nursing management of premature babies

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

1. Premature Baby Prepared by Ms. Jenisha Adhikari BSN

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. Skin: thin, gelatinous, shiny and excessive pink with abundant lanugo and very little vernix edema may be present. breast nodules are small or absent,

13. Subcutaneous fat is deficient,

14. deep sole creases are often not present Preterm Term

15. 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

16. 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

17. Central Nervous system poor reflexes Reflexes : moro , sucking, swallowing and other reflexes are absent or sluggish Uncoordinated sucking swallowing leads to feeding difficulties

18. Vulnerable to develop intra ventricular/ peri ventricular hemorrhage

19. 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

20. 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

21. Abdominal distension

22. necrotizing entercolitis

23. Temperature regulation Loose more heat due to large area so cause hypothermia Subcutaneous fat is less, less brown fat Inadequate thermal response

24. Cardio- vascular system Delayed closure of ductus arteriosus

25. Inadequate peripheral circulation Intra cranial hemorrhage due to poor auto regulation of cerebral blood flow

26. Renal immaturity GFR and urine concentration are reduced Metabolic distribution Hypoglycemia Hypocalcemia Hypoproteinemia Hypoxic

27. 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

28. Genitalia : in male ; testes are undescended , scortum poorly pigmented

29. in female; labia majora are widely separated exposing labia minora and clitoris

30. 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).

31. 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

32. Maintain body temperature Keep the baby in incubator with temperature and humidity maintained

33. Positioning Change the baby’s position from prone position ; it relives abdominal discomfort by passage of flatus and prevent aspiration Change position 2 hourly

34. Kangaroo mother care Encourage KMC and exclusive breastfeeding

35. Oxygen therapy It should be administered only when indicated O 2 should administer with head box when O2 saturation falls below 85%

36. 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

37. 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

38. 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

39. Prevention of nosocomial infection Strict handing washing before and after touching the baby Minimal handeling

40. Phototherapy Early phototherapy is advice to keep the serum bilirubin level within safe limit to prevent need for exchange transfusion usually premature develops hyperbilirubinaemia

41. Factor to be avoid for pre term babies Routine O 2 administration without monitoring Prophylaxis antibiotics Formula feeding Rough handling Excessive light and sound

42. 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

43. Low blood sugar (hypoglycemia) Neonatal respiratory distress syndrome pulmonary hemorrhage Kernicterus Patent ductus arteriosus Severe intestinal inflammation(necrotizing enterocolitis )

44. 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

45. 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.

46. 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

47. 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

48. 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

49. Thank you