CARE OF LBW NEWBORN IN COMMUNITY: PERSONAL EXPERIENCE AND INNOVATION

DR. NEHAL VAIDYA

Care of LBW newborn is a challenging task in India. The Indian neonatologists have to deal with economical and social problems of the LBW’s family apart from medical challenges. Also, there are a lot of myths both on the side of family members and at the level of GPs.

Here is some of the experience that I want to share.

Our unit is Level 3 care neonatal intensive care unit, located at Bhuj, a district head quarter of kachchh. Our unit is working since past 3 years. We are the pioneer of such care in the area. We have saved babies weighting up to 900gms. We give surfactant and also partial parenteral nutrition.If babies are more than 28 wks maturity and weighting more than 1000 gms most of them will be saved in our unit.

Here are some of the policies of our unit which we believe are innovative and making difference in the end result

ASEPSIS:Such babies are usually shifted to mother on 7th or 8th day of life. Before shifting, we explain the relatives how to keep away from germs. We ask them to buy soap or sterillium and emphasize hand washing each time before touching the baby. Also we tell them to ask all the relatives to not to come to “see” the baby.

They are asked to buy a white khadi cloth [abt 3 mtrs] to keep the baby. We are very strict regarding use of this cloth. Nothing else is tolerated.

The cloth helps a lot in keeping baby clean in our view.

TEMP REGULATION:The parents are also asked to buy a digital thermometer. Mother and care taker are explained the importance of THERMONEUTRAL ENVIRONMENT [AND NOT ONLY HYPOTHERMIA]. They are asked to maintain baby’s temp between 97 to 98 F. if temp is less mother is required to give skin to skin heat. If temp is more baby is kept open. Temperature is re assessed after 30 min .The temp is measured in axilla.

FEEDING:Mother and the care taker is explained the method of tube feeding and the risks of the same. Most of our babies are discharged with tube in situ .relatives are told about aspiration technique and daily increments. we use mother’s milk only.

DISCHARE POLICY:

BABIES WT IS NOT THE DISCHARGE CRITERIA. We look at the stability of vitals, skill and alertness of the relatives, distance from our place.

Relatives are asked to come immediately if

Baby’s color changes to blueFeed aspirate is more than 25% of the last given feedTemperature remains low or high despite proper measures.

When relatives know importance of maintaining the vitals they come back immediately if any thing goes wrong.

WHAT CAN BE DONE FOR COMMUNITY?

We feel if above policies are applied on larger scale, results would be far better.

For care of LBW in community

Every mother should know tube feeding. This saves a lot as hospital stay is drastically reduced.Every mother should have a digital thermometer. (Even our illiterate mothers learn 97 98 99 numbers!)

Advantages of digital thermometer

No observer variation despite less accuracyNo chance of brakeage as it is plastic made.

FOLLOW UP:

Babies are followed up every week. Their tube is changed. Vitals are assessed.

Tube is removed only when baby is able to suck proper amount of milk orally. We ask the mother to give trial and then we aspirate immediately. If amount is the desired one, the tube is removed.

We highly prefer tube feeding over spoon/cup feeding .the advantage we see are

Sure and measured delivery – sure wt gain(no spillage possibility like cup or spoon)Less consuming on tired mother- tube feeding takes only 5-7 min while spoon may take 30 – 40 min

However if the family members insist on spoon feeding, we explain the proper technique and ask them to come back if baby urinates less than 8 times a day.

We practically show them the difference of wt gain on tube and on cup. If the baby keeps gaining on spoon or cup we continue the same.

Most of our babies are off tube when they reach 1800 gms to 2000 gms

We see that relatives learn to measure temp by themselves so same can be helpful at home.