Care of the Extremely Low Birth Weight Infants in India: Nestle

Speaker: Dr. Tapabrata Chatterjee - MD (Pead), FRCP (Edin), MRCPCH (UK), Associate Professor, Deptt. of Pediatrics, Ramakrishna Mission Seva Pratisthan, Kolkata Presented at: Nestlé Nutrition Institute Conference, Kolkata

Summary

Dr. Tapabrata speaks about the challenges in treating with 26 weeker babies such as parental choice, cost of care and also the motivation of the NICU team. He stresses the need for pre-delivery counselling. He shares data showing incidence of multiple major morbidity. It talks about prescribed steps and challenges across different stages namely, 1st hour, 1st day, 1st week, 1st month and 1st year. He explains various options for care through the stages such as nutrition, developmental supportive care, counselling of babies, neuro development. Dr. Chaterjee stresses the need for parental counselling, hygiene standards and nutrition in infection control.

Extremely Low Weight Baby (ELBW) are preterm babies born immature. The babies born at 26 weeks are quite safe since the technology is available and the team should be motivated to take care of the babies in the Neonatal Intensive Care Unit (NICU). The video goes on to discuss the ethical dilemmas like cost, counselling etc. Immature babies can have various ailments in the future like cerebral palsy which have a prognosis while others that have a treatment. The video goes on to talk about antenatal steroids which can be given to mothers who are going to deliver immature babies though the correct dosage is required.

The care of ELBW is discussed in the 1st hour, 1st day and 1st week. In the first hour temperature is very important. Plastic sheets should be wrapped to stabilise temperature and use a transporter to transport these babies from the delivery room to the NICU. Various problems regarding temperature are discussed like pre heated towels. Oxygen is also discussed. It is generally believed that giving 100% oxygen is beneficial though this has been proven otherwise. IV access in these babies is very difficult and multiple entries can cause infections. UVC’s are suggested in place of IV since they are easy to use.

Suction in babies is vehemently advised against except for a few situations. Rubbing is also advised against similarly so with the use of Sodium bicarbonate. Hypoglycaemia needs to be avoided at any cost though that might lead to hypothermia which also needs to be avoided. Infection needs to be avoided at all costs. Hand washing is the best way to keep away infection. There is a 6 step way to wash hands and doctors should follow it. Cell phones shouldn’t be carried in NICU since they carry germs. Antibiotics should be used only if necessary. Prolonged use can cause problems. Donor milks is recommended for nutrition purposes. Enteral feeding should be started at the earliest and breast feeding is the best. These babies should not be deprived of nutrition. Ventilation is required in 1st week. Minimal handling of the babies in the first week can reduce infection. Kangaroo care by mother or father is recommended. Good infection control, nutrition, less invasion and motivation is required to take care of ELBW babies.