Care of low birth weight (<2.5 kg) and premature babies

Low birth weight and premature babies are at risk of a number of problems – it is important to try and anticipate these, and to recognise and treat if necessary.

Definitions

Low birth weight (LBW): <2499g
Very low birth weight (VLBW): <1500g
Extremly low birth weight (ELBW): <1000g

Hypoglycaemia and feeding

Small babies should be fed every 3 hours (by breast or EBM by cup/NGT).
The daily feed volume should be calculated as below, and divided by 8 to give the 3-hourly feed volume. Use the birth weight for calculations untill the actual weight is above the birth weight!

Day	1	2	3	4	5 onwards
Amount/day	60 ml/kg	90 ml/kg	120 ml/kg	150 ml/kg	150-200 ml/kg

Example:
A baby with birth weight 1.6kg baby, now on day 3 of life with 1,5 kg, requires 120 ml x 1.6 kg = 192 ml/day ÷ 8 = 24 ml/feed

If the baby shows any signs of hypoglycaemia (lethargy, floppiness, convulsions, apnoea, abnormal neurological behaviour) please check the blood glucose level.
If it is not possible to check the blood glucose, go ahead and treat.

Emergency treatment of hypoglycaemia
(blood glucose <45mg /<2.5mmol/l)

2 ml/kg 10% dextrose IV

if there is no IV line give same amount via NGT

Recheck after 30 minutes to ensure the blood glucose level has improved.
Make sure the baby is fed.
If there is persist hypoglycaemia consider IV fluids with 10% dextrose.

Hypothermia

Prevent hypothermia by keeping in hot cot/under heater and ensuring baby is well wrapped and wearing a hat.
If still hypothermic, try KMC even if they are on cpap/oxygen.
When the baby is stable, it should be nursed in 'Kangaroo' position.
If a baby is cold don't warm up faster than 1 C per hour.
Please ensure baby is well hydrated and DO NOT USE WARMED IV FLUID BAGS TO WARM THE BABY.

Infection

Premature delivery may be due to maternal infection. Have a very low threshold for starting antibiotics in premature babies. Remember that signs of sepsis in a newborn can be very non-specific Neonatal sepsis
(ALL BABIES WEIGHING <1500g TO BE STARTED ON ANTIBIOTIC)

Respiratory Distress Syndrome

Very premature babies lack surfactant and therefore may have marked respiratory distress.
Put the baby on O2, cover with antibiotics and ensure they are kept warm.
IF IN SEVERE RESPIRATORY DISTRESS AND >1000g CONSIDER CPAP.
See CPAP

For Flowcharts for intensification and weaning of CPAP also see link above.

Apnoea of prematurity

Very premature babies have immature respiratory centres in the brain and sometimes "forget" to breath.
We use aminophylline as a respiratory stimulant for babies <34/40 gestation: 6mg/kg STAT, then 2.5mg/kg BD.