PRETERM NEONATE

ARUNA. A P
I BATCH MSC NURSING
DEFINITION

 Any neonate born before 37 weeks

(<259 days) of gestation irrespective
of the birth weight.
 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
ETIOLOGY

Spontaneous

 Induced
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
 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
 Chronic and acute systemic maternal
disease
 Antepartum haemorrhage
 Cervical incompetence
 Maternal genital colonization and
infections
 Cigarette smoking during pregnancy
 Acute emotional stress
 Physical exertion
 Sexual activity
Trauma
 Bicornuate uterus
 Congenital malformations
Induced

 Maternal diabetes mellitus

 Placental dysfunction as indicated by
unsatisfactory fetal growth
Eclampsia
 Fetal hypoxia
 Antepartum haemorrhage
 Severe rhesus iso immunization
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
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
Face and head:

 Face appears small

 large head size
 Sutures are widely separated
 Fontanels are large
 Small chin
 Protruding eyes
 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
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
Genitals:

 MALE:
 testes undescended
 scrotum poorly developed
 FEMALES :
 labia majora widely separated exposing
labia minora
 hypertrophied clitoris
CHARACTERISTICS OF
PRETERM INFANTS
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
 Soles and
Ear cartilage palms

Soft and pliable Minimal creases

Smooth
appearance
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
Female genitalia

 Clitoris is prominent
 Labia majora are poorly developed and
gaping
Scarf sign

 Elbow may be easily

brought across the
chest with little or
no resistance
 DIFFERENCE BETWEEN
PRETERM AND TERM
INFANT
CHARACTERISTI PRETERM TERM
CS
Posture The preterm infant Term infant has
lies in a relaxed more subcutaneous
attitude , limbs fat tissues and
more extended rests in a more
The body size is flexed attitude
small
Head may appear
somewhat larger in
proportion
Ear
Preterm Term
 Ear Cartilages are  The mature infants ear
poorly developed cartilages are well
 Ear may fold easily formed

 Hair is fine and feathery  Hair is more likely to

form firm , separate
 Lanugo may cover the
strands
back and face
Sole
preterm term
 More rigid  Well and deeply
 Fine wrinkles creased
Female genitalia

preterm term
 Clitoris is prominent .  Labia majora fully
Labia majora are poorly developed
developed and gaping  Clitoris not prominent
Male genitalia
preterm term
 Male infant’s scrotum is  Scrotum well developed
undeveloped and not  Pendulous
pendulous
 Rugated
 Minimal rugae are  Testes well down in the
present scrotal sac
 Testes may be in the
inguinal canal or in the
abdominal cavity
Scarf sign
preterm term
Elbow may be resisting
easily brought attempt to
across the bring the
chest with elbow past the
little or no midline
NEUROLOGIC EVALUATION
CHARACTERIS PRETERM TERM
TICS

GP REFLEX weak Strong

HEEL TO EAR Heel is easily Not possible ,

MANEUVER brought to the ear, since there is
meeting with no considerable
resistance resistance at the
knee
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
Respiratory system
 Resuscitation difficulties at birth
 Hyaline membrane disease
 Breathing is periodic and associated
with intercostal recessions due to soft
rib
 Pulmonary aspiration
 Atlectasis
Cardio vascular system

The closure of
ductus
arteriosus is
delayed
among
preterm infants
G I system
 Regurgitations and aspirations
 Abdominal distention and functional
intestinal obstruction
Enterocolitis
Hyperbilirubinemia
Hypoglycemia
 Thermo - regulation
Excess heat loss

Infections
 Renal immaturity
 The blood urea nitrogen is high
Acidosis
 Edema
 Toxicity of drug
 Nutritional problems
anemia
 Deficiencies of folic acid and vit E
 osteopenia and rickets
 Biochemical disturbance
 hypoglycemia, hypocalcemia, hypoxia
MANAGEMENT

 ARREST OF PREMATURE
LABOUR
Bed rest and sedation
Tocolytic agent
Ethanol
Magnesium sulphate
Tocolytic agents

 Isoxsuprine (duvadilan)
Retodrine
Salbutamol
Terbutaline
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
ASSESSMENT
NEW BALLARD SCORE
Optimal management at birth

 The baby should be promptly dried,

kept effectively covered and warm
 Vit K 0.5mg IM
 Shift to NICU
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
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
Provide effective
and safe
oxygenation
Nutrition
tactile and
kinesthetic
stimulation
 Prone position
 Photo therapy
 Prevention of
nosocomial
infection
 Weight record
Immunizations
 Family support
 Discharge policy
 Follow up
 Home care of preterm babies
COMMON PROBLEMS OF
PRETERM NEWBORNS
 Nosocomial infections
Hypothermia
 Respiratory distress syndrome
Aspiration
 Patent ductus arteriosus
 Chronic lung disease
 Necrotizing enterocolitis
 Intraventricular haemorrhage
 Retinopathy of prematurity
 Late metabolic acidosis
 Nutritional disorders
 Drug toxicity
NURSING MANAGEMENT
 Problem with respiration
 Problems with thermoregulation
 Fluid and electrolyte imbalance
Infection
Pain
 Parental / maternal separation
NURSING DIAGNOSIS

 impaired gas exchange

 ineffective thermoregulation related to
prematurity
 imbalanced nutrition
 Altered growth and development related
to hospitalization
 altered parenting
THANK YOU…