LOW BIRTH WEIGHT& PREMATURITY

Birth weight < 2500 g, gestational age is not taken into account.

LBW could be :Term Preterm Postterm

Based on BW:Low birth weight (LBW) : BW 1500 - < 2500

gVery Low Birth Weight (VLBW): BW 1000 g -

<1500 gExtremely LBW (ELBW) : BW < 1000 g

Based on GA:Preterm baby Appropriate for

gestational age (AGA)Small for gestational age (SGA)

PRETERM BABY

Preterm baby born before 37 weeks gestation

Have more problems than term babies who are small

( less than 2,5 kg at birth)

The more preterm the baby is, the more likely the baby

is to have problem

Preterm baby may have a problem that is specific

jaundice of prematurity, but may have any other problem

that a full-size, term baby can have( jaundice associated

with sepsis)

Feeding difficulty

Abnormal body temperature

Breathing difficulty

Necrotizing enterocolitis

Jaundice

Intraventricular bleeding

Anaemia

Low blood glucose

Retinopathy of prematurity

Apnea of Prematurity

Retinopathy of

prematurity

Apnea of Prematurity

Bronchopulmonary

dysplasia

Osteopenia of

Prematurity

Regardless of what other problems they may have

all preterm babies require special considerations for

feeding, fluid management and maintenance of normal

body temperature (ideally using kangaroo mother care)

Day of life 1 2 3 4 5 6 7+

ml/kg body weight of feed and/or fluid

60 80 100 120 140 150 160+

Total daily feed and fluid volumes for babies from birth

Ensure the baby is fed as soon as possible after birth

(within one hour if possible)

Encourage the mother to breastfed the baby or to give

expressed breast milk

General principles of feeding preterm babies

Difficulty feeding the babies are not mature enough

to feed well.

Good feeding established by 34 – 35 weeks post-

menstrual age.

Provide special support & attention to the mother

during this difficult period

Her breast milk is the best food for the baby

Breastfeeding is especially important for preterm baby.

It is usually normal if the baby :

Tires easily & suckles weakly at first

Suckles for shorter periods of time before resting

Falls asleep during feeding

Pause for long periods between suckling

It may take longer for a preterm baby to establish

breastfeeding

Assure the mother that breastfeeding will

become easier once the baby becomes bigger.

The mother follow the general principles of

exclusive breastfeeding

Encourage early and exclusive breastfeeding whenever

possible

Explain to the mother and her family the benefits of early

and exclusive breastfeeding :

Breast milk contains the exact nutrients the baby needs

and promotes the baby’s growth

Easily digested and efficiently used by the baby’s body

Protects the baby from infection

Used as a contraceptive method 12

Encourage mother to breastfed the baby on demand

(eight or more times in 24 hours) for as long as the baby

wants

Advise the mother that she should not :

Force the baby to feed

Interrupt a feed before the baby is done

Use artificial teats or pacifiers

Give the baby any other food or drink

13

Include the mother’s family

Ensure the mother eats nutritious food and has enough

to drink

Avoid washing or wiping her nipples before breastfeeding

If the mother is too ill or she chooses not to breastfed

a breast milk substitute

14

Signs of correct attachment

Baby’s chin touches the breast

Baby’s mouth is wide open with the

lower lips curled out

More of the areola is visible above

than below the mouth

Baby suckles with slow, deep

sucks and pauses sometimes

15

CALM

Established an IV line

Reassess the baby after 12 hours :

If the baby’s condition is improving restart feeds,

observing carefully

If the baby’s condition is not improving IV fluid at

maintenance volume for another 12 hours

Preterm babies require different feed and fluid

volumes based on their condition and weight

Babies without major illness

1,75 – 2,5 kg

Allow the baby to begin breastfeeding.

If the baby cannot be breastfed expressed

breast milk using an alternative feeding method

Day of life

1 2 3 4 5 6 7

Feed volume every 3 hours (ml/feed)

12 18 22 26 30 33 35

Table Volumes of breast milk for a by weighing 1,5-1,748 kg

without major illness

If the baby weighs 1,25 – 1,5 kg at least 8 times in

24 hours

If the baby weighs less than 1,25 kg at least 12 times

in 24 hours

Ensure the baby is receiving enough milk by assessing

the baby’s growth

Day of life

1 2 3 4 5 6 7

Feed volume every 3 hours (ml/feed)

10 15 18 22 26 28 30

Table Volumes of breast milk for a by weighing 1,25-1,49 kg

without major illness