Preterm Infants

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Preterm Infants

• by
• Dr. Nahed Said El Nagger

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Learning objectives

• Define preterm/ premature infant.
• List two common Classification of high risk
  infants.
• Identify the causes of prematurity.
• Discuss the physiological handicaps of premature
  baby.
• State characteristics of Prematurity.
• Describe therapeutic management for Preterm
  Infants.
• Design plan of care for premature baby.

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Premature Infant
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Classification of high risk infants

• Classification according to size
• Low birth weight (LBW)
• infants is less than 2500 g.
• Very low birth weight (VLBW)
• infants is less than 1500 g.
• Extremely low birth weight (ELBW)
• infant birth weight less than 1000 g.

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Classification according to gestational age

• Premature (preterm) infant born before
  completion of 37 weeks of gestation, regardless
  of birth weight.
• Full term infants an infant born between the
  beginning of the 38-42 weeks of gestation,
  regardless of birth weight.
• Postmature (post-term) an infant born after 42
  weeks of gestational age, regardless of birth
  weight.

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Causes of prematurity

• Unknown causes (50).
• Maternal factors
• Preeclampsia (also known as toxemia or high blood
  pressure of pregnancy).
• Chronic medical illness (such as heart or kidney
  disease).

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Causes of prematurity

• Infection (such as group B streptococcus, urinary
  tract infections, vaginal infections, infections
  of the fetal/placental tissues).
• Drug use (such as cocaine).

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• Causes of prematurity
• Abnormal structure of the uterus.
• Cervical incompetence (inability of the cervix to
  stay closed during pregnancy).
• Previous preterm birth.

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• Factors involving the pregnancy
• Abnormal or decreased function of the placenta.
• Placenta previa (low lying position of the
  placenta).
• Placental abruption (early detachment from the
  uterus).
• Premature rupture of membranes (amniotic sac).
• Polyhydramnios (too much amniotic fluid).

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Physiological handicaps of Premature Baby

• Some of the problems premature babies may
  experience include
• Temperature instability
• inability to stay warm
• due to low body fat.

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Factors Predisposing the Newborn to Excessive
Heat Loss

• Large surface area results in heat loss to
  environment
• Newborns thin layer of adipose is poor.
• Newborn cannot shiver to increase heat production

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Respiratory problems

• Hyaline membrane disease/respiratory distress
  syndrome
• a condition in which the air sacs cannot stay
  open due to lack of surfactant in the lungs.
• Chronic lung disease/broncho-pulmonary dysplasia
  
• long-term respiratory problems caused by injury
  to the lung tissue.

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Respiratory problems

• Air leaking out of the normal lung spaces into
  other tissues.
• Incomplete lung development.
• Apnea (stopping breathing)
• occurs in about half of babies born at or
  before 30 weeks.

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Cardiovascular

• Patent ductus arteriosus (PDA) - a heart
  condition that causes blood to divert away from
  the lungs.
• Too low or too high blood pressure.
• Low heart rate - often occurs with apnea.

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• Gastrointestinal
• Difficulty feeding - many are unable to
  coordinate suck and swallow before 35 weeks
  gestation.
• Poor digestion.
• Necrotizing enterocolitis (NEC) - a serious
  disease of the intestine common in premature
  babies.

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Neurologic

• Intraventricular hemorrhage - bleeding in the
  brain.
• Poor muscle tone.
• Seizures - may be due to bleeding in the brain.
• Retinopathy of prematurity.

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• Immun System Handicape.
• Infections
• premature infants are more susceptible to
  infection and may require antibiotics

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Characteristics of Prematurity

• Small baby, often weighing less than 2,500 grams.
  
• Lies on relaxed attitude and head appear
  somewhat larger in proportion to the body size.
• Thin, shiny, pink or red skin, able to see veins.
  
• Little body fat.

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Clinical assessmentExamine skin for prematurity
Thin, transparent skin in preterm infants
Pale pink skin of a term infant (hair shaved to
site IV line)
Wrinkled peeling skin of dysmaturity in an IUGR
infant
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Characteristics of Prematurity

• Little scalp hair, but may have lots of lanugo
  (soft body hair).
• Ear cartilages are poorly developed and ear may
  fold easily.
• The sole of the foot appears more turgid and may
  have only fine wrinkles.

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• Grasp reflex is weak.
• Weak cry and body tone.
• Genitals may be small and underdeveloped.
• Scarf sign elbow may be easily brought to the
  midline of the chest with little or no
  resistance.
• Heel to ear maneuver heel is easily brought to
  the ear, meeting with no resistance.

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• Therapeutic management for Preterm Infants
• When the delivery of a preterm is anticipated
• Intensive care nursery is alerted.
• Team approach implemented (neonatologist, an
  advanced practice nurse, and a respiratory
  therapist)
• For the delivery.

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• Treatment of prematurity
• Specific treatment for prematurity will be
  determined based on
• babys gestational age, overall health and
  medical history.
• extent of the disease.
• tolerance for specific medications, procedures or
  therapies.
• expectations for the course of the disease.

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Prenatal corticosteroid therapy.

• Research has found that giving the mother a
  steroid medication at least 48 hours prior to
  delivery
• greatly reduces the incidence and severity of
  respiratory disease in the baby.
• Another major benefit of steroid treatment is
  lessening of intraventricular hge (bleeding in
  the baby's brain).

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• Prenatal corticosteroid therapy.
• Although studies are not clear, prenatal
  steroids may also help reduce the incidence of
  NEC and PDA. Mothers may be given steroids when
  preterm birth is likely between 24 and 34 weeks
  of pregnancy. Before that time, or after, the
  medication usually is not effective.

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Examples of nursing diagnosis of preterm baby

• Ineffective breathing pattern related to
  pulmonary and neuromuscular immaturity, decreased
  energy, and fatigue.
• Ineffective thermoregulation related to immature
  T. control and decreased subcutaneous body fat.

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Examples of nursing diagnosis of preterm baby

• Risk for infection related to deficient
  immunologic defenses.
• Imbalanced nutrition less than body requirements
  related to inability to ingest nutrients.

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Care of premature babies

• Temperature-controlled beds.
• Monitoring of temperature, blood pressure, heart
  and breathing rates and oxygen levels.
• Giving extra oxygen by a mask or with a breathing
  machine.
• Mechanical ventilators (breathing machines) to do
  the work of breathing for the baby.

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• Intravenous (IV) fluids - when feedings cannot be
  given, or for medications.
• placement of catheters (small tube) into the
  umbilical cord to give fluids and medications and
  to draw blood.
• X-rays (for diagnosing problems and checking tube
  placement).

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• Care of premature babies
• Special feedings of breast milk or formula,
  sometimes with a tube into the stomach if a baby
  cannot suck. Breast milk has many advantages for
  premature babies as it contains immunities from
  the mother and many important nutrients.

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• Care of premature babies Medications and other
  treatments for complications, such as
  antibiotics.
• Kangaroo Care
• a method of caring for premature babies using
  skin-to-skin contact with the parent to provide
  contact and
• aid parent-infant attachment.

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• Studies have found that babies who "kangaroo" may
  have shorter stays in the NICU.

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questions please
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Thank You