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Premature
Baby
Prepared by
Ms. Jenisha Adhikari
BSN
Premature Baby
• A baby born before 37 weeks of gestation
calculating from the first day of last menstural
period is defined as preterm baby/ premature
baby.
• These babies are known as preemies
Age of Viability
Most neonatologist define the age of viability as
being about 24 weeks of gestation.
Why do premature newborns need special care?
• A premature newborn is not fully ready to deal with
our world.
• Their little bodies still have areas that need to
mature and fully develop.
Some of these areas include the
• Lungs
• digestive system
• immune system
• skin.
Sources: March of Dimes,
Updated April 08, 2018
Length of Pregnancy Likelihood of Survival
23 weeks 17 percent
24 weeks 39 percent
25 weeks 50 percent
26 weeks 80 percent
27 weeks 90 percent
28 to 31 weeks 90 to 95 percent
32 to 33 weeks 95 percent
34+ weeks Almost as likely as a full-term baby
Premature Birth and Survival Statistics
Causes
• Maternal factor
– Pre eclampsia
– Heart or kidney disease
– Infection (such as group B streptococcus, urinary
tract infections, vaginal infections, infections of
the fetal/placental tissues)
– Drug use (such as cocaine)
– Abnormal structure of the uterus
– Cervical incompetence (inability of the cervix to
stay closed during pregnancy)
– Previous preterm birth
• Factors involving the pregnancy:
– Abnormal or decreased function of the placenta
– Placenta previa
– Placental abruptia
– Premature rupture of membranes
– Polyhydramnios
• Fetal factor
– Multiple pregnancy
– IUGR
– Congenital malformation
– Rh incompatibility
Characteristic
• Posture :
– hypotonic,
– assume extended posture due to poor muscle tone
• Skin:
– thin, gelatinous, shiny and excessive pink with
abundant lanugo and
– very little vernix edema may be present.
– breast nodules are small or absent,
• Subcutaneous fat is deficient,
deep sole creases are often not present
Preterm Term
• Face and head : face is small and head is large
as per body.
• Sutures are widely separated and frontanels are
large.
• Protuding eye due to shallow orbit and absent
of buccal pads of fat
• Ear cartilage is deficient with poor recoil
• Hair appears wooly and fuzzy
• Planter creases; not so dark and very few in
number
• Nails: Bright pink colored nail beds and very
soft nails
• Activity : less activity of limbs
• Sucking : poor sucking ability
• Cry : weak cry
• Breast : no breast tissue palpable
• Central Nervous system
– poor reflexes
– Reflexes : moro, sucking, swallowing and other
reflexes are absent or sluggish
– Uncoordinated sucking swallowing leads to
feeding difficulties
•Vulnerable to develop intra ventricular/ peri
ventricular hemorrhage
• Respiratory system
– Period of apnea usually less that 20 seconds
– Poor cough reflex leads to increase risk of
infection
– Deficiency of surfactant leads to respiratory
distress syndrome
• Gastro intestinal system
– Functional immaturity of liver cause
hyperbilirubinaemia, hypoglycemia and poor
detoxification of drug
– Tendency to regurgitate to an incompetent cardio-
esophageal sphincter and small capacity of the
stomach
•Abdominal distension
•necrotizing entercolitis
• Temperature regulation
– Loose more heat due to large area so cause
hypothermia
– Subcutaneous fat is less, less brown fat
– Inadequate thermal response
• Cardio- vascular system
– Delayed closure of ductus arteriosus
– Inadequate peripheral circulation
– Intra cranial hemorrhage due to poor auto
regulation of cerebral blood flow
• Renal immaturity
– GFR and urine concentration are reduced
• Metabolic distribution
– Hypoglycemia
– Hypocalcemia
– Hypoproteinemia
– Hypoxic
• Nutritional deficiency
– Prone to develop anemia at 6-8 weeks because of
low iron storage
• Susceptibility of infection
– 3 to 10 times more vulnerable to infection than
term babies
– Low level of IgG
• Genitalia :
– in male ; testes are undescended, scortum poorly
pigmented
• in female; labia majora are widely separated
exposing labia minora and clitoris
Management
• A baby born at 24 weeks would generally
require a lot of intervention, potentially
including mechanical ventilation and other
invasive treatments followed by a lengthy stay
in a neonatal intensive care unit (NICU).
