Preterm premature newborn

Preterm premature newborn | Chapter 22 | Midwifery For Diploma In Nursing

Preterm premature newborn- This course is designed to understand the care of pregnant women and newborn: antenatal, intra-natal and postnatal; breast feeding, family planning, newborn care and ethical issues, The aim of the course is to acquire knowledge and develop competencies regarding midwifery, complicated labour and newborn care including family planning.

Preterm premature newborn

Preterm baby:

A baby born before 37 completed weeks of gestation calculating from the first day of last menstrual period is known as preterm baby.

Or

The term refers to a baby bom before a gestation period of 37 weeks. This replaces the old term prematurity.

 

Preterm premature newborn

Figure: preterm / premature newborn

Predisposing factors of preterm baby

1. Poor nutritional status of the mother.

2. Maternal illness like toxemias, antepartum hemorrhage (APH), anemia and chronic infections.

3. Excessive smoking, drugs.

4. Overwork, fatigue, mental tension etc

5. Twinning.

6. Increasing parity.

7. High altitude.

Causes of preterm baby

1. Maternal history of preterm birth, spontaneous abortion, incompetent cervix or other uterine anomalies.

2. Infection
3. Premature rupture of membranes.
4. Pre-eclampsia.
5. Adolescent pregnancy.
6. Polyhydramnios.
7. Multiple gestations.
8. Oligohydramnios.
9. Placental insufficiency and Rhesus disease.
10. Maternal habits such as cigarette smoking, substance abuse and poor diet.

Features of preterm baby

1. Fine fuzzy, scanty hair.
2. Relatively head is large.
3. Large fontanelle and sutures
4. Craniotabes present.
5. Breast nodules very small or absent with small nipple.
6. Poor ear cartilage,
7. Absent eyebrows but prominent eyes
8. Buccal pad of fat is minimal.
9. Excessive lanugo hair present all over the body.
10. Small chest.
11. Relatively large abdomen.
12. Liver, spleen and kidneys are often palpable
13. Umbilical hernia may be present.
14. Visible gut peristalsis may be there.
15. Undescended tests, light-coloured scrotal skin with few rugosities are seen
16. In girl child labia majora does not cover labia minora.
17. On soles-very few creases are seen.
18. Nails are soft.
19. Overall poor musculature and less subcutaneous fat.

Management of the preterm neonate with nursing care

A. Immediate management:
1. Cord to be clamped quickly to prevent hypervolaemia and development of hyperbilirubinemia
2. Cord length to be 10-12 cm for use if exchange transfusion is required
3. Air passage to be cleared of mucus promptly
4. Adequate oxygenation to be provided (not exceeding 35%)
5. The baby should be wrapped including head in a sterile warn towel to prevent hypothermia and its sequelae such as hypoxia, hypoglycemia and metabolic acidosis.
6. Injection of vitamin K to be given to prevent haemmorhagic problems
B. Intensive care:
1. Monitor body temperature at regular intervals to prevent hypothermia and hyperthermia. The temperature should be maintained between 35’5o to 37 ‘2°C or (96-99° F)
2. Smaller babies are to be nursed in incubator where temperature and humidity can be regulated.
3. Oxygen to be administered to tide over maintain desirable level of saturation.
4. Prophylactic antibiotic therapy, the initial cyanotic phase and later to
5. Nutrition: Gavage feeding or parenteral nutrition depending on age and vigour of the baby.
C. Nursing care:
1. Temperature twice daily or according to institutional policy.
2. Weight every day to know if the newborn is over hydrated or under hydrated
3. Continuous observation and monitoring in the first 48 hours.
4. Visitation of mother.
5. Providing manually expressed breast milk to baby until able to suck and swallow.
D. Observation for signs of progress such as
1. Colour pink all the time.
2. Smooth and regular breathing.
3. Increasing vigour exhibited by limb movements and cry.
4. Progressive gain in weight after the first week.
5. Teach mother about the feeding to be continued, vitamin supplements, immunization and check-up.

Prevention of preterm baby

  • Quit smoking beforepregnancy or as early as during pregnancy.
  • Avoid drinking alcohol and using recreational drugs.
  • Advise health care provider of all medications that are taking, because some may be harmful to pregnancy and might need to be phased out.
  • Maintain an adequate amount of weight gain throughout pregnancy, depending on what health care provider thinks is right for women.
  • Eat a nutritious and well-balanced diet.
  • Avoid heavy lifting and work, and standing for long periods of time.
  • Minimize the stress in life whenever possible, and deal with stress using relaxation techniques, exercise, nutrition, and rest.
  • Go to prenatal classes.
  • Avoid infections as much as possible.
  • Premature delivery due to incompetent cervix can be reduced with a surgical procedure that closes the cervix from the 14th week of pregnancy until the ninth month.
  • Some chronic maternal illnesses can lead to premature birth if they are not treated properly during pregnancy.
  • They need to be appropriately managed during pregnancy.
  • If health care provider thinks women are high risk for premature labour, she may suggest that they refrain from having sexual intercourse.

 

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Complications of preterm baby

1. Asphyxia because of immaturity.

2. Cerebral haemorrhage

3. Hypothermia.

4. Pulmonary syndromes such as pulmonary oedema, intra-alveolar haemorrhage and respiratory distress syndrome.

5. Foetal shock following rough handling or rough resuscitation.

6. Jaundice because of hepatic insufficiency and inadequate excretion of bile.

7. Heart failure.

8. Oedema.

9. Infections such as bronchopneumonia, meningitis and gastroenteritis.

10. Anaemia due to lack of stored iron, hypofunction of bone marrow and excessive haemolysis.

11. Retrolental fibroplasias (Retinopathy of prematurity).

12. LBW baby

Or (Another answer)

A. Short-term complications:

  • Breathing problems.
  • Heart problems.
  • Brain problems.
  • Temperature control problems.
  • Gastrointestinal problems.
  • Blood problems.
  • Metabolism problems.
  • Immune system problems.

B. Long-term complications:

  • Cerebral palsy.
  • Impaired learning.
  • Vision problems.
  • Hearing problems
  • Dental problems.
  • Behavioral and psychological problems.
  • Chronic health issues.

Difference between preterm and term baby

 

Preterm premature newborn

 

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