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

Principles of care (ENBC)

Prevent B. asphyxia

Keep warm

Promote XBF

Prevent infections

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

APGAR SCORE

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

After Birth

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!

Hunger Cues

Is baby ready to feed?

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

Keeping warm in

SCBU/NICU

Incubator care

Warming cot

Clothing – cap/booties/mittens

KMC

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

Prevent infection

Hand Washing/Hand Washing /Hand Washing!

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

Signs of stress in SCBU baby

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

Reduce light/noise

Covering incubator

Reducing noise

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)

Nesting

swaddling

Technique

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!