Management
• Optimal management at birth
– Give vitamin K 1mg to prevent hemorrhage
– Promptly dry and kept warm with gentle handling
– The cord is to be clamped quickly to prevent
hypervolemia and development of
hyperbilirubinaemia
• Maintain body temperature
– Keep the baby in incubator with temperature and
humidity maintained
• Positioning
– Change the baby’s position from prone position; it
relives abdominal discomfort by passage of flatus
and prevent aspiration
– Change position 2 hourly
• Kangaroo mother care
– Encourage KMC and exclusive breastfeeding
• Oxygen therapy
– It should be administered only when indicated
– O2 should administer with head box when O2
saturation falls below 85%
• Feeding and nutrition
– Babies < 1.2 kg gestation <30 weeks and sick babies
should start IV dextrose solution
– 10-20 ml EBM
2-3 hourly through NG can
be started to all babies
irrespective of age and
weight 2 hourly <1 kg and
3 hourly > 12kg
• Nutritional supplement
– When the baby is stable and tolerate eternal
feeding, EBM fortified multivitamin and folic acid
can be given
– Iron supplementation (2-3mg/kg elemental iron )
after 2-3 weeks
– Calcium supplementation (220mg/day ) and
phosphorus (100 mg/day) to prevent osteopenia for
< 1.5 kg
• Gentle rhythmic stimulation
– Gentle tactile stimuli by the mother
– Soothing auditory stimuli as family voice, music
– Eye to eye contact, colored object provide visual
inputs
• Prevention of nosocomial infection
• Strict handing washing before and after
touching the baby
• Minimal handeling
• Phototherapy
– Early phototherapy is advice to keep the serum
bilirubin level within safe limit to prevent need for
exchange transfusion usually premature develops
hyperbilirubinaemia
Factor to be avoid for pre term babies
– Routine O2 administration without monitoring
– Prophylaxis antibiotics
– Formula feeding
– Rough handling
– Excessive light and sound
Possible Complications
• Anemia Possible long-time complications
• Bronchopulmonary dysplasia (BPD)
• Mental or physical disability or delay Infection
or
• neonatal sepsis
• Retinopathy of prematurity,
• Risk of Disabilities
• Low blood sugar (hypoglycemia)
• Neonatal respiratory distress syndrome
• pulmonary hemorrhage
• Kernicterus
• Patent ductus arteriosus
• Severe intestinal inflammation(necrotizing
enterocolitis)
Nursing Diagnosis
• Impaired Gas exchange related to immature
pulmonary functioning
• Ineffective thermoregulation related to lack
of subcutaneous fat
• Altered nutrition : less than body requirements
related to weak feeding reflexes
Impaired Gas exchange related to
immature pulmonary functioning
• Assess respiratory status, noting signs
of respiratory distress(e.g., tachypnea, nasal
flaring, grunting, retractions, rhonchi, or
crackles)
• Assess skin color for cyanosis
• Promote rest,minimize stimulation& energy
expenditure.
Ineffective thermoregulation related to
lack of subcutaneous fat
• Assess Vital signs (especially temperature)
• Place infant in a warmer, incubator, or open
bed with radiant warmer or open crib where in
infant also has appropriate clothing
• Use heat lamps during certain procedures &
warm objects coming in contact with the
infants body such as clothing
Altered nutrition : less than body
requirements related to weak feeding
reflexes
• Assess presence of reflexes associatedwith
feeding (i.e swallowing, sucking & coughing)
• Breast feeding or KS feeding 2 hourly
• Initiate intermittent or tube feedings as
indicated
Prevention
• Identifying mothers at risk for preterm labor
• Prenatal education of the symptoms of preterm
labor
• Avoiding heavy or repetitive work or standing
for long periods of time that can increase the
risk of preterm labor
• Early identification and treatment of preterm
labor
Thank
you

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nursing management of premature babies

  • 2. Premature Baby • A baby born before 37 weeks of gestation calculating from the first day of last menstural period is defined as preterm baby/ premature baby. • These babies are known as preemies
  • 3. Age of Viability Most neonatologist define the age of viability as being about 24 weeks of gestation.
