CASE PRESENTATION

ON
LOW BIRTH WEIGHT BABY

SUBMITTED TO: - SUBMITTED BY: -

Mr. Manpreet Singh Anamika

Asst. Professor M.Sc. Nsg 2nd Year
(Child Health Nursing)
IDENTIFICATION DATA

Name of mother: Kamaljit Kaur

Age of mother: 32 years/Female

L.M.P: 09.07.2020

EDOD: 15.04.2021

Date of Delivery: 28.02.2021

GPLAS Score: G1 P1 L1 A0 S0

Name of child: Baby of Kamaljit Kaur

Sex: Male child

Gestational Period: 30 weeks/05days

Age: 5 days

Developmental age: Neonates

Religion: Sikh

Date of birth: 28.02.2021

Birth weight: 700 gm

Diagnosis: Low birth weight

Address: Maholi Kalan

CHIEF COMPLAINTS: -
Baby have breathing problem, increase heart rate after birth & poor breast feeding of baby.

PRESENT ILLNESS (MEDICAL/SURGICAL):-

➢ Heart rate increased

➢ Fetal distress
➢ Poor feeding
➢ Body skin bluish

Surgical: - No any present illness to the child.

PAST ILLNESS (MEDICAL/SURGICAL) :-

No any past medical and surgical history of the child

FAMILY HISTORY: -

Child is lived in nuclear family

Mr. Devinder Singh Mrs. Kamaljit Kaur

Patient (Father) (Mother)

Father

Mother
B/O Kamaljit Kaur
 BIRTH HISTORY

✓ Prenatal history: Pregnancy was confirmed at 4th weeks of pregnancy. Pre-natal care initiated at 12 weeks of gestation and continued
throughout the pregnancy. Nothing uneventful was reported during pregnancy. Three antenatal visits were done by the mother. IFA
prophylaxis was taken by the mother, TT immunization was taken by the mother.
✓ Natal history: Delivery done at 30 weeks & 05 days of gestation by LSCS in Civil Hospital Ludhiana. No any abnormalities during the
intra- natal period.
✓ Postnatal history: No complaints reported during the postnatal period by the mother. Lochia Rubra was present. Birth weight of baby is
700gm and length were 45cm, baby cried immediately after birth. APGAR score is 8 and 9.
IMMUNIZATION TAKEN: -

S.no Vaccine Dose Route

1. BCG 0.05ml ID
2. Hepatitis B 0.5ml IM
3. OPV 2 drops Oral

SOCIO ECONOMIC STATUS: -

Baby of Kamaljit Kaur belongs to a middle-class family. The monthly income of father is Rs. 20,000/-
Housing: The parents lives in 5 rooms cemented house with separate bathroom and toilet. The ventilation and lighting is adequate in the
house and uses tube and bulb as the source of light in the night. Water supply from the municipal corporation taps. The disposal of waste is
done by burning method.
PHYSICAL EXAMINATION-

Head

Head circumference: 23.3cm

Caput succedaneum Not present

Cephalohematoma Not present

Encephalic Not present

Microcephaly Not present

Encephalopathy Not present

Size of fontanel Normal not depressed

Forceps marks Not present

Eyes

Size: Appropriate for age

Shape: Normal

Symmetry: Symmetrical

Sclera Shiny and white in colour

Pupils Equal, round, reactive to light and accommodation

Discharge No any discharge

Vision: Not checked

Movement: Normal eye movement in all directions

Ears

Pinna: Normal in shape

Position: Equal alignment

Cartilage: Cartilage present

Auditory canal: Normal

Tympanic membrane: Not assessed

Hearing: Normal i.e. baby react toward loud voices

Nose

Shape of nose: Normal

Shape of bridge of nose: Normal

Potency of nostril: Adequate

Perforation: None

Septum: Normal, not deviated

Nasal mucosa: Pink and moist

Discharge: No discharge
Mouth

Size of oral cavity Small cavity

Opening of oral cavity Normal

Tounge Normal no tie

Cleft lips Not present

Cleft palate Not present

Neck

Goiter Not present

Thyroglosal Not present

Bronchial arch Normal

Lymph nodes Not palpable

Range of motion Movement is adequate

Chest

Size Normal range

Shape Round

Symmetry Symmetrical

Nipples and breast Spacing normal and no discharge

Scapula symmetry Appears symmetrical

Inspection Round in shape

Auscultation Normal sound is heard

Heart rate 170p/m

Palpation No tenderness, tumor or growth

Breath sounds Normal breath sounds are heard

Apnea It was present at birth remain up to 10-15 sec

Respiration rate It was 66 breaths/min

Periodical breathing pause It was 5-10 sec show bradypnea

Abdomen

Inspection No scar present, normal healthy cord is present

Palpation Liver margin not palpable

Auscultation Dull bowel sounds

Percussion Normal, no fluid accumulation

Umbilicus Hernia absent

Reproductive System

Urethral and anal patency are normal

Testis is normal

SYSTEMIC EXAMINATIONS

Integumentary system

Skin: Bluish discoloration of the skin was present skin turgor elasticity

Colour: Bluish

Skin cresses: Present

Texture: Dry and thin

Gastrointestinal system:

