPOGLYCAEMIA

• Awarness of symptoms , sometime asymptomatic

• Blood Glucose level

• Hypoglycemia : < 45 mg/dL

• Dextrose infusion

• Glucose Infusion Rate ( G I R )

 INTRAVENTRICULAR
HEMORRHAGE
• Due to weakness of blood brain barrier and
hypoxemia

• Decreasing of consicousness , deficit

neurologics, seizure

• USG or CT scan

• Consult to Pediatric Neurology Division and

Neurosurgery
 SUMMARY
• Premature birth and low birth weight (LBW) still a health
problem with high Morbidity and mortality

• The survival at high risk of LBW for long term

neurocognitive deficits

• Two types of LBW : premature and IUGR

• Problems accordingly to the type

• Management consist of : warmth, feeding, management

of complication

• Breast feeding is prioritized, in case of breastmilk is not

available, consider milk formula
THANK
YOU