  • 4. Why do premature newborns need special care? • A premature newborn is not fully ready to deal with our world. • Their little bodies still have areas that need to mature and fully develop.
  • 5. Some of these areas include the • Lungs • digestive system • immune system • skin.
  • 6. Sources: March of Dimes, Updated April 08, 2018 Length of Pregnancy Likelihood of Survival 23 weeks 17 percent 24 weeks 39 percent 25 weeks 50 percent 26 weeks 80 percent 27 weeks 90 percent 28 to 31 weeks 90 to 95 percent 32 to 33 weeks 95 percent 34+ weeks Almost as likely as a full-term baby Premature Birth and Survival Statistics
  • 7. Causes • Maternal factor – Pre eclampsia – Heart or kidney disease – Infection (such as group B streptococcus, urinary tract infections, vaginal infections, infections of the fetal/placental tissues)
  • 8. – Drug use (such as cocaine) – Abnormal structure of the uterus – Cervical incompetence (inability of the cervix to stay closed during pregnancy) – Previous preterm birth
  • 9. • Factors involving the pregnancy: – Abnormal or decreased function of the placenta – Placenta previa – Placental abruptia – Premature rupture of membranes – Polyhydramnios
  • 10. • Fetal factor – Multiple pregnancy – IUGR – Congenital malformation – Rh incompatibility
  • 11. Characteristic • Posture : – hypotonic, – assume extended posture due to poor muscle tone
  • 12.
  • 13. • Skin: – thin, gelatinous, shiny and excessive pink with abundant lanugo and – very little vernix edema may be present. – breast nodules are small or absent,
  • 14.
  • 15. • Subcutaneous fat is deficient,
  • 16. deep sole creases are often not present Preterm Term
  • 17. • Face and head : face is small and head is large as per body. • Sutures are widely separated and frontanels are large. • Protuding eye due to shallow orbit and absent of buccal pads of fat • Ear cartilage is deficient with poor recoil • Hair appears wooly and fuzzy
  • 18. • Planter creases; not so dark and very few in number • Nails: Bright pink colored nail beds and very soft nails • Activity : less activity of limbs • Sucking : poor sucking ability • Cry : weak cry • Breast : no breast tissue palpable
  • 19. • Central Nervous system – poor reflexes – Reflexes : moro, sucking, swallowing and other reflexes are absent or sluggish – Uncoordinated sucking swallowing leads to feeding difficulties
  • 20. •Vulnerable to develop intra ventricular/ peri ventricular hemorrhage
  • 21. • Respiratory system – Period of apnea usually less that 20 seconds – Poor cough reflex leads to increase risk of infection – Deficiency of surfactant leads to respiratory distress syndrome
  • 22. • Gastro intestinal system – Functional immaturity of liver cause hyperbilirubinaemia, hypoglycemia and poor detoxification of drug – Tendency to regurgitate to an incompetent cardio- esophageal sphincter and small capacity of the stomach
  • 23.
  • 26. • Temperature regulation – Loose more heat due to large area so cause hypothermia – Subcutaneous fat is less, less brown fat – Inadequate thermal response
  • 27. • Cardio- vascular system – Delayed closure of ductus arteriosus
  • 28. – Inadequate peripheral circulation – Intra cranial hemorrhage due to poor auto regulation of cerebral blood flow
  • 29. • Renal immaturity – GFR and urine concentration are reduced • Metabolic distribution – Hypoglycemia – Hypocalcemia – Hypoproteinemia – Hypoxic
  • 30. • Nutritional deficiency – Prone to develop anemia at 6-8 weeks because of low iron storage • Susceptibility of infection – 3 to 10 times more vulnerable to infection than term babies – Low level of IgG
  • 31. • Genitalia : – in male ; testes are undescended, scortum poorly pigmented
  • 32. • in female; labia majora are widely separated exposing labia minora and clitoris
  • 33. Management • A baby born at 24 weeks would generally require a lot of intervention, potentially including mechanical ventilation and other invasive treatments followed by a lengthy stay in a neonatal intensive care unit (NICU).
