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By ULY CLINIC staff

Prematurity and low birth weight

Prematurity refers to the term that means the baby is before 37 completed weeks. Premature infants are associated with long time hospitalization and mortality. Low birth weight refers to when an infant is borth with a body weight below 2.5 kg

Low birth weight baby's can be classified asfollows

 

  • Low birth weight 2.5Kg to 1.5kg

  • Very low birth weight 1.5Kg to 1kg

  • Extremely low birth weight <1kg

Investigations to be done at birth

 

  • FBP

  • Blood for culture and sensitivity

  • CRP

  • CSF for biochemistry, microbiology

  • Urinalysis and urine culture

  • Swabs for gram stain and culture

  • Chest x ray

  • Serum electrolytes, calcium and magnesium

  • Renal and Liver function tests

 

Treatment
 

Babies with birth weight between 2.5Kg and 1.5 kg.
 

  • Start breastfeeding within one hour of delivery
     

Babies with birth weight < 1.5Kg
 

If unable to breastfeed

 

Fluid requirement on the first day of life is 80ml/kg given as:

  • 1ml of expressed breast milk (EBM) by NGT (trophic feeds) AND the remaining to be given as 10% Dextrose IV

  • Give breast milk 2– 4 ml every 2–3 hours by NGT until suckling reflex present 
    then

  • Start feeding with cup and spoon or an eyedropper and increase (1–2 ml 
    per feed each day) on a daily basis as tolerated then

  • Increase the amount of the feeds 150 –180ml/kg/day over the next 2 weeks of life the

  • Transfer the baby to Kangaroo Mother Care Unit (KMC) when stable

If able to breastfeed

 

  • Start breast feeding within 1 hour of delivery if they are able to suck. If unable to breastfeed give breast milk 2– 4 ml every 2–3 hours by NGT until suckling reflex present then

  • Start feeding with cup and spoon or an eyedropper and Increase (1–2 ml per feed each day) on a daily basis as tolerated then

  • Increase the amount of feeds to 150–180ml/kg/ day over the next 2 weeks of life then

  • Transfer the baby to KMC when stable.

For stable babies Start milk feeds.

  • Give 2–4 ml every 2–3 hours by nasogastric tube for the first two days then

  • Start feeding with cup and spoon or an eye dropper and Increase (1–2 ml per feed each day) on a daily basis as tolerated three days then

  • Increase the amount of the feeds to 150–180ml/kg/ day over the next 2 weeks of life then

  • Transfer the baby to KMC when stable.

Table below shows Oral Feeding chart for LBW babies

KMC Functions

 

  1. Provide Warmth

  2. EBF

 

Give daily supplements when on full enteral feeds

  • Vitamin D 400 IU

  • Calcium 120-140 mg/kg

  • Phosphorus 60-90 mg/kg

  • Iron (2 mg/day) and Folic acid (1.2mg per day) should be started at 4 weeks of age until 6months of age

Last updated on 22.08.2020

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References

  1. Tanzania standard treatment guideline for pediatric, 2017 edition  page  52-53

  2. Mediscape. Prematurity. https://emedicine.medscape.com/article/975909-overview. August 22.2020

  3. WHO. Care of the preterm and low-birth-weight newbornhttps://www.who.int/maternal_child_adolescent/newborns/prematurity/en/. August 22.2020

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