Post on 16-Jul-2015
Prof Dulani GunasekeraMBBS,MD FRCP(Lon),FSLCP
University of Sri Jayawardenapura
Care of the “Small” Baby
classification 2 types –
Term - growth retarded < 2.5Kg
(SFD/IUGR)
Preterm – adequate for gestational age (AGA)
small for gestational age (SGA)
• Old classification -
Low birth weight (LBW) < 2.5Kg
Very Low birth weight (VLBW) < 1.5kg
Extremely Low Birth Weight ( ELBW) < 500g
(this does not take prematurity into account)
Risks of being a small baby
Risks – at birth – Birth asphyxia
birth - 24hrs - hypoglycemia*
hypothermia
• If preterm – all systems immature -
lungs - surfactant deficiency
immune system – infections
gut – swallowing/ absorption
liver – jaundice, hypoglycemia
At Birth Before baby arrives –
Check resus’n equipment: in working order?!
paed. Team informed/ready
Take maternal history
Turn off air conditioning/fan
Receive onto WARM towel
• If BW > 2.0Kg deliver to mother’s
abdomen dry & skin to skin contact
Breast feed
At Birth- cont. If well - dry, skin to skin contact
cover with warm towel
breast feed
• Cord care
• wrap in dry WARM towel, CAP
• Vit K 1 mg IM
• Weighing/measuring – NOT a priority
If preterm/small baby take to radiant warmer
Assess CTBH/APGAR* score If low RESUSCN
ASSES - CTBH
C - color – PINK, cyanosed, pale
B – breathing – REGULAR /irregular / no
breathing
T - tone – GOOD, poor, floppy
H – heart rate - >100/min <100/min 0 HR
Delivering VLBW baby (<1.5kg)
Deliver into clean plastic bag directly
DO NOT DRY!
Cover head
assess
Continue resucn sos
elective CPAP
+/-Surfactant
Transport in Incubator
Keeping warm
prevent hypothermia – if well;
in ward – draught free/ fan off
cap/booties/mittens/cover
Kangaroo Mother Care*
(KMC)
If ill - SCBU – incubator/warming cot
Promote XBF – very
important!
“Ten Steps to successful BF ” – BFHI
BF technique – position
attachment
bonding
BF Support in SCBU/ward/MBC/LMC
REINFORCE/ SUPPORT/ NON JUDGMENTAL
Primi mothers need extra support!
In SCBU/NICU
Keep warm
Early feeding
prevent infection
Newborn babies Also get stressed!
“Developmental care” – Aims to minimize
stress:
light & noise stress
minimize handling &
clustering of care
feeding a small(preterm) baby AIM - prevent hypoglycemia, maintain nutrition –
Check RBS – on admission & 8 hourly/sos
normal RBS > 45mg/dl (2.5mmol/L)
If > 2Kg : Demand feeds OR
If < 2kg : regular 2- 3 hourly feeds
+/- Assisted feeding* - EBM with cup naso-gastric
tube
+/- IV fluids/Total Parenteral Nutrition (TPN)
Early TROPHIC feeding with EBM – v. important
Prevent infection – SCBU/NICU
In SCBU - all HW - alcohol rub between pts.
Minimal handling
barrier nursing – single nurse
own equipment
isolate infected babies
• hospital policy – septic rooms
separate outside
admissions
Developmental care
means interventions that:
support the behavior of infant
protect sleep rhythms
Promote growth and maturation.
Interventions include:
reduction of noxious environmental stimuli
optimal handling and positioning measures
cluster/cue based care
Reduce noxious(bad) stimuli
Reduce light – cover incubator tops/sides
reduce lighting
Reduce noise – cell phones, alarms, TALKING
equipment: incubator doors
• During procedures -
Reduce painful stimuli - non nutritive sucking
cuddling/swaddling
grasping finger
Optimal(best)
positioning/handling
Neutral position – flexed
Nesting, swaddling
Cluster care – give care at same time
eg. Routine care, temp, feeding
blood & other sampling
• “Cue” based care
• involve mother in care giving
• Kangaroo Mother Care (KMC)
Prevent infection
In ward -
Hand washing ! - staff/ mothers/ visitors
Restrict visitors!
Handle when needed
KMC*
Promote XBF
Prevent infection
at Home -
Hand washing
Restrict handling
Clean clothing
XBF
KMC
Visitors!
Advise mother!