Preterm
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This document defines a preterm neonate as any baby born before 37 weeks of gestation. It discusses the causes of preterm birth including health issues in the mother and multiple pregnancies. It describes the physical characteristics of preterm infants such as small size, thin skin, and underdeveloped organs. Complications of preterm birth are outlined involving the respiratory, cardiovascular, gastrointestinal and neurological systems. The management of preterm labor and care of preterm newborns is summarized including monitoring for common problems like infections, breathing issues, and nutritional deficiencies.
Preterm
- 1. PRETERM NEONATE ARUNA. A P I BATCH MSC NURSING
- 2. DEFINITION Any neonate born before 37 weeks (<259 days) of gestation irrespective of the birth weight.
- 3. Premature birth , commonly used as a synonym for preterm birth, refers to the birth of a baby before the developing organs are mature enough to allow normal postnatal survival
- 5. Spontaneous Health status of the mother (low socio economic status) Multiple pregnancy: Number of multiple pregnancies are increasing due to advanced parental age from delayed child bearing and ART. PIH:
- 6. It is the most common complication of pregnancy and is occurring in 6- 10% of pregancies and is rising Placental problems Preterm labour and premature rupture of membrane Low maternal weight
- 7. Chronic and acute systemic maternal disease Antepartum haemorrhage Cervical incompetence Maternal genital colonization and infections Cigarette smoking during pregnancy Threatened abortion
- 8. Acute emotional stress Physical exertion Sexual activity Trauma Bicornuate uterus Congenital malformations
- 9. Induced Maternal diabetes mellitus Placental dysfunction as indicated by unsatisfactory fetal growth Eclampsia Fetal hypoxia Antepartum haemorrhage Severe rhesus iso immunization
- 10. CLINICAL FEATURES Measurements: Size is small with relatively large head Crown- heel length is less than 47cm Head circumference is less than 33 cm But exceeds the chest circumference by more than 3 cm
- 11. Activity and posture: General activity is poor Automatic reflex response such as moro response, sucking and swallowing are sluggish or incomplete Baby assumes an extended posture due to poor tone
- 12. Face and head: Face appears small large head size Sutures are widely separated Fontanels are large Small chin Protruding eyes
- 13. Optic nerve is usually unmyelinated Ear cartilage is deficient or absent with poor recoil Hair appears woolly, and fuzzy and individual hair fibres can be seen separately
- 14. Skin and subcutaneous tissues: Skin is thin, gelatinous, Shiny and excessively pink Abundant lanugo Very little vernix caseosa Edema may be present Subcutaneous fat is deficient Breast nodule is small or absent Deep sole creases are often not present
- 15. Genitals: MALE: testes undescended scrotum poorly developed FEMALES : labia majora widely separated exposing labia minora hypertrophied clitoris
- 16. CHARACTERISTICS OF PRETERM INFANTS
- 17. Skin Bright pink, often translucent, depending on the degree of maturity Smooth and shiny ( may be edematous) Small blood vessels clearly visible underneath the thin epidermis Fine lanugo hair is abundant Hair is sparse, fine and fuzzy on the head
- 18. Ear cartilage Soft and pliable Soles and palms Minimal creases Smooth appearance
- 19. Male genitalia Male infant’s scrotum is undeveloped and not pendulous Minimal rugae are present Testes may be in the inguinal canal or in the abdominal cavity
- 20. Female genitalia Clitoris is prominent Labia majora are poorly developed and gaping
- 21. Scarf sign Elbow may be easily brought across the chest with little or no resistance
- 22. DIFFERENCE BETWEEN PRETERM AND TERM INFANT CHARACTERISTICS PRETERM TERM Posture The preterm infant lies in a relaxed attitude , limbs more extended The body size is small Head may appear somewhat larger in proportion Term infant has more subcutaneous fat tissues and rests in a more flexed attitude