Inspection: No scare and lesion

Palpation: No tenderness

Auscultation: Bowel sound is normal

Percussion: Dull sound is hear

Liver function

Bilirubin level >5mg/dl

Hypoglycemia was present blood glucose level was < 30mg p/dl (1.65mmol/l)in first 24 hours of life<then 45mg/dl(2.5mmol/l) indicate
metabolic problem in newborn normal range was 50 mg per /dl 8.3gm p/dl but in this infant level was 4.0 so vitamin k 1mg i/m was given to
infant

Conjugate bilirubin: 6mg/dl was normal range but, in this infant, it was >6mg indicate jaundice infant kept in phototherapy

Back:

Spine: c shape supine, flat and straight and fine

No lesion and not scar are present

Extremities:

Symmetry of extremities: Symmetrical

Joints: No pain, tenderness

Hip location: No hip dislocation

Range of motion: Less range of motion

Muscles: Less fat due to extreme low birth weight

Not presence of polydactyly and syndactyly

Palmer creases: Normal

VITAL SIGNS: -

Temp Pulse Respiration Heart Rate

100 ℉ 30 b/m 66p/min 170p/m

99 ℉ 36 b/m 70p/min 148p/m

99.6 ℉ 36 b/m 76p/min 148p/m

ANTHROPOMETRIC MEASUREMENTS: -

✓ Chest circumference 33cm

✓ Weight 700g
✓ Height 45cm
✓ Head circumference 23.3cm

REFLEXES: -

REFLEXES PRESENT OR NOT

Rooting reflex According to mother rooting reflexes is present baby is

sucking the breast milk

Globular Present the Globular reflex

Moro’s Poor the Moro’s reflex

 Swallowing & sucking Present

Doll’s eye Present

Tonic neck reflex Present

Palmer grasp reflex Present

GROWTH AND DEVELOPMENTAL: -

Physical Fine motor Social and Emotional Intellectual Development Language Development
Development Development

Lies in fetal Closes eye to bright light. Bonds with mother not Beginning to develop concepts Cries vigorously
position with yet developed. e.g. becomes aware of physical Respond to low-pitched
knees tucked up sensations such as hunger. tones by moving his limbs

Unable to raise Opens eye when held in an Explores using his senses
head. Head falls upright position.
backwards if
pulled to sit cry to indicate need.

Reacts to sudden
sound
INVESTIGATION: -

Name of investigation Patient Value Book value Remarks

Random blood sugar <35 mg p/dl 50 mg p/dl hypoglycemia
Spo2 88% 100% Respiratory distress/acidosis
CRT <25 sec 35sec Abnormal
Bilirubin >5mg p/dl <5mgp/dl Normal
Conjugate bilirubin 4mgp/dl 6mg p/dl Normal

HB 13.1mg/dl Mch11.17 Normal

Fch11.5-15.0
Neutrophil 48.8 % 40-80 % Normal

Lymphocytes 37.6% 20-40% Normal

Esonophil 2.5% 01-0.6% Raised

Monocyte 10.3 % 2-10% Raised
Basophli 0.8% 1-2 Normal
Platelet count 4.30thou/mm3 150-400thou/mm Raised

RBC count 3-90thou/mm3 3-6-5.thou/mm3 Normal

MEDICATION: -

NAME OF DRUG DOSE ROUTE TIME ACTION

Meropenam 40mg IV BD Antibiotic

Amikacine 20mg IV BD Antibiotic

Linsopam 25mg IV BD Antibiotic

 DISEASE CONDITION
INTRODUCTION

Low birth weight has been defined by the World Health Organization (WHO) as weight at birth of less than 2,500 grams (5.5 pounds),This
practical cut-off for international comparison is based on epidemiological observations that infants weighing less than 2,500 g are approximately
20 times more likely to die than heavier babies. More common in developing than developed countries, a birth weight below 2,500 g contributes
to a range of poor health outcomes.

