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PRETERM BABY

INTRODUCTION

Full-term pregnancy lasts 37 to 40 weeks. About 12% of newborns are born


prematurely (preterm). Many of these newborns are born just a few weeks early and
do not experience any problems related to their prematurity

DEFINITION

 A premature newborn is, by definition, delivered before 37 weeks of


development in the uterus. A premature newborn has underdeveloped organs,
which may not be ready to function outside of the uterus.

CAUSES
The reasons for premature birth are frequently unknown. The risk of premature birth
is,
 Higher among adolescents and older women
 Women of lower socioeconomic status
 Women with inadequate prenatal care
 Multiple fetuses (twins, triplets, quadruplets).
 Poor nutrition
 Untreated infections, such as
 urinary tract infections
 sexually transmitted diseases,
 Previous premature birth
 Life-threatening disorders,
 heart disease
 severe high blood pressure
 kidney disease,
 Preeclampsia or eclampsia
 Placental insufficiency

SYMPTOMS
o Premature newborns usually weigh less than 5½ pounds (2.5 kilograms)

o Some weigh as little as 1 pound (½ kilogram).

o Symptoms often depend on immaturity of various organs. For example, some


organs, such as the lungs or brain, may not be fully developed.

o Premature newborns may also have difficulty regulating their body


temperature and the level of sugar in the blood.

o The immune system is also underdeveloped.

o Physical Features of a Premature Newborn are,

 Small size

o Large head relative to rest of the body


o Little fat under the skin
o Thin, shiny, pink skin
o Veins visible beneath the skin
o Few creases on soles of feet
o Scant hair
o Soft ears, with little cartilage
o Underdeveloped breast tissue
o Boys: Small scrotum with few folds. Testes may be undescended
in verypremature newborns
o Girls: Labia majora not yet covering labia minora
o Rapid breathing with brief pauses (periodic breathing), apnea
spells (pauses lasting longer than 20 seconds), or both
o Weak, poorly coordinated sucking and swallowing reflexes
o Reduced physical activity and muscle tone (a premature newborn
tends not to draw up the arms and legs when at rest as does a full-
term newborn)
o Sleeping for most of the time

COMPLICATIONS

Risk of complications increases with increasing prematurity and depends in


part on the presence of certain causes of prematurity, such as infection, diabetes,
high blood pressure, or preeclampsia in the mother.

UNDERDEVELOPED BRAIN: These problems include

 Inconsistent breathing: The part of the brain that controls regular breathing may
be so immature that newborns breathe inconsistently, with short pauses in
breathing or periods during which breathing stops completely for 20 seconds or
longer
 Difficulty coordinating feeding and breathing: The parts of the brain that
control reflexes involving the mouth and throat are immature, so premature
newborns may not be able to suck and swallow normally, resulting in difficulty
coordinating feeding with breathing.
 Bleeding (hemorrhage) in the brain: Newborns born very prematurely are at
increased risk of bleeding in the brain. Bleeding typically begins in an area of the
brain called the germinal matrix and may extend into fluid-filled spaces within
the brain called the ventricles. Newborns with very large hemorrhages are at
higher risk of having developmental delay, cerebral palsy, or learning disorders,
and a few may not survive.

UNDERDEVELOPED DIGESTIVE TRACT AND LIVER: An underdeveloped


digestive tract and liver can cause several problems, including

 Frequent episodes of spitting-up: Initially, premature newborns may have


difficulty with feedings. Not only do they have immature sucking and swallowing
reflexes, but also their small stomach empties slowly, which can lead to frequent
episodes of spitting up (reflux).
 Intestinal damage: Very premature newborns may develop a serious
complication in which part of the intestine becomes severely damaged called
necrotizing enterocolitis
 Jaundice: In premature newborns, the liver is slow in clearing bilirubin (the
yellow bile pigment that results from the normal breakdown of red blood cells)
from the blood. Rarely, very high levels of bilirubin accumulate and put newborns
at risk of developing kernicterus. Kernicterus is a form of brain damage caused
by deposits of bilirubin in the brain.

UNDERDEVELOPED IMMUNE SYSTEM: Infants born very prematurely have


low levels of antibodies, substances in the bloodstream that help protect against
infection. Antibodies cross the placenta. Therefore, the risk of developing infections,
especially infection in the blood (sepsis), is higher in premature newborns.

UNDERDEVELOPED KIDNEYS: Before delivery, waste products produced in the


fetus are removed by the placenta and then excreted by the mother's kidneys. After
delivery, the newborn's kidneys must take over these functions. Kidney function is
diminished in very premature newborns but improves as the kidneys mature.
Newborns with underdeveloped kidneys may have difficulty regulating the amount
of salt and water in the body.