- 23. Ear Preterm Ear Cartilages are poorly developed Ear may fold easily Hair is fine and feathery Lanugo may cover the back and face Term The mature infants ear cartilages are well formed Hair is more likely to form firm , separate strands
- 24. Sole preterm More rigid Fine wrinkles term Well and deeply creased
- 25. Female genitalia preterm Clitoris is prominent . Labia majora are poorly developed and gaping term Labia majora fully developed Clitoris not prominent
- 26. Male genitalia preterm Male infant’s scrotum is undeveloped and not pendulous Minimal rugae are present Testes may be in the inguinal canal or in the abdominal cavity term Scrotum well developed Pendulous Rugated Testes well down in the scrotal sac
- 27. Scarf sign preterm Elbow may be easily brought across the chest with little or no resistance term resisting attempt to bring the elbow past the midline
- 28. NEUROLOGIC EVALUATION CHARACTERISTICS PRETERM TERM GP REFLEX weak Strong HEEL TO EAR MANEUVER Heel is easily brought to the ear, meeting with no resistance Not possible , since there is considerable resistance at the knee
- 29. COMPLICATIONS OF PRETERM BIRTH Central nervous system: immaturity of central nervous system Poor cough reflex Incoordinated sucking and swallowing Retrolental fibroplasias Intra ventricular and periventricular hemorrhage brain damage
- 30. Respiratory system Resuscitation difficulties at birth Hyaline membrane disease Breathing is periodic and associated with intercostal recessions due to soft rib Pulmonary aspiration Atlectasis broncho pulmonary dysplasia
- 31. Cardio vascular system The closure of ductus arteriosus is delayed among preterm infants
- 32. G I system Regurgitations and aspirations Abdominal distention and functional intestinal obstruction Enterocolitis Hyperbilirubinemia Hypoglycemia
- 33. Thermo-regulation Excess heat loss Infections Renal immaturity The blood urea nitrogen is high Acidosis Edema
- 34. Toxicity of drug Nutritional problems anemia Deficiencies of folic acid and vit E osteopenia and rickets Biochemical disturbance hypoglycemia, hypocalcemia, hypoxia and hypoprotinemia
- 35. MANAGEMENT ARREST OF PREMATURE LABOUR Bed rest and sedation Tocolytic agent Ethanol Magnesium sulphate
- 36. Tocolytic agents Isoxsuprine (duvadilan) Retodrine Salbutamol Terbutaline
- 37. INDUCTION OF PREMATURE LABOUR L/S ratio Antenatal corticosteroids: Betamethasone: 12mg IM q24h for 2 doses Dexamethasone : 6mg IM every 12 hours for 4 doses
- 38. ASSESSMENT
- 41. Optimal management at birth The baby should be promptly dried, kept effectively covered and warm Vit K 0.5mg IM Shift to NICU
- 42. MONITORING Vital signs Activity and behavior Color, Tissue perfusion Fluids, electrolytes and ABG’s Tolerance of feeds Look for development of RDS., apneic attacks, sepsis, PDA, NEC, IVH etc Weight gain velocity :
- 43. CARE OF NEWBORN cushioned bed Avoid excessive light, excessive sound, rough handling and painful procedures. Use effective analgesia and sedation for procedures Provide warmth Ensure asepsis Cover the baby appropriately
- 44. Provide effective and safe oxygenation Nutrition tactile and kinesthetic stimulation
- 45. Prone position Photo therapy Prevention of nosocomial infection Weight record
- 46. Immunizations Family support Discharge policy Follow up Home care of preterm babies
- 47. COMMON PROBLEMS OF PRETERM NEWBORNS Nosocomial infections Hypothermia Respiratory distress syndrome Aspiration Patent ductus arteriosus Chronic lung disease
- 48. Necrotizing enterocolitis Intraventricular haemorrhage Retinopathy of prematurity Late metabolic acidosis Nutritional disorders Drug toxicity
- 50. Problem with respiration Problems with thermoregulation Fluid and electrolyte imbalance Infection Pain Parental / maternal separation
- 51. NURSING DIAGNOSIS impaired gas exchange ineffective thermoregulation related to prematurity imbalanced nutrition Altered growth and development related to hospitalization altered parenting Anxiety related to lack of knowledge
- 52. THANK YOU…