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UNIT II Maternal-Newborn Nursing and Womens Health

Sepsis. Sepsis is a generalized infection of the bloodstream. Preterm newborns are at risk for developing
this complication because of the immaturity of many
body systems. The liver of the preterm infant is immature and forms antibodies poorly. Body enzymes are
inefficient. There is little or no immunity received from
the mother, and stores of nutrients, vitamins, and iron
are insufficient. There may be no local signs of infection, which also hinders diagnosis. Some signs of
sepsis include a low temperature, lethargy or irritability, poor feeding, and respiratory distress. Maternal
infection and complications during labor can also predispose the preterm infant to sepsis.
Treatment involves administration of intravenous
antimicrobials, maintenance of warmth and nutrition,
and close monitoring of vital signs, including blood
pressure. Keeping nursing care as organized as possible will help conserve energy. An incubator separates the infant from other infants in the unit and
facilitates close observation. Maintenance of strict
Standard Precautions is essential (see Appendix A).
Poor Control of Body Temperature
Keeping the preterm infant warm is a nursing challenge. Heat loss in the preterm infant results from the
following factors:
The preterm infant has a lack of brown fat, which
is the bodys insulation.
There is excessive heat loss by radiation from a
surface area that is large in proportion to body
weight. The large surface area of the head predisposes the infant to heat loss.
The heat-regulating center of the brain is
immature.
The sweat glands are not functioning to
capacity.
The preterm infant is inactive, has muscles that
are weak and less resistant to cold, and cannot
shiver.
The posture of the preterm infants extremities is
one of leg extension. This increases the surface
area exposed to the environment and increases
heat loss.
Metabolism is high, and the preterm infant
is prone to low blood glucose levels
(hypoglycemia).
These and other factors make the preterm newborn
vulnerable to cold stress, which increases the need for
oxygen and glucose. Early detection can prevent
complications.

Nursing Tip
Signs and symptoms of cold stress include the following:
Decreased skin temperature
Increased respiratory rate with periods of apnea
Bradycardia
Mottling of skin
Lethargy

Nursing Care. The infants skin temperature will fall

before the core temperature falls. Therefore a skin
probe is used to monitor the temperature of preterm
infants. The skin probe is placed in the right upper
quadrant of the abdomen. Care should be taken to
ensure that the probe is not directly over a bony pro
minence, in the line of cool oxygen input, or under
a diaper.
The infant is placed under a radiant warmer or in
an incubator to maintain a warm environment. The
temperature of the incubator is adjusted so that the
infants body temperature is at an optimal level (36.2
to 37 C [97.1 to 98.6 F]).
Hypoglycemia and Hypocalcemia
Hypoglycemia (hypo, less than, and glycemia, sugar
in the blood) is common among preterm infants. They
have not remained in the uterus long enough to acquire
sufficient stores of glycogen and fat. This condition is
aggravated by the need for increased glycogen in the
brain, the heart, and other tissues as a result of
asphyxia, sepsis, RDS, unstable body temperature, and
similar conditions. Any condition that increases energy
requirements places more stress on these already deficient stores. Plasma glucose levels lower than 40mg/
dL indicate hypoglycemia in a term infant, and in a
preterm infant, lower than 30mg/dL.
The brain needs a steady supply of glucose, and
hypoglycemia must be anticipated and treated
promptly. Any condition that increases metabolism
increases glucose needs. Preterm infants may be too
weak to suck and swallow formula and often require
gavage or parenteral feedings to supply their 120- to
150-kcal/kg/day needs.
Hypocalcemia (hypo, below, and calcemia, calcium
in the blood) is also seen in preterm and sick newborns. Calcium is transported across the placenta
throughout pregnancy, but in greater amounts during
the third trimester. Early birth can result in infants
with lower serum calcium levels.
In early hypocalcemia the parathyroid fails to
respond to the preterm infants low calcium levels.
Infants stressed by hypoxia or birth trauma or who are
receiving sodium bicarbonate are at high risk for this
problem. Infants born to mothers who are diabetic or
who have had low vitamin D intake are also at risk for
developing early hypocalcemia.
Late hypocalcemia usually occurs about age 1 week
in newborn or preterm infants who are fed cows milk.
Cows milk increases serum phosphate levels, which
cause calcium levels to fall.
Hypocalcemia is treated by administering intravenous calcium gluconate. During intravenous therapy
the nurse should monitor the infant for bradycardia.
Adding calcium lactate powder to the formula also
lowers phosphate levels. (Calcium lactate tablets are
insoluble in milk and must not be used.) When calcium
lactate powder is slowly discontinued from the