  • 34. Management • Optimal management at birth – Give vitamin K 1mg to prevent hemorrhage – Promptly dry and kept warm with gentle handling – The cord is to be clamped quickly to prevent hypervolemia and development of hyperbilirubinaemia
  • 35. • Maintain body temperature – Keep the baby in incubator with temperature and humidity maintained
  • 36. • Positioning – Change the baby’s position from prone position; it relives abdominal discomfort by passage of flatus and prevent aspiration – Change position 2 hourly
  • 37. • Kangaroo mother care – Encourage KMC and exclusive breastfeeding
  • 38. • Oxygen therapy – It should be administered only when indicated – O2 should administer with head box when O2 saturation falls below 85%
  • 39. • Feeding and nutrition – Babies < 1.2 kg gestation <30 weeks and sick babies should start IV dextrose solution – 10-20 ml EBM 2-3 hourly through NG can be started to all babies irrespective of age and weight 2 hourly <1 kg and 3 hourly > 12kg
  • 40. • Nutritional supplement – When the baby is stable and tolerate eternal feeding, EBM fortified multivitamin and folic acid can be given – Iron supplementation (2-3mg/kg elemental iron ) after 2-3 weeks – Calcium supplementation (220mg/day ) and phosphorus (100 mg/day) to prevent osteopenia for < 1.5 kg
  • 41. • Gentle rhythmic stimulation – Gentle tactile stimuli by the mother – Soothing auditory stimuli as family voice, music – Eye to eye contact, colored object provide visual inputs
  • 42. • Prevention of nosocomial infection • Strict handing washing before and after touching the baby • Minimal handeling
  • 43. • Phototherapy – Early phototherapy is advice to keep the serum bilirubin level within safe limit to prevent need for exchange transfusion usually premature develops hyperbilirubinaemia
  • 44. Factor to be avoid for pre term babies – Routine O2 administration without monitoring – Prophylaxis antibiotics – Formula feeding – Rough handling – Excessive light and sound
  • 45. Possible Complications • Anemia Possible long-time complications • Bronchopulmonary dysplasia (BPD) • Mental or physical disability or delay Infection or • neonatal sepsis • Retinopathy of prematurity, • Risk of Disabilities
  • 46. • Low blood sugar (hypoglycemia) • Neonatal respiratory distress syndrome • pulmonary hemorrhage • Kernicterus • Patent ductus arteriosus • Severe intestinal inflammation(necrotizing enterocolitis)
  • 47. Nursing Diagnosis • Impaired Gas exchange related to immature pulmonary functioning • Ineffective thermoregulation related to lack of subcutaneous fat • Altered nutrition : less than body requirements related to weak feeding reflexes
  • 48. Impaired Gas exchange related to immature pulmonary functioning • Assess respiratory status, noting signs of respiratory distress(e.g., tachypnea, nasal flaring, grunting, retractions, rhonchi, or crackles) • Assess skin color for cyanosis • Promote rest,minimize stimulation& energy expenditure.
  • 49. Ineffective thermoregulation related to lack of subcutaneous fat • Assess Vital signs (especially temperature) • Place infant in a warmer, incubator, or open bed with radiant warmer or open crib where in infant also has appropriate clothing • Use heat lamps during certain procedures & warm objects coming in contact with the infants body such as clothing
  • 50. Altered nutrition : less than body requirements related to weak feeding reflexes • Assess presence of reflexes associatedwith feeding (i.e swallowing, sucking & coughing) • Breast feeding or KS feeding 2 hourly • Initiate intermittent or tube feedings as indicated
  • 51. Prevention • Identifying mothers at risk for preterm labor • Prenatal education of the symptoms of preterm labor • Avoiding heavy or repetitive work or standing for long periods of time that can increase the risk of preterm labor • Early identification and treatment of preterm labor