Preterm Infants by Dr. Nahed Said El Nagger
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.
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.
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.
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).
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).
Causes of prematurity: • Abnormal structure of the uterus. • Cervical incompetence (inability of the cervix to stay closed during pregnancy). • Previous preterm birth.
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).
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.
Factors Predisposing the Newborn to Excessive Heat Loss • Large surface area results in heat loss to environment • Newborn’s thin layer of adipose is poor. • Newborn cannot shiver to increase heat production
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.
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.
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.
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.
Neurologic: • Intraventricular hemorrhage - bleeding in the brain. • Poor muscle tone. • Seizures - may be due to bleeding in the brain. • Retinopathy of prematurity.
Immun System Handicape. • Infections – premature infants are more susceptible to infection and may require antibiotics
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.
Clinical assessmentExamine skin for prematurity Thin, transparent skin in preterm infants Wrinkled peeling skin of dysmaturity in an IUGR infant Pale pink skin of a term infant (hair shaved to site IV line)
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.
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.
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.
Treatment of prematurity Specific treatment for prematurity will be determined based on: • baby’s 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.
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).
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.
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.
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.
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.
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).
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.
Care of premature babiesMedications 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.
Studies have found that babies who "kangaroo" may have shorter stays in the NICU.