Low-cost Management of Low Birth Weight Babies Prof. MAK Azad - - PowerPoint PPT Presentation

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Low-cost Management of Low Birth Weight Babies Prof. MAK Azad - - PowerPoint PPT Presentation

Aug 22, 2023 221 likes •601 views

Low-cost Management of Low Birth Weight Babies Prof. MAK Azad Chowdhury Head of the Department of Neonatology Bangladesh Institute of Child Health (BICH) Dhaka Shishu Hospital Objective of the presentation To emphasize that management of

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Low-cost Management of Low Birth Weight Babies

  • Prof. MAK Azad Chowdhury

Head of the Department of Neonatology Bangladesh Institute of Child Health (BICH) Dhaka Shishu Hospital

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Objective of the presentation

  • To emphasize that management of the

LBW babies does not cost much and high-tech facility is not required in most

  • f the cases.
  • f the cases.
  • They can very well be managed at the

district and sub-district hospitals and undue referrals and sufferings beavoided.

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Premature babies can be saved before intensive care is available...

Public health approaches

Improved individual neonatal care eg feeding, warmth, hygiene, antibiotics, resuscitation

Neonatal intensive care introduction and scale up:

Over 60% reduction can be achieved before neonatal intensive care Over 60% reduction can be achieved before neonatal intensive care and history shows the impact would be huge and history shows the impact would be huge

Data sources for UK and US historical data: (CDC, 2012, Office for National Statistics, 2012, NIH, 1985, Smith et al., 1983, Data sources for UK and US historical data: (CDC, 2012, Office for National Statistics, 2012, NIH, 1985, Smith et al., 1983, Jam Jamison et al., 2006, ison et al., 2006, Lissauer Lissauer and and Fanaroff Fanaroff, 2006, Baker, 2000, Philip, 2005, , 2006, Baker, 2000, Philip, 2005, Wegman Wegman, 2001). With thanks to Boston Consulting Group , 2001). With thanks to Boston Consulting Group

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METHODS

As an example we present management of LBW babies in Dhaka Shishu Hospital in recent years in the special care baby unit. Dhaka Shishu (Children) Hospital (650 Beds) provides primary, secondary as well as tertiary care services to Dhaka Shishu (Children) Hospital (650 Beds) provides primary, secondary as well as tertiary care services to sick children. There is 1 NICU and 1 Paediatric ICU where some critically ill babies are taken care of, most of the low birth weight babies are managed in the baby cots and in the words without any high-tech device.

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Low Birth Weight Babies

35% 65%

LBW

65% 354/995

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Categories of LBW Babies

80 100 120 140 160 180 200

28 (8%) 93 (26%) 39 (11%)

194 (55%)

20 40 60 80 28 (8%)

(11%)

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Co-morbid conditions with LBW

15 20 25 30 35 40 45

12% 42% 8% 10% 12%

5 10 15 12%

8% 10% 5% 12% 2% 2% 1% 6%

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Cleanliness and Hygiene

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Cleanliness and Hygiene

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Keeping warm Keeping warm

Wrapping the baby covering head

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Keeping warm Keeping warm

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Incubator care

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Breast feeding of premature/LBW infant Breast feeding of premature/LBW infant

1300gm Baby 1300gm Baby

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1150gm Baby

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Gavage Gavage Feeding Feeding

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Fluid Management

IV Fluid Aliquot 6/8 hourly Aliquot 6/8 hourly

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Antibiotics

  • First line-Ampicillin +Gentamicin
  • Second line-Ceftazidine + Amikacin
  • Third line-Meropenum+Nitilmicin
  • Third line-Meropenum+Nitilmicin
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Incubator Care

150 200 250 50 100 150

<1000 gm 1000-1300 gm >1300 gm

100% 45% 5%

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Outcome of <1300 gm Babies

20 30 40 50 60

31% 33%

10 20

Incubator Care No Incubator Care 33%

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Phototherapy

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PDA Closure

  • Fluid restriction
  • Diuretics
  • Drugs- (if platelet count is not very low)
  • Drugs- (if platelet count is not very low)
  • Ibuprofen-10mg/kg/dose-1stday, 5mg /

Kg/day daily- another 2 days

  • Paracetamol-15mg/kg/dose QDS daily-3

days

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KMC in Dhaka Shishu Hospital

  • Since July, 2013, 596 received KMC care in our

unit

  • Successfully discharged 554 cases and are

being followed up. being followed up.

  • Twenty five cases died, 17 cases DORB(7.1%).
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Neonatal age Six months age

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KMC (For twin)

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Variable Case (n=60) Control (n=40) p-value Mean Hospital stay 15.61±10.56 18.15±4.5 0.1545

Weight gain & Hospital stay

Mean Hospital stay (days: mean±SD) 15.61±10.56 18.15±4.5 0.1545 Weight gain (gm: mean±SD) 299.41±219.27 126.00±347.74 0.0029

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Other effects

  • Effective thermal control
  • Reduced apnea
  • Reduced apnea
  • Reduced infection
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Overall Mortality of LBW

84% 16% 84% Died

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Mortality of KMC Babies

7.1%

Survived

92.9%

Survived Died

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ROP Screening

<34 Weeks/ 1800gm >3 Weeks Post Natal age

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ROP Screening

173 cases screened from Nov 2014 to Sept 2015 ROP Present 47 (27%) Laser Therapy 22 (13%) Laser Therapy 22 (13%)

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Identified Risk Factors for ROP

Risk Factors Number (%) Blood transfusion 11(7% ) Oxygen Therapy 35(20% ) Septicemia 21(12% ) RDS 13(8%)

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CPAP

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Conclusion

Replicating this model throughout the country along with appropriate supply of antibiotics and orientation

  • f the paediatricians will contribute
  • f the paediatricians will contribute

significantly to reduction of the high neonatal deaths in Bangladesh.

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Thank You very much