1. h MANAGEMENT OF LOW BIRTH WEIGHT BABY FOR OPTIMAL GROWTH AND DEVELOPMENT M. Sholeh Kosim Perinatology Sub Division Pediatrics Department Medical Faculty Diponegoro University- Dr. Kariadi Hospital Semarang 1

3. Morbidity and mortality still high accordingly to the complication

4. Medical and technology development leads to increasing the survival at high risk of LBW for long term neurocognitive deficits .2

7. Neonatal deaths : 75 % due to LBW

8. Infant deaths : 50 % caused by LBW

9. Complication :

10. Prone to malnutrition

11. Recurrent infection

12. Neurodevelopmental handicaps 3

13. 4

14. 5

15. 6

16. 7

18. Gestation <34 wks

19. Unable to feed*

20. Sick neonate*

21. Irrespective of birth weight and gestation8

23. Hypothermia

24. Tachypnea, grunt, gasping, apnea

25. Seizures, vacant stare

26. Abdominal distension

27. Bleeding, icterus over palms/soles9

29. Working with families to develop complication plan for newborns

30. Early recognition and appropriate management of newborn illness10

32. Mucus extractor

33. Self-inflating bag of newborn size

34. 2 masks (for normal and small newborns)

35. 1 clock

36. At least one person skilled in newborn resuscitation present at birth11

38. Most low birth weight newborns in developing countries are term or near term (Small for gestation age)

39. Increased risk of hypothermia and poor growth12

41. Management at birth accordingly to Guidelines of Resuscitation (AHA/AAP)

42. Consider :

43. Early intubation

44. Early CPAP

45. Prevent hypothermia

46. Prevent hyperoxia 13

47. 14

48. 15

49. Genetic Nutrition LBW OPTIMAL G & D Immunization Proper management Psycho social Stimulation 16

51. Chronic lung disease

52. retinopathy of prematurity

53. NEC

54. periventricular leukomalacia

55. Effect to growth and development

56. Defense to free radial just developped in third semester  premarure baby prone to be17

58. Feeding

59. Detection and management of complications (e.g., resuscitation, assisted respiration, infection )18

61. Dry newborn with clean (warm) cloth or towel

62. Remove wet towel and wrap/cover with a second dry towel

63. Bathe after temperature is stable19

64. 20

65. 21

66. 22

67. 23

69. Could be in hospital or after early discharge24

70. 25 Kangaroo Mother Care

72. Held upright (or diagonally) and prone against skin of mother, between her breasts

73. Head is on its side under mother’s chin, and head, neck and trunk are well extended to avoid obstruction to airways

74. Newborn’s clothing:

75. Usually naked except for nappy and cap

76. May be dressed in light clothing

77. Mother covers newborn with her own clothes and added blanket or shawl26

79. Breastfed on demand

80. Supervised closely and temperature monitored regularly

81. Mother needs lots of support because kangaroo care:

82. Is very tiring for her

83. Restricts her freedom

84. Requires commitment to continue27

85. 28 Effectiveness of Kangaroo Mother Care Randomized controlled trial Conducted in three tertiary and teaching hospitals in Ethiopia, Indonesia and Mexico Study effectiveness, feasibility, acceptability and cost of kangaroo mother care when compared to conventional methods of care Cattaneo et al 1998.

87. Helps breathing of newborn to be more regular; reduce frequency of apneic spells

88. Promotes breastfeeding, growth and extra-uterine adaptation

89. Increases the mother’s confidence, ability and involvement in the care of her small newborn

90. Seems to be acceptable in different cultures and environments29

92. Seems to be acceptable in different cultures and environments

93. Contributes to containment of cost— salaries, running costs (electricity, etc.)deLeeuw et al 1991; Karlsson 1996; Lamb 1983; Ludington-Hoe et al 1993; Ross 1980. 30

95. Breastmilk = best nourishment

96. Already warm temperature

97. Facilitated by kangaroo care

98. If Breast milk is not availble, consider milk formula : Preterm formula --- until 2000 gm then change to After Discharged Formula31

99. 32 START ANTIBIOTIC ADMINISTRATION EVEN WITHOUTH ANY SYMPTOMS

100. 33

101. 34

102. 35

103. 36

104. 37

105. 38

106. 39 LBW: Supplements

107. 40

109. Assess : Antenatal steroids ???

110. Surfactant

111. CPAP : BUBBLE CPAP 41

113. SUPPORTING TREATMENT :

114. NUTRITION

115. OXYGENATION

116. WARMTH

117. IMMUNOTHERAPY ; IF IT IS NEEDED 42

119. Foto therapy

120. Feeding : Breast milk

121. Fluid therapy

122. Antibiotics according to condition of infection 43

124. Due to : prematurity and toxic oxygen

125. Awarness to : baby with Ventilator and high flow/consentration of O2

126. Opthalmologic examination :

127. < 32 weeks of gestation

128. < 1500 grams

129. Done : 1 months of age

130. Lasik surgery 44

132. Complication : Hypoxemia

133. Oxygenation and breathing stimulation : Aminophylline or Theophylline

134. Mechanical Ventilator45

136. Blood Glucose level

137. Hypoglycemia : < 45 mg/dL

138. Dextrose infusion

139. Glucose Infusion Rate ( G I R ) 46

141. Decreasing of consicousness , deficit neurologics, seizure

142. USG or CT scan

143. Consult to Pediatric Neurology Division and Neurosurgery 47

145. Confirmed by clinically and laboratory

146. Shoulde corrected by considering anion gap

147. Administration of bicarbonate : awarness of false route 48

149. The survival at high risk of LBW for long term neurocognitive deficits

150. Two types of LBW : premature and IUGR

151. Problems accordingly to the type

152. Management consist of : warmth, feeding, management of complication

153. Breast feeding is prioritized, in case of breastmilk is not available, consider milk formula49

154. THANK YOU 50