DEFINITION: -

Birth weight is the first weight of the fetus or newborn obtained after birth. For live births, birth weight should preferably be measured within the
first hour of life, before significant postnatal weight loss has occurred.
Low birth weight is defined as less than 2,500 g (up to and including 2,499 g).

Very low birth weight is less than 1,500 g (up to and including 1,499 g).

Extremely low birth weight is less than 1,000 g (up to and including 999 g).

CAUSES :-

Book picture Patient picture

➢ The primary causes of VLBW are premature birth (born <37 ➢ The primary causes of VLBW are premature birth (born
weeks gestation <37 weeks gestation
➢ Often <30 weeks) ➢ X
➢ Intrauterine growth restriction (IUGR) ➢ IUGR
➢ Due to problems with placenta ➢ X
➢ Maternal health, or to birth defects. ➢ X
➢ Many VLBW babies with IUGR are preterm and thus are ➢ Very low birth weight baby with IUGR
both physically small and physiologically immature.
➢ VLBW ➢ VLBW
➢ More than 50% of twins and sother multiple gestations are ➢ X
VLBW.
➢ Maternal health: Women exposed to drugs, alcohol, and ➢ X
cigarettes during pregnancy are more likely to have LBW or
VLBW babies.
➢ Mothers of lower socioeconomic ➢ X
➢ Poor pregnancy nutrition inadequate prenatal care ➢ X
Increased long term risks :-
➢ cerebral palsy ➢ X
➢ Developmental delay ➢ X
➢ Learning disabilities ➢ X
•Retinopathy of prematurity (ROP) ➢ X
•Prematurity itself ➢ X
•Hyperbilirubinemia ➢ X
•Meningitis ➢ X
•Hypotension ➢ X
Complication of pregnancy: ➢
Are also the factors that can contribute to VLBW.
➢ Neonatal complications are increased in VLBW ➢ X
➢ ELBW ➢ Present
Clinical problems:
➢ VLBW and ELBW include: ➢ VLBW and ELBW include:
➢ Hypothermia ➢ Hypothermia
➢ Hypoglycemia ➢ Hypoglycemia
➢ Increased O2 consumption and metabolic acidosis. ➢ X
➢ Hypoxia ➢ Hypoxia
➢ Prenatal asphyxia ➢ X
➢ Respiratory Distress Syndrome, due to surfactant deficiency ➢ Respiratory Distress Syndrome, due to surfactant
➢ Apnea deficiency
➢ Fluid and electrolyte imbalances due to increased insensible ➢ Fluid and electrolyte imbalances
water loss (due to ↑ surface area/body weight, thin skin),
impaired renal function. They are at risk for dehydration
➢ Fluid overload ➢ X
➢ Hypernatremia ➢ X
➢ Hyperkalemia ➢ X
➢ Hypomagnesaemia ➢ X
➢ Hyperbilirubinemia (Indirect)((unconjugated) ➢ X
hyperbilirubinemia due to bruising or hemorrhage, ↓ RBC
survival, hepatic immaturity, delayed enteric feedings and ↓
gut motility.
 ➢ IUGR ➢ Present
➢ Direct (conjugated) hyperbilirubinemia ➢ X
➢ Anemia ➢ X
➢ Impaired nutrition ➢ Impaired nutrition
➢ Infection ➢ Presence of infection

TREATMENT:

Because of the increased risk for multiple problems, these infants require meticulous attention to all facets of their care. The following are but a
brief summary of certain aspects of the care of these fragile infants:

1. Resuscitation

2. Respiratory Care: The majority of ELBW (i.e., <1,000 g) will require intubation at birth (to assist in their cardiopulmonary adaptation to
extra-uterine life).
3. Oxygen therapy: Maintain SpO2 in range of 85-92%. If SpO2 is > 94%, arterial oxygen tension may be high (>100 mmHg) because of the
inaccuracy of the pulse oximeter at high saturations. This puts the infants at ↑ risk for ROP. Do not write titration orders for oxygen.

4. Fluids: On the 1st day of life, preterm infants should receive restricted fluids (e.g., 6080 mL/kg/d). However, for ELBW infants, fluid intake
should be higher (e.g., 100125 mL/kg/d). Follow intake and output closely, at least q12h for the first several days.
NURSING DIAGNOSIS BASED ON NURSING THEORIES:

 Virginia Henderson’s Need Theory

1st Diagnose is based on Virginia Henderson’s Need Theory, aspect is breath normally.

➢ Impaired Gases exchange related to lack of lung surfactant.

