Preterm

preterm neonate

1. PRETERMNEONATE
.
ARUNA A P

I BATCH MSC NURSING

2. DEFINITION
 37
Any neonate born before 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

4. ETIOLOGY
Spontaneous

Induced

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
6- 10%
pregnancy and is occurring in

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
 - 47
Crown heel length is less than cm
 33
Head circumference is less than cm

But exceeds the chest circumference by
3
more than 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
CHARACTERISTI

CS
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. Femalegenitalia
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. Scarfsign
preterm

Elbowmaybe

easilybrought

acrossthe

chestwith

littleorno
resistance
term

resisting

attemptto

bringthe

elbowpastthe
midline

28. NEUROLOGIC EVALUATION
CHARACTERIS
TICS
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

Theclosureof

ductus

arteriosusis

delayed

among

preterminfants

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
 : 12 24 2
Betamethasone mg IM q h for doses
 : 6 12
Dexamethasone mg IM every hours
4
for doses

38. ASSESSMENT

39. NEW BALLARD SCORE

41. Optimal management at birth
 ,
The baby should be promptly dried

kept effectively covered and warm
 0.5
Vit K mg IM

Shift to NICU

42. MONITORING

Vital signs

Activity and behavior
 ,
Color Tissue perfusion
 , ’
Fluids electrolytes and ABGs

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

49. NURSING MANAGEMENT

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…