MANAGEMENT OF LBW INFANTS IN RURAL SET UP DR. RAJATSUBHRA MUKHOPADHYAY MBBS, DCH, DNB (Child) TRAINED (Institute of Child Health) RESEARCH SCHOLAR

Low birth weight Importance ~ Definition : 2500 g VLBW: LESS THAN 1500 g Incidence : 30 % neonates Importance ~ LBW babies account for 75% neonatal deaths and 50% infant deaths LBW babies are more prone to : -Failure to thrive - malnutrition - neurodevelopmental delay Long term:Diabetes,Heart disease,SynX

Two types of LBW neonates 1] Pre-term (1/3):Symmetric, Asym. 2] SFD/SGA(2/3):Term, Pre-term Place of Management : 2-2.5kg …Home Based management 1.5-2 kg ...LEVEL II Care Hosp Below 1.5kg ...LEVEL III care Hosp.

Problems of LBW babies APNOEA,BIRTH ASPHYXIA, RDS, HYPOTHERMIA, HYPOGLYSEMIA, HIE, CONVULSION, HDN MALROTATION, AITP NITP,HYPERBILIRUBINAEMIA, SEPTICEMIA,ECTHYMA, NEC

Challenges of LBW Infants Managements Environment-Temp, Hygiene, Oxygen, Feeding O2 Mask, B&G mask, Ventilator, Surfactant, Aminophylline, Steroid Temp-Ambient 36.5 D C(Prob-cold stress)-Rx- Rooming in, warmer, phototherapy, sunlight, steroid, Ca, Mg, Vit-E Hygiene-Training & Counseling, prophylactic antibiotics, bath, oil talc & soap FEEDING- Method & Nutrition NUTRITIONAL CHALLENGES Excessive water losses Inability to maintain normal body temperature. Digestive & Renal immaturity Higher metabolic rate Low energy & nutrient stores

REQUIREMENTS OF MAJOR NUTRIENTS IN LBW infants Calories 130 Kcal/Kg/day Water 150 ml/Kg/day Carbohydrates 16 gm/kg/day Fats 7 gm/kg/day Protein 3.5 gm/kg/day

Other requirements Vit A 700-1500 IU/kg/day Vit D 400 IU/day. Large doses not required Folate 25-50 mg/kg/day Vit K ----- IM Vitamin K 1mg wt. is > 1.5 kg, 0.5 mg < 1.5 kg ******* Ca… 400mg/d; Mg…50mg/d,…Zn 200mcg/d,...vit E 0.7IU/d (specially along PUFA.LLIA, Fe.) ******* Fe- 2-6mg/kg/day,Afer 4 weeks (Not needed at birth)

A feed should provide (per dl) about 2 grams of protein (whey dominant) 4 grams of Fats (PUFA, MCT, MUFA) MUFA & MCT Directly absorbed, helps in nutrition growth, liver enzyme generation, neural & brain dev: 10 – 12 grams carbohydrates (preferably as Lactose and Maltodextrins) 70 – 80 kcal is suitable for LBW babies

Major differences between term and pre-term formula: Partial substitution of glucose polymers for lactose Protein conc. To support rapid growth Whey to casein 60:40 Partial subs LCF with MCT, absorption Ca+2 & PO4-4

Enteral feeds Nutrition goals: a) volume ------ 150ml/kg/day b) calories ------ 120 kcal/kg/day c) protein ------ 3.5-4gm/kg/day Breast milk vs. formula mother’s own pre-term milk is best But needs extra Ca+2 & PO4 -4 When human milk is not available Formula with high Ca+2 & PO4-4

LBW – NUTRITION METHODS 2-2.5 KG – 1] breast feeding,2] formula feeding & others 1.5– 2 KG 1] E B F, 2] K S F 3] GAVAGE FEEDING 4]FORMULA FEEDING 5] NNFT 6] IVF Below 1.5kg –Same +TPN +EXCHANGE+IVG

Few Low Birth weight Newborns

Few LBW with improper management

CASE STUDIES (With proper management) 1

2

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