Low Birth Weight

Overview:

Fetal circulation in babies with low birth weight (LBW) is similar to that in full-term infants, with key shunts like the ductus venosus, foramen ovale, and ductus arteriosus allowing blood to bypass the lungs. However, LBW infants, especially those born prematurely, often have immature circulatory and respiratory systems, which can lead to difficulties in closing these shunts after birth, resulting in complications such as patent ductus arteriosus (PDA) or persistent foramen ovale. These issues can require medical interventions like oxygen therapy or surgical correction. Additionally, LBW infants may have increased vulnerability to respiratory distress syndrome (RDS) and may require intensive respiratory support to ensure adequate oxygenation and circulation.

1. Skin Care 

Prevent or minimize skin breakdown by: 

• Protect skin by using pectin-based barrier (skin prep) for taping ETT. 

• Minimize tape use and changing. 

• Avoid the use of adhesives (Benzoin). 

• Use sterile water to clean skin, avoid the use of soap. 

• Avoid the use of alcohol (dries skin). 

2. Temperature: 

Minimize insensible water loss and maintain a neutral thermal environment by: 

• Use a prewarmed, double-walled incubator, or cover the top of radiant warmer with plastic wrap ensuring that it does not touch the infant. 

• Prewarm linens, hands, and anything else that may come in contact with the infant. 

• Monitor body temperature closely during procedures, particularly if the infant is covered by drapes. 

• Adjust humidity as appropriate. 

3. Respiratory Support: 

Consider the following for infants receiving mechanical ventilator or NCPAP: 

• Usually, intubation and surfactant replacement is necessary to treat the premature infant’s surfactant deficiency. 

• Mechanical ventilator settings are usually consistent with higher rate and lower PIP to reduce lung energy. 

• Protect the infant's airway, use caution when repositioning to avoid dislodgement .

• Have resuscitation equipment readily available  .

• Wean oxygen, as tolerated, to avoid hyperoxia, a risk factor for retinopathy of prematurity (ROP). Always know your

  hospital's policy on SPO2 ranges. It's very important to keep FiO2 as low as possible to maintain the correct SPO2 range. 

• Avoid wide swings in oxygen saturation levels.

4. Other Considerations:

• Humidify and heat all respiratory gases to minimize insensible fluid losses. 

• Use consistent positioning during CXR for ETT placement (have the patient in the same position, if possible, for CXR). 

• Use diligence with NCPAP positioning to avoid skin breakdown. The entire head gear needs to be removed and integrity checked focusing on forehead, ears, behind the ears, nares and top lip. The mask and prongs are interchanged to prevent breakdown. A hat on the infant's head is helpful to prevent misshaping the head. Always know your hospital protocol on skin integrity checks. 

• Minimize suctioning (reduce stress and minimize rapid changes in cerebral blood flow) .

• Monitor the infant very closely for changes in breathing, oxygenation, and ventilation. 

• Consider changing the infants' position sometimes to prevent atelectasis in dependent lung. 

5. Supportive Care: 

Provide neurodevelopment support: 

• Mimic fetal positioning, provide closed boundaries, facilitate hand-to-mouth movement, avoid rapid position changes for cerebral blood flow, turn slowly and gently. 

• Provide “cluster” care with RN (touching the baby at the same time to minimize handling). 

• Maintain a low environmental noise level, maintain low light in the environment, as appropriate, and protect eyes when lights are used. 

• Assess and treat pain, as indicated .

• Be aware of medication side effects (such as respiratory depression).