On this page
Care priority and warning signs
Care priority
Refer URGENTLY
Red flags
- Any signs of PSBI/Very Severe Disease
- Hypothermia (<35.5°C)
- Feeding difficulties
- Apnea/bradycardia
- Severe jaundice
Assessment
- Look/Feel: Determine weight for age.
- Check if weight is < 1.5 kg.
- Check if Weight-for-Age Z-score is < -3 (using WHO growth charts).
Classification
- Weight < 1.5 kg OR Weight for age Z-score < -3 -> VERY LOW WEIGHT
Key features
- Weight < 1.5 kg OR Weight-for-Age Z-score < -3.
- Indicates extremely high risk of complications like hypothermia, hypoglycemia, infection.
- Requires specialized care, often including Kangaroo Mother Care (KMC) and specific feeding support.
- Urgent referral is necessary.
Management
Non-pharmacological management
- Keep infant warm: Initiate skin-to-skin contact (KMC) immediately (Page 40).
- Support feeding: Encourage breastfeeding if possible. May require cup feeding or NG tube feeding with EBM or special preterm formula.
- Handle gently.
Pre-referral treatment
- Treat to prevent low blood sugar: Ensure feeding (EBM preferred - Page 40).
- Keep infant warm using KMC or warm wrapping during transport (Page 40).
- Give pre-referral antibiotic if signs of PSBI also present (Page 40).
Follow-up
- To be managed at referral hospital facility with expertise in low birth weight / preterm infant care.
Counselling points
- Explain that the baby's weight is very low, which requires special care in hospital for warmth and feeding.
- Teach/initiate KMC for warmth during transport.
- Advise on importance of EBM if possible.
- Write a detailed referral note indicating very low weight and any associated conditions/treatments.
Differential diagnosis
- Prematurity
- Intrauterine Growth Restriction (IUGR) / Small for Gestational Age (SGA)
- Severe malnutrition acquired postnatally
- Underlying congenital anomaly or syndrome
- Severe infection causing weight loss/poor gain
Complications
- Hypothermia
- Hypoglycemia
- Sepsis / PSBI
- Apnea / Respiratory distress
- Feeding intolerance / Necrotizing enterocolitis (NEC)
- Failure to thrive
- Neurodevelopmental impairment
- Death
Prevention
- Antenatal care (maternal health/nutrition, preventing preterm birth).
- Appropriate care at birth for preterm/LBW infants.
- Kangaroo Mother Care.
- Early and appropriate feeding support.
- Infection prevention.
References
IMCI Chart Booklet - Page 38 (Classification based on weight criteria implied from page 37 TB section), Page 40 (Pre-referral for warmth/hypoglycemia)