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Common Neonatal Problem

Low birth weight babies

Who is a premature / low birth weight baby?

Premature babies are those who are born before completing thirty seven weeks of pregnancy, that is, 3 weeks or more before the expected date of delivery. A low birth weight baby has a birth weight"<" 2.5 kg. Many premature babies also have a low birth weight. Sometimes, babies born at full term may also have a low weight. Premature babies and low birth weight babies are more vulnerable to infections and other complications than full-term babies and need to be given special care.

What are the important points to be kept in mind for home care of premature or low birth babies (LBW)??

Any baby who is born before completing 37 weeks of pregnancy (i.e. is born 3 weeks or earlier than the expected date of delivery) or has a weight less than 2.5 kg, requires special care. This baby must be shown to a doctor who will decide if the baby can be treated at home or requires to be admitted for medical supervision. The key

  1. Feeding: Breast milk is ideal for these babies. Milk of a mother with a premature baby is specially suited to meet the requirements of the premature baby. Most low birth weight babies and premature infants born after 34-35 weeks of gestation can suckle at the breast effectively. They may however get tired easily by the effort involved in sucking. Therefore, they need to be fed for a longer duration at each feed. If a baby cannot suckle effectively at the breast or gets tired easily, they can be offered expressed breast milk with a cup and spoon. If that is also difficult, then these babies need to be admitted since they may require to be given feeds using tube feeding technique under medical supervision.
  2. Temperature regulation: Low birth weight infants are more prone to becoming cold, especially during winter. Thus they need to be kept covered with warm clothes even more carefully, taking care to keep the hands, feet and head covered. Touching the feet of the baby gives a good idea about his temperature. Normally, the feet should be pink in color and feel warm to touch. If the feet are turning blue or feel cold to touch, the baby needs more warmth. This can be done if the mother holds the baby close to her body so that her body heat warms the baby. Heaters can be used to increase the room temperature taking care they are kept at a safe distance
  3. A LBW infant can catch infection more easily than other babies. Hands must be washed before touching or feeding the baby and handling the baby by visitors should be restricted to a minimum. If the baby develops signs of sickness he should be promptly shown to a doctor. These signs are discussed in a separate section,

 

How do I feed my premature/low birth weight child?

Mother‘s milk is specially suited to meet the requirements of the premature baby. Most low birth weight babies and premature infants born after 34-35 weeks of gestation can suckle at the breast effectively. They may however get tired easily by the effort involve in sucking. Therefore, they need to be fed for a longer duration at each feed

 

What should I do if my premature or low birth weight child cannot suckle?

If your baby cannot suckle effectively at the breast or gets tired easily; you can give expressed breast milk with a cup and spoon. If your baby finds it difficult, then consult a doctor. Hospitalisation may be required to feed such babies.

 

How can I ensure adequate warmth for my premature/low birth weight (LBW) baby

Low birth weight infants are more prone to develop hypothermia (decreased body temperature). You need to keep your baby covered with warm clothes, taking care to keep the feet and head covered. Touching the feet of the baby gives a good idea about his temperature. If the feet is pink in colour and feel warm to touch, it is normal. If the feet are turning blue or feel cold to touch, the baby needs more warmth. Holding the baby close to your body provides warmth to your baby. Heaters can be used to increase the room temperature but they should be kept at a safe distance.

 

What precautions should I take that my LBW baby does not get infection?

LBW infant can catch infection more easily than other babies. You must wash your hands before touching or feeding the baby. Handling the baby by visitors should be restricted to a minimum. If the baby developssigns of sickness consult a doctor.

 

Vomiting

What is the cause of vomiting in neonates?

Many babies vomit on the first day of life due to irritation of stomach by swallowed maternal fluids. Vomiting/ regurgitation after feeds is also very common and is due to ingestion of air during feeding. The milk brought out is usually small in amount and is curdled. The baby continues to gain weight adequately. The regurgitation of milk can be prevented by use of proper feeding position by mother and burping the baby for 10 to 15 minutes after each feed. This helps in bringing out the swallowed air. Burping is done by tapping on the back keeping her/him in upright position on the lap. If the vomiting is persistent, projectile (forceful), yellow/green colored or is interfering with weight gain, the baby needs to be evaluated by a doctor.

Cord infection

How do I know that my baby’s cord is healthy?

A normal umbilical cord should be dry. It gradually shrivels and falls off by itself by 7-10 days. If the cord gets infected, it looks damp or wet. The skin around the base of the cord may become red and some-times pus may be seen there. A baby with infection of the cord requires treatment and must be shown to a doctor. If the treatment is delayed, the baby may develop additional features like fever, lethargy or poor feeding. These signs indicate that the infection is spreading to the rest of the body as well. Early treatment of cord infection prevents spread of infection to the rest of the body, a serious illness in a newborn baby.

What are the signs of cord infection?

If the cord gets infected, it looks damp or wet. The skin around the base of the cord may become red and sometimes pus maybe seen there. A baby with infection of the cord requires treatment and must be shown to a doctor. If the treatment is delayed, the baby may develop additional features like fever, lethargy or poor feeding. These signs indicate that the infection is spreading to the rest of the body as well. Early treatment of cord infection prevents spread of infection to the rest of the body

 

Jaundice

Do all new born babies get jaundice?

all new born babies get jaundice? Many newborns that are otherwise normal develop yellow colour of their skin (jaundice) after the first day. This is called physiological jaundice. It appears on the second day, reaches a peak on the 4th or 5th day and then disappears by 7th or 8th day. It does not require any treatment. If the baby has jaundice that appears within 24 hours of birth, persists beyond 14 days of life, or is deep, involving abdomen, palms and soles, must be consult a doctor

Nappy rash

How should a nappy rash be treated?

A rash on the buttocks usually results exposure of skin to prolonged wetness. Use of plastic nappies and delay in changing nappies is a common cause of nappy rash. The buttocks should be cleaned gently with wet cotton, allowed to dry and exposed to air for at-least some time during the day. Local application of coconut oil helps in healing. A rash that does not respond to these measures needs to be shown to a doctor.

Cry

Why do babies cry?

The babies usually cry when they are hungry or in discomfort. This may be due to an unpleasant sensation of full bladder before passing urine, painful evacuation of hard stools, tight fitting clothes or mere soiling by urine and stools. Some times they just want to be picked up. Many babies are irritable when sleepy. The spells of crying unrelieved by feeding, changing the soiled napkins or by rocking the baby may be due to abdominal colic which subsides spontaneously. It does not require any treatment. Excessive, inconsolable cry may be a sign of a medical problem in a baby and must be shown to the doctor.

Signs of serious sickness

What are the signs of serious sickness in a neonate??

A baby who is feeding well, is alert and active in between the periods of sleeping, and has warm and pink palms and soles is a healthy baby. The signs of serious sickness in a neonate include:

  1. Fever/ feels cold to touch despite adequate clothing and warm environment
  2. Loose stools, specially a change from the previous pattern
  3. Abnormal movements suggestive of convulsions
  4. Continuous crying
  5. Cough/ difficulty in breathing
  6. CIrritability
  7. Lethargy or excessive sleepiness
  8. Inability to feed
  9. Persistent vomitin
  10. Abdominal distension
  11. Pus from ears/ umbilical stump/ boils over skin

A baby with any of these signs must be shown to a doctor without delay.

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