UNDERDEVELOPED LUNGS: The lungs of premature newborns may not have


had enough time to fully develop before birth. Such newborns are likely to have
respiratory distress syndrome, causing visibly labored breathing, flaring of the
nostrils while breathing in, a grunting sound while breathing out, and a bluish
discoloration to the skin (cyanosis) if oxygen levels in the blood are low

DIFFICULTY REGULATING BLOOD SUGAR LEVELS: Because premature


newborns have difficulty feeding and maintaining normal blood sugar (glucose)
levels, Without regular feedings, newborns may develop low blood sugar levels
(hypoglycemia). Others become listless with poor muscle tone, feed poorly, or
become jittery. Rarely, seizures develop. Premature newborns are also prone to
developing high blood sugar levels (hyperglycemia) if they receive too much sugar
intravenously, but hyperglycemia rarely causes symptoms.
DIFFICULTY REGULATING BODY TEMPERATURE: Because premature
newborns have a large skin surface area relative to their weight compared to full-
term newborns, they tend to lose heat rapidly and have difficulty maintaining normal
body temperature, If they are exposed to a cool environment, premature newborns
will generate extra body heat, markedly increasing their rate of metabolism and
making it difficult for them to gain weight.

PROGNOSIS
Over recent decades, the survival of premature newborns has improved
dramatically. For most premature newborns, the long-term prognosis is very good,
and they develop normally. However, risk of death and long-term problems begins
to increase in infants born before 26 weeks of pregnancy and particularly in those
born before 24 weeks. Risks include delayed development, cerebral palsy, and vision
impairment.

PREVENTION
The best way for premature birth to be prevented is,

Ante-natal

 The expectant mother should take good care of her own health.

 Eat a nutritious diet

 Avoid alcohol, tobacco, and drugs

 Treat a medical condition. Ideally

 Early and regular prenatal care


 Any complications of pregnancy should be recognized early and
treated.

Intra-natal

 Obstetricians may give drugs to the pregnant woman to slow or stop


contractions for a short time.

 During that interval, corticosteroids, such as betamethasone


, may be given to the mother to speed the development of the fetus's
lungs to reduce the risk of the newborn developing respiratory distress
syndrome and also to reduce the risk of brain hemorrhage.

TREATMENT
Treatment involves managing the complications of prematurity, such as
respiratory distress syndrome and high bilirubin levels (hyperbilirubinemia). Very
premature newborns are given nutrition into their veins until they can tolerate
feedings into their stomach through a feeding tube and eventually feedings by
mouth. The mother's breast milk is the best food for premature infants. Use of breast
milk decreases the risk of developing necrotizing enterocolitis. Premature newborns
may need to be hospitalized for days, weeks, or months.

CARE OF THE PRE-TERM NEONATE

 Immediate care following the birth

 The cord to be clamped quickly

 The cord length is kept long

 The air passage should be cleaned


 Adequate oxygen through the hood

 Baby should be wrapped the whole body including the head

 Intensive care protocol

 Maintain the body temperature –place in the incubator

 Respiratory support- clear the air passage and oxygen administration

 Infection-prevent infection by following aseptic techniques, do not take


the baby out from the incubator on and off, minimum handling

 Nutrition-can start 2 hous after birth, breast milk by NG feed, palida


feed, then to direct breast feeding

 Favorable signs of progress

 Colour becomes pink

 Smoth breathing
 Progressive weight gain

 Time to discharge

 If the baby gains weight, sucking to breast sucessfully

 Advice on discharge

 Monitoring by the health worker

 Follow up schedule

 Immunization

 Prescribe the multivitamin drops

 Kangaroo mother care

CONCLUSSION

. However, the more prematurely newborns are born, the more they are prone
to serious and even life-threatening complications. Extreme prematurity is the single
most common cause of death in newborns. Also, newborns born very prematurely
are at high risk of long-term problems, especially delayed development and learning
disorders. Nonetheless, most infants who are born prematurely grow up with no
long-term difficulties. The risk of premature birth is decreased with early prenatal
care.

HEALTH EDUCATION:

1. Disease condition: Educated child mother about disease condition, its


causes, available treatment, prognosis.
2. Exclusive breast feeding; Explained in detail about importance of
exclusive breast feeding
3. Immunization: explained the importance of immunization in their
level of understanding to parents.
4. Prevention of infection: Educated mother about importance of
hygienic practices in preventing infection to child
5. Follow up care.

BIBLIOGRAPHY :

1. Ghai OP, Vinod KP, Arvind B. Ghai Essential Peadrics.7th edn. CBS Publishers. New
Delhi:2009:Pg:295.

2. Wong DL,Whaley &wong.nursing care of infants and children.6th edn.Mosby.1999.Pg. 841.

3. Dutta DC. Text book of Obsterics. 6th ed. New central book agency: Kolkata;2004.p.458-62