Dr. Najaf Masood Assistant Professor Pediatrics BBH Rawalpindi Low - - PowerPoint PPT Presentation

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Dr. Najaf Masood Assistant Professor Pediatrics BBH Rawalpindi Low - - PowerPoint PPT Presentation

Oct 17, 2022 252 likes •711 views

Dr. Najaf Masood Assistant Professor Pediatrics BBH Rawalpindi Low Birth Weight Normal birth weiht (NBW) 2500-3900g Low Birth Weight < 2500g Very Low Birth Weight <1500g Extremely Low Birth Weight <1000g

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  • Dr. Najaf Masood

Assistant Professor Pediatrics

BBH Rawalpindi

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Low Birth Weight

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Normal birth weiht (NBW)

  • 2500-3900g
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  • Low Birth
  • Weight < 2500g
  • Very Low Birth
  • Weight <1500g
  • Extremely Low Birth Weight
  • <1000g
  • Incredibly Low Birth Weight
  • <750g
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Incidence

  • Developed countries

– 30% LBW-IUGR

  • Developing countries

– 70% LBW-IUGR

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Infant Classification by gestational (postmenstrual) age

  • Preterm < 37wks
  • Term 37 to 41 wks
  • Post term 42 wks
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Intrauterine Growth Retardation

  • Also referred to as SGA
  • Birth weight is two standard below the

mean for gestational age or as below tenth percentile

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Symmetric IUGR

  • All three parameters are equally affected
  • Early in onset
  • Disease affecting fetal cell no.

– Chromosomal – Genetic – Teratogenic – Infections – hypertension

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Asymmetric IUGR

  • Normal head circumference
  • Late onset
  • Poor maternal nutrition
  • Late onset or exacerbation of maternal

vascular disease

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Etiology

  • Low socioeconomic status
  • Maternal under nutrition
  • Anemia
  • Inadequate prenatal care
  • Drugs misuse
  • Obstetric complication
  • Bad obstetric history
  • Maternal activity
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Maternal Conditions

  • Under 16 Years
  • Chronic medical illness

– hypertension – Cyanotic heart disease – Renal disease

  • infections
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Fetal Conditions

  • Fetal Distress
  • Multiple gestation
  • Erythroblastosis
  • Non immune hydrops
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Uterine

  • Uterine malformation

– bicornuate

  • Uterine trauma
  • Cervical incompetence
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Placental

  • Placental dysfunction
  • Placenta previa
  • Abruptio placenta
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Others

  • Premature rupture of membrane
  • Polyhydroamnios
  • Iatrogenic
  • Trauma
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Assessment of gestational Age

  • Rapid visual assessment
  • Ballard score
  • Obstetric information
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Ballard score

  • Neurological maturity
  • Physical maturity
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Problems of Prematurity

  • Respiratory
  • Perinatal depression
  • RDS
  • Apnea
  • Chronic lung disease
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  • Perinatal depression
  • Intracranial hemorrhage
  • Periventricular leukomalacia

Neurological Problems including

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Cardiovascular

  • Hypotension
  • hypovolemia
  • Cardiovascular dysfunction
  • vasodilatation
  • Patent ductus arteriosus
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  • Hematologic
  • Anemia
  • Hyperbilirubinemia
  • Nutritional
  • Gastrointestional
  • Factor for necrotizing enterocolitis
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  • Patent ductus arteriosus
  • Adequate oxygenation
  • Fluid restriction
  • Possible intermittent diuresis
  • Fluid and electrolyte therapy
  • Nutrition
  • Hyperbilirubinemia
  • Phototherapy
  • Exchange transfusion
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  • Metabolic
  • Renal
  • Temperature regulation
  • Immunologic
  • Ophthalmologic
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Management of the premature infant

  • Delivery
  • Appropriately equipped and staffed hospital
  • Resuscitation and stabilization
  • Anticipation and prevention
  • Clear airway
  • Initiate breathing
  • Adequate oxygen delivery
  • Maintenance of proper temperature
  • Care of umbilical cord
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Thermal regulation

  • Environmental temperature at which
  • xygen consumption is minimal yet

sufficient to maintain body temperature

  • Maintain temp 36.5-37 oC
  • Humidity 40-60%

–overhead radiant warmer, closed incubator

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Oxygen therapy and assisted ventilation

  • Ways of administration

– Head hood – Nasal prong – Continuous positive airway pressure

  • Risk of injury

– Eyes – lung

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Fluid Requirment

  • Term

– 60-70ml/kg – 100-120ml/kg

  • Preterm

– 70-80ml/kg – 150ml/kg

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  • Daily weight
  • Urine
  • Serum urea nitrogen
  • Serum sodium level
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Total Parenteral Nutrition

  • Life saving for VLBW
  • CVP, peripheral vein
  • Aminoacid2.5-3 gm/kg/d
  • Glucose 10-15gm/kg/d
  • Intralipid 2-3gm/kg/d
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Feeding

  • Method of feeding
  • Avoid fatigue & aspiration
  • Keep NPO

– Respiratory distress – Hypoxia – Circulatory insufficiency – CNS depression – Severe immaturity

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Nasogastric feeding

  • <1.5 kg

– 10ml/kg/d – 20-30ml/kg/d

  • >1.5 kg

– 20-25ml/kg/d

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Oral feeding

  • 34 wks….>2kg
  • Synchronized process of sucking

– Stong sucking effort – Coordination of swallowing

  • Trophic feeding
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  • Iron
  • Folic acid
  • Vitamin A, D, E, K
  • Calcium
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  • Hand washing
  • Avoid over crowding
  • Skin care
  • Early enteral feeding
  • Broad spectrum

– Nosocomial infection

Infection

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Immunization

  • As in term
  • Pertussis vaccine is contraindicated in

infants with possible or documented evolving neurological problem

  • Preterm infants with chronic respiratory

distress should receive influenza immunization at 6 months of if they are not hospitalized

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Long Term Problems of Prematurity

  • Developmental disability
  • Major handicaps
  • Sensory impairments
  • Minimal cerebral dysfunction
  • Retinopathy of Prematurity
  • Chronic lung disease
  • Poor growth
  • Increased frequency of congenital anomalies
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Prognosis

  • Developed countries

– 1.5-2 kg 95% survival

  • High risk of morbidity & mortality in IUGR
  • Higher incidence of rehospitalization in

first 2 yr of life

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Discharge criteria

  • Resolution of acute life threatening illness
  • Stable temp regulation
  • Gaining weight on oral feed
  • Free of apnea
  • Mother’s knowledge
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