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

2. 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

3. 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 kg ...LEVEL II Care Hosp Below 1.5kg ...LEVEL III care Hosp.

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

5. 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

6. REQUIREMENTS OF MAJOR NUTRIENTS IN LBW infants
Calories Kcal/Kg/day
Water ml/Kg/day
Carbohydrates gm/kg/day
Fats gm/kg/day
Protein gm/kg/day

7. Other requirements Vit A 700-1500 IU/kg/day
Vit D IU/day. Large doses not required
Folate mg/kg/day
Vit K -----
IM Vitamin K mg 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)

8. 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

9. 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

10. Enteral feeds Nutrition goals: a) volume ------ 150ml/kg/day
b) calories kcal/kg/day
c) protein gm/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

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

12. Few Low Birth weight Newborns

13. Few LBW with improper management

14. CASE STUDIES (With proper management) 1

15. 2

16. THANK YOU