2nd Diagnose is based on Virginia Henderson’s Need Theory, aspect is eat and drink adequately.

➢ Fluid volume deficit related to insensible water loss and inadequate breast feed.

3rd Diagnose is based on Virginia Henderson’s Need Theory, aspect is select suitable clothes - dress and undress.

➢ Risk for cold stress related to in mature temperature regulating center mechanism.

4rth Diagnose is based on Virginia Henderson’s Need Theory, aspect is keep the body clean and well groomed & protect the integument.

➢ Risk of infection related to hospital acquired infection.

  Florence Nightingale Environment Theory:
Ventilation and warmth

Health of houses

Petty management

Noise

Variety

Food intake

Food

Bed &bedding

Light

Cleanliness of rooms/wall

Personal cleanliness

Chattering hopes and advices

Observation of the sick

5th Diagnose is based on Florence Nightingale Environment Theory, aspect is Observation of the sick

➢ Deficit knowledge related to home care and disease condition of the baby.
 NURSING CARE PLAN

Nursing assessment Nursing Goal Intervention Implementation Rational Evaluation

Diagnose
1.Subjective data: - Impaired To maintained Assess the general General condition of patient Help in maintained Balance is
Mother said that - I
Gases Balance condition of infant. was assessed it indicate of O2 and Co2. maintained
delivered in between
exchange respiratory distress. between the
o2/co2
Before 9th month
related to O2 and CO2.
-Baby not cries after
lack of Assess the level of level of cyanosis was Help in management
birth
lung cyanosis. assessed it was peripheral of acidosis.
Blueness of body was
surfactant cyanosis.
present.
based on
Objective data: -
Virginia Assess the Apgar score of The Apgar score was <the 6 Help in identified
I observed the condition
Henderson infants in 1 min after birth. p/min. respiratory distress.
of the baby, assessed the
’s Need
skin of the baby
Theory. Clear airway and Air passage was cleaned and Help in gases
administer O2 as per O2 was given as pre doctor Maintains.
doctor orders. order.

warmth was planned. warmth was provided by Help in prevent the

increased room temperature hypothermia.
34 c-.
Nursing Nursing Goal Intervention Implementation Rational Evaluation
assessment Diagnose
2.Subjective Fluid volume To maintain Assess the sucking Sucking reflex was checked it Help to know the There was no
data: -
deficit related fluid volume, reflex of newborn was poor so feed provided by condition of infant. hypoglycemia
Mother said
to insensible prevent orogastric feeding. and dehydration
that my baby
water loss and hypoglycemia feed taken by
passed more
inadequate and Assess fluid and Result of blood sugar was shown Help in prevention of orogastric and
urine. Not
breast feed dehydration electrolytes Hypoglycemia so 10% Dextrose hypoglycemia. spoon
take breast
based on was given as pre doctor order 30
feed
Virginia ml for 8 hours.
remain in
Henderson’s
sleep
Need Theory. Assess the skin Skin turgor was checked by Help in assessment of
Objective
data:- turgor pinch of skin and see the dehydration.
I observed the
condition of fontanel there was
baby, Not take
no sign of dehydration.
breast feed,
passed more
urine. sleep all
Plan for daily weight Daily weight was taken it was Help to identified the
over the day
record. increased per day. health status of infant.
Nursing Nursing Goal Intervention Implementation Rational Evaluation
assessment Diagnose
3. Subjective Risk for cold To maintain Assess the gestational age Gestational age was To know the function Now the body
data
stress related body of neonate. assessed it was 37weeks. regulating center which temperature was
Mother of
baby said that to in mature temperature in Control temperature. in normal range
my baby
temperature normal range it was 98℉.
looks warm
Objective regulating Plan for maintains the warmer was switch on Help in prevention of
data:-
center environmental temperature and temperature was heat loss due to
I observed the Mechanism of labor room/NICU now28±2℃ environment.
condition of
based on 28±2℃.
the child, I
checked the Virginia
temp. of the
Henderson’s Plan for prevention heat Newborn dry Help in prevention from
baby it was
100℉ Need loss. immediately after birth heat loss.
Theory. and cotton cloth was
Applied to newborn.

