Dr.Rajkumar PatilAsstt.Prof.,Dept. of Community Medicine

A V Medical College,Pondicherry

Low birth weight

(LBW)Gestational age Pre-term Term Post term

LBW classificationPre-term babies Small for date(SFD) babies:

– <10th percentile for the gestational age– higher risk

SFD

Problem statement

Global

17% of live births

India

30% of live births(but 5% less than 2 kg)

Risk factors for LBW

Malnutrition Severe anaemia Infection Unregulated fertility Age(<16 yr) Hard physical work during pregnancy Smoking

Prevention and control of LBW

Dietary improvementsIFA tabletsControlling infectionsEarly detection and treatment of disordersFamily planning

Management of LBW babies

Intensive careFeedingAntibiotics

Weight <1.5 kg Incubatory care(Temp.,Humidity,Oxygen) Kangaroo Mother Care(>1.5 kg,normal)

Weight >1.5 kg Incubatory care(Temp.,Humidity,Oxygen) Radiant warmer Kangaroo Mother Care

NICU

Kangaroo mother care (KMC)

Infant Feeding

Bottle feedingBreast feeding

Global Recommendations for

Infant and Young Child Feeding (IYCF)

Exclusive breastfeeding for 6 months

Continue breastfeeding for up to 2 years or more

Introduce nutritionally adequate and safe

complementary foods after the age of 6 months

Colostrum

Importance

• Antibody -protects from infection and allergy

• White cells- protects from infection

• Purgative- clears meconium; helps prevent jaundice

• Growth factors- helps intestine mature; prevents allergy

• Vitamin A -reduces severity of infections; prevents eye diseases

Nature’s way of coating the baby’s intestines with antibodies even before he starts taking anything else

Breastfeed on demand

Show mothers how to breastfeed

Tell her how to maintain lactation if she is separated from the infant

8-10 times or more in 24 hours

Breastfeed at night also

No restrictions on length/numbers of breastfeeds

ABCD of benefits by breast feeding

•Available easily•Allergic condition reduced•Anti-microbial factors

•Best food for infant•Bonding between mother and child•Body shape returns quickly back to pre-pregnancy level•Breast cancer risk reduced•Bleeding reduced•Biochemical advantages (Prevents hypocalcaemia & hypomagnesaemia)

•Clean•Cheap

•Development of IQ, jaw, mouth•Digested easily

Constituent Human milk(gm/l)

Cow’s milk(gm/l)

Proteins 11 33

1. Casein 4 28

2. Soluble proteins(lactalbumin,lactotransferrin,lysozyme)

7 5

Non-proteinNitrogenous substances

0.32 0.32

Lipids 35 35

Carbohydrates

70(lactose 62)

50

Minerals 2 8

Vitamin C 60 mg 20 mg

Vitamin D 50IU 25IU

Energy 640-720 kC 650 kC

Human milk and cow’s milk

Some Contents of Human milk

ProteinoMore cysteine (essential for premature)oIgG,lysozymes

FatsoPUFA richoEasier to digest

CarbohydratesoLactose for brainoLactobacillus growth in intestine beneficial

Vitamins and MineralsoVitamin A,C and DoLow Iron better bioavailabilityoLess Ca but better absorbed oLess sodium,less load on kidney

Signs of correct attachment mouth wide open

lower lip is turned outside

chin touching the breast

areola of breast not visible below the lower lip

areola of breast and nipple are inside baby’s mouth

tongue under the teat

Helping Mothers with Breast Problems

• Fullness• Engorgement• Mastitis• Breast abscess• Cracked nipple• Sore nipple• Inverted nipple

Expression of breast milk

Expression of breast milk

Burping the child

Artificial Feeding

Not on human milk

Indications

Mother very ill/died/unavoidably absent

Failure of breast milk production

Mother rejects infant

Principles of artificial feeding

1.Think of infants requirements: Energy:100kC/kg Protein:2 g/kg Carbohydrate:10 g/kg

2.After 4 months diluted milk can be used

3.Feeding 6-8 times (during illness more feeds)

What can be used for artificial feeding?

1.Dried milk

Dried whole milkSimple to reconstituteFortified with vitaminsExpensive

2.Cow’s milk

CheapEasily availableDilute with water for <4 months infant (25-33% water)Add sugar (5-10 gm)

Risks of artificial feedingFor child:diarrhoea and respiratory infections

allergy and milk intolerance

infant mortality

malnutrition,Vitamin A deficiency

chronic diseases (DM,hypertension)

Lower IQ

For mother:interferes with bonding

pregnancy sooner

overweight

anaemia

ovarian and breast cancer

Weaning

Weaning is gradual process to introduce foods other than breast milk or infant formula at around 6 months

Breast feeding should also be continued till 2 years

Baby Friendly Hospital Initiative (BFHI)

Launched in 1991 by WHO and UNICEF

10 steps to be fulfilled by the hospitals

1. Have a written breastfeeding policy that is routinely communicated to all health care staff

2. Train all health care staff in skills necessary to implement

this policy

3. Inform all pregnant women about the benefits and management of breastfeeding

4. Help mothers initiate breastfeeding within a half an hour of birth

5. Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants

6. Give newborn infants no food or drink other than breast milk, unless medically indicated

7. Practice rooming-in : allow mothers and infants to remain together 24 hours

8. Encourage breastfeeding on demand

9. Give no artificial teats or pacifiers

(dummies or soothers) to breastfeeding infants

10.Foster the establishment of breastfeeding support groups

and refer mothers to them on discharge from the hospital