Birthweight

• Low birth weight: <2500g regardless of age
• Very low birth weight: <1500g regardless of age
• Extremely low birth weight: <1000g regardless of age

Complications of prematurity are the underlying reasons for the higher rate of infant mortality and morbidity in preterm infants compared with full-term infants. The risk of complications increases with increasing immaturity.

The first few minutes

• Cooling of face and physical stimulation is a major stimuli to start breathing. Drying with a towel is very effective.
• The umbilical cord is clamped and cut cleanly close to the skin. Cord stump drops off.
• The plastic stump can be removed after 2 days.
• Failure of the cord to detach after 7 days indicates leukocyte adhesion deficiency.

The first hours

• Vitamin K IM to prevent hemorrhagic disease of the newborn.
• Hepatitis B vaccination

The first day

Infants sleep for most of the time and feed sometimes, but they must:

• Suck and swallow easily. If not consider congenital abnormality, hypoglycaemia or infection.
• Pass Urine. Boys not passing urine within the first 24 hours consider posterior urethral valves.
• Pass meconium within the first 48 hours. If not consider bowel obstruction or Hirschsprungs Disease

First examination (not discussed here)

The first week

• Feeding, stool and urine production normal
• Jaundice occurs in more than 50% of babies after the first 24 hours of age.
• Metabolic screening is performed for cystic fibrosis, hypothyroidusm, phenylketouria and other metabolic conditions from a heel prick.
• Screening for hearing problems - Swish Test

The first month

• Baby should gain 150-250g a week (~30g a day)

Preterm is defined as a neonate whose calculated gestational age from last menstrual period is <37 completed weeks.

Most preterm have low birth weights, but not all low birth weights are preterms. Birth weight terminology

Overview Breastfeeding is recommended as sole source of nutrition until 6 months of age. Solid food commencement advised age 6 months (can be earlier). Weight gain should be 150-200g/week in first 6 months (20-30g/day). Weight loss immediately post birth - should be regained by 2 weeks.

When is breast milk not enough?

Prematurity

• <35weeks and <2.5 kg - need Iron and Pentavite
• <33week and Low Birth weight - need fortifier with breast milk

Poor supply

• Top up formula feeds
• Motilium - enhances milk supply