10.5 Care of the low birth weight newborn (1500-2500 g)

Low birth weight indicates prematurity (less than 37 weeks) or intrauterine foetal growth retardation or a combination of the two.

Low birth weight newborns, whether premature or not, are at significant short-term risk of hypothermia, hypoglycaemia, apnoea, respiratory distress, jaundice, infection, anaemia, dehydration and feeding problems, and at significant long-term risk of poor psychomotor development.

Newborns who are sick or who weigh less than 1500 g should be referred to a neonatal care unit whenever possible.
Newborns who weigh 1500 to 2500 g, regardless of the term, are managed in the maternity hospital if they are not sick, according to the recommendations below.

10.5.1 Kangaroo care

Figures 10.4 - Kangaroo care

The Kangaroo mother care1 is a method of caring for infants that involves putting them on the mother's chest skin-to-skin, preferably 24 hours a day.
This method can be used for all non-sick infant whose birth weight is less than 2500 g (prematurity and/or intrauterine foetal growth retardation).

The bare infant is placed vertically against the mother’s chest; the mouth should always be able to reach the nipple. Use a pagne to hold the infant.
If needed, use a blanket to keep the mother and infant warm.
When the mother is sleeping, her bust should be raised and the infant should be monitored.

The objectives of the Kangaroo care are:
– To keep the infant warm and to prevent or treat hypothermia.
– To help get breastfeeding started and keep it going.
– To foster the mother-infant bond and reduce the infant’s stress.
– To reduce episodes of apnoea and bradycardia in premature infants.

Note: the skin-to-skin contact can also be done by the father, another family member or a wet-nurse during periods when the mother is not available.

10.5.2 Thermoregulation

– Cover the infant’s head to reduce heat loss.
– Make sure that the room temperature is at least 25°C.
– Use the Kangaroo care (Section 10.5.1).

10.5.3 Feeding

– Exclusive breastfeeding is the best choice (Appendix 3).

– If sucking is ineffective but the swallowing reflex is present: express the milk manually or using a breast pump and feed the infant using a cup/spoon (Appendix 3, Section 3.2 and Section 3.3).

– If sucking is ineffective and the swallowing reflex is poor or absent: express the milk and feed the infant using a gastric tube (Appendix 3, Section 3.2 and Section 3.4).

– For the daily amounts required for feeding, see Appendix 4.

– If the mother does not have enough milk:
• In the first 72 hours of life, make up the required amounts with 10% glucose PO.
• After 72 hours of life, make up the amount with infant formula (or if not available, use diluted F 100 milk2 ).
At the same time, continue to stimulate the mother’s milk production (breast pump and the “supplementary nursing" technique, Appendix 3, Section 3.5).

– For newborns less than 1500 g, glucose is routinely given in addition to the mother’s milk (Appendix 4).

In case of regurgitation:
– Administer each meal very slowly.
– Hold the infant tilted slightly head-up.

In case of vomiting, abdominal distension, blood in the stool or greenish, foul-smelling stool, stop feeding and request a medical opinion.

In all cases, try putting the infant to the breast periodically to test if breasfeeding is effective or not.

10.5.4 Monitoring

Same monitoring as for a newborn > 2500 g, plus:
– Daily weighing;
– Temperature every 4 hours;
– Blood glucose test before every meal or every 3 hours until there are 3 consecutive normal results. In case of hypoglycaemia, see Section 10.3.5.

Ref Notes
1 For more information: World Health Organization. Kangaroo mother care: a practical guide. 2003.

Diluted F-100 milk: 1 sachet (456 g) of F-100 milk in 2800 ml of water.