Assess the vital of Vital of new born in Help to maintain the

newborn ½ hourly. normal range. body temperature of the
baby.
Nursing Nursing Goal Intervention Implementation Rational Evaluation
assessment Diagnose
4. Risk of To reduce the risk Assess the condition To provide the base line To prevent the further The risk of the
Subjective infection of infection. of the child. data to the child. risk of infection. infection is reduced.
data: related to
Mother said hospital
that she had acquired
concerned infection Educate the mother Mother wash the hand To prevent from
for her baby based on before and after before and after touch to infection.
related Virginia touching to the child the child.
infection. Henderson’s wash hand properly.
Objective Need Theory.
data:-
I observed
the Provide the education Provided the education to To prevent the further
condition of to the parents of the the child parents complications.
the baby child. regarding the nosocomial
and the infection.
hospital
environment
for the
baby. Provide the infection To isolate the child from To prevent the further
less environment to the infected children. infection.
the child.
Nursing Nursing Goal Intervention Implementation Rational Evaluation
assessment Diagnose
5.Subjective Deficit To provide Assess the ability of Parents knowledge was Help to known the Parents have enough
data: -
knowledge information to parents about assessed assistant and ability of parents in knowledge about care
Mother asked
related to parents premature care of counseling was provided home care of infant. of child and about the
question
home care regarding home newborn. regarding home care disease condition.
regarding
and disease care based on
home care.
condition of Florence Plan for Demonstration was To know the ability of
Lack of
the baby is Nightingale Demonstration provided and parents are mother in care of
experience
based on Environment preterm care. advised to participate in newborn
regarding
Florence Theory. preterm infant care.
preterm care
Nightingale
Objective
data: Environment Plan for provide Information was provided Help to identified the
Question
Theory. information regarding about the danger signs and symptoms of
about
signs and symptoms symptoms of respiratory respiratory distress.
how to feed
of respiratory distress. Distress.
baby.
How will
Plan to Provide Information provided Help in administration
maintain
information about related to the side-effects of medication.
body
medication. and the action of the
temperature
medicine.
Health Education:
Hypothermia and hygiene: -
Education was given that keep baby dry after birth put cloth and apply socks and cotton cap on head. Maintain room temperature and body
temperature by using warmer and room heater.
Switch on the warmer before received baby from labor room. Maintain Perineal hygiene and remove wet dipper immediately.
Nutrition: -
Assess the nutritional of the new born and feed was advice as per bodyweight.
I/V dextrose was given as per body weight.
Swallowing reflex was checked and advised to mother for kattori spoon feeding two hourly.
Advise to checked the baby body weight daily at same time and same machine.
Advise the mother to provide feed in frequent interval and demand feeding.
Cord care: -
Advise the mother to keep the cord dry and clean. Do not apply any things over the cord.
Advice to assess the condition of the cords. An educate the mother check for discharge and redness at the site of insertion of cord.
Eye care: -
Clean hand with water and soap before eye care. Educate the mother to clean eye with plain water and normal saline. Educate the mother Use
one swab at one time clean eye inner canter to outer canter in one stock. Educate the mother for any discharge redness in this condition inform to
physician.
Evidenced Based Study:
Background. This study was done to assess the maternal and sociodemographic factors associated with low birth weight (LBW)
babies. Methods. An unmatched case control study was done involving 159 cases (mothers having LBW singleton babies) and 159 controls
(mothers having normal birth weight singleton babies). Results. More than 50% of LBW babies were from the mothers with height ≤145 cm
while only 9.43% of NBW babies were from the mothers with that height. Finally, after multivariate logistic regression analysis, maternal
height, time of first antenatal care (ANC) visit, number of ANC visits, iron supplementation, calcium supplementation, maternal education, any
illness during pregnancy, and hypertension were found as the significant predictors of LBW. However, maternal blood group AB, normal
maternal Body Mass Index (BMI), mother’s age of 30 or more years, and starting ANC visit earlier were found to be protective for
LBW. Conclusion. Study findings suggest that selectively targeted interventions such as delay age at first pregnancy, improving maternal
education and nutrition, and iron and calcium supplementation can prevent LBW in Nepal.
BIBLIOGRAPHY

✓ Dutta Parul, “Pediatric Nursing”, published by Elsevier publication, New Delhi, edition 7th, page no 294- 305.
✓ www.rightdiagnosis.com/h/Low birth weight baby/intro.htm
✓ www.lpch.org/DiseaseHealthInfo/HealthLibrary/.../hyperb.
✓ www.ncbi.nlm.nih.gov

✓ pedsinreview.aappublications.org/content

✓ www.uptodate.com/.../premature -in-the-premature

✓ Bhaskar RK, Deo KK, Neupane U, Chaudhary Baskar S, Yadav BK, Pokharel HP, Pokharel PK. A Case control study on risk factors

associated with low birth weight babies in Eastern Nepal. International journal of pediatrics.2015 Dec10;2015