Care of the Low Birthweight Newborn

Q1. How should I keep my baby warm at home?

Please make sure that the room is neither unduly cold nor warm. You know the room temperature is OK for your baby if you feel comfortable. To keep the room warm, keep the windows and doors shut. This avoids draught of air. You may use room heater or 200 Watt bulb, especially during winters, to provide additional warmth. However, you must ensure that the baby is placed not too close to the heater or bulb. Kangaroo care is a simple and effective method to keep your baby warm (Fig. 1). Does my baby need additional clothing? Babies <2.5 kg need to be kept warm. The general rule is to add an extra layer of clothing to the baby than what the adults are wearing. The head should always be kept covered. In winter, one may add gloves, sweater, and socks. How do I know my baby’s temperature is normal? The best way to know that all is well with the baby is to look at the color of the soles/ feet. Normally, the soles/feet should be pink. If they have shades of blue or appear off white, it tells us something is wrong.

Q2. Advise me about bathing, massaging, and exposing to sunlight.

It is a safe practice to postpone bathing till your baby has attained a weight of 2.5 kg. During this period, the emphasis is on wiping or sponging the baby. This needs to be done daily. Also remember to use lukewarm water. It should be checked by dipping your finger ensuring that it is neither unduly warm nor cold. Sponge the baby from head to toe. This should be immediately followed by drying with clean towel and putting clothes on the baby. Is massage good for my baby? Oil massage is good for your baby. It should be done gently. Avoid vigorous rubbing, turning the baby upside down or putting oil into ears, nose, or any openings. Remember any maneuver which upsets the baby is not OK. One may use coconut oil or olive oil. It is better to avoid irritant oils such as mustard oil. Can I use fan and/or AC? One can use fan or AC, especially during summer. Ensure that the baby is kept away from the blast of air. Ensure the temperature of AC is not <26°C. What about exposing to sunlight? Sunlight coming inside the room is encouraged but keeping the baby exposed to sun is not. Direct exposure to sunlight is avoided as it may lead to temperature fluctuations and may mask jaundice.

KEYPOINTS 1. A preterm/low birthweight is at risk for temperature fluctuation and needs additional support. 2. Good practices include avoiding bath till weight of 2.5 kg, keeping baby and mother together, providing Kangaroo mother care (KMC), additional clothings during winter, and keeping the head of the baby covered always. 3. A normal baby has a temperature between 36.5 and 37.5°C.

Q3. What is Kangaroo mother care (KMC)? How do I practice it?

If your baby is low birth weight (<2.5 kg) or born preterm, KMC is the best method of caring for the baby. KMC means keeping the baby continuously between the mother’s breasts, in skin-to-skin contact for prolonged period and feeding with only mother’s milk. Benefits to Mom Kangaroo mother care (KMC)

The baby with a diaper, cap, and socks is placed in skin-to-skin contact between the mother’s breasts. The baby’s head should be partially extended and turned to the side so that the baby can breathe well. The baby must be flexed (hips and arms bent) and well supported. The baby may be held in this position with a binder. The mother with her baby in KMC can either sit in a chair or lie down on a bed with many pillows to maintain a semi-reclining position of about 30–40°. The mother should wear clean clothes and wash hands well for KMC

Q4. When to start and stop KMC?

Kangaroo mother care is started as soon as your baby is stable. Your doctor will let you know when to start. Once the baby is placed in KMC position, the baby should remain so for as long as possible and at least for 1 hour. Ideally, a baby should receive KMC for 24 hours/day. This may not be possible for only the mother and other family members can also provide KMC. When do I stop KMC? Generally, as the baby grows and gains weight (usually around 2.5 kg), he/she starts wriggling out every time KMC is given. This is an indication that baby no longer needs KMC. It can, however, be continued during night and also if the baby is sick.

KEYPOINTS 1. Kangaroo mother care is simple, safe, and an effective way to care for low birthweight babies. 2. Kangaroo mother care saves lives, prevents complications in newborns, and also has benefits for mother. 3. Kangaroo mother care is keeping the baby in continuous skinto-skin contact on the mother’s chest for prolonged period with exclusive breastfeeding. 4. Any family member can provide KMC when mother is unable to do so.

Q5. What is the best way to feed my baby?

The best way to feed your baby is breast milk. It is the birthright of every newborn baby. For you, it is a wonderful experience and a miracle of nature. Breast milk provides ideal nourishment and a special bonding experience that many mothers cherish.

Breastfeeding

• Benefits Protects against infection. Breastfed babies have fewer infections and hospitalization. During breastfeeding antibodies and other germ fighting factors pass from mother to her baby and strengthen the immune system. It protects against ear infection, diarrhea, respiratory infections, and meningitis.
• It also protects your baby against allergies, asthma, diabetes, obesity, and sudden infant death syndrome.
• Breast milk is more easily digested and contains vitamins and minerals that a baby needs.
• It is free and on demand.
• Different taste each day as the milk flavor depends on what their mother has eaten.
• Convenience. No special preparations required.
• Smarter babies as breastfed babies have higher intelligent quotients (IQs).
• Stimulates emotional bonding.
• Beneficial for mom too—less postpartum bleeding, help regain weight, lesser chances of breast and cervical cancer.

Challenges

• Personal comfort: Mother may feel uncomfortable with breastfeeding, especially in public places, if working or traveling.
• A big time societal support for mothers at work and home.
• Mother needs healthy and well-balanced diet.

Q6. Should I give formula feeding?

There is no role of giving formula feeding routinely for any baby. Commercially prepared infant formulas are alternatives to breast milk. They are to be used if the mother has no milk, or inadequate milk or has a medical illness or drug treatment which makes mothers milk not a choice for feeding. Use of formula milk should be only on advice of the doctor. With support and counseling almost all moms are able to exclusively breastfeed their baby.

Pros

• Caregiver feeding possible.
• Not affected by maternal food, medications or illness.

Drawbacks

• Lack of antibodies which leaves the baby vulnerable to infection.
• Need planning, storage, and preparation.
• Need clean water for preparation and clean area for storage.
• Need parental understanding and access to resources for safe-feeding practices.
• Once prepared, must be used within 1 hour.
• Risk of contamination.
• Risk of under- or overdilution feeding.
• Scoop size, mixing instructions, and calorie density vary among manufacturers.
• Clean hands, clean containers, and clean feeding devices are must.
• Does not contain antibodies which are present in human milk.
• Does not match the complexity of breast milk.
• Expensive.