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PRETE
RM
BABIES
PRESENTED BY:
Dhanalakshmy. M
First year M.Sc NURSING
Govt college of nursing
Alappuzha
Introduction
Birth
babies.
Definition
Incidence
About
CAUSES OF
PREMATURITY
The
Induced
Spontaneous
Poor
Low
socio-economic status
maternal weight
Chronic
Antepartum
Cervical
hemorrhage
incompetence
Maternal
Contd
Cigarette
Threatened
Acute
abortion
emotional stress
Physical
Sexual
exertion
activity
Trauma
Bi-cornuate
Multiple
uterus
pregnancy
Congenital
malformations
Induced
The
CLINICAL
FEATURES
Measurements
Their
length is
less than 47 cm
Head
circumference is
general activity is
poor
Their
automatic reflex
baby assumes an
Disproportionately
large head size
Contd.
Optic
cartilage is deficient or
is thin,
may be
present.
Contd..
Subcutaneous
fat is
Genitals
In
undescended and
scrotum is poorly
developed.
Contd..
In
female infants,
PHYSIOLOGIC
AL
HANDICAPS
of central
nervous system is
expressed as inactivity
and lethargy, poor
cough reflex and
in-coordinated sucking
and swallowing
Contd..
Resuscitation difficulties at
birth and recurrent apneic
attacks.
Retinopathy of prematurity .
Respiratory system
Cuboidal
alveolar lining-
membrane
disease
Breathing is mostly
diaphragmatic, periodic
and associated with
intercostal recessions
Contd
Pulmonary
aspiration
and atelectasis
They
are vulnerable
to develop chronic
pulmonary
insufficiency
Cardio-vascular system
In grossly immature
infants( less than 32
weeks) EKG shows left
ventricular preponderance.
Gastro- intestinal
system
Due
to poor and
and
Contd..
Entero-colitis
Development of kernicterus at
lower serum bilirubin levels.
Thermo-regulation
Hypothermia
Excessive
is invariable.
Infections
Infections
handling, humid
Renal immaturity
The blood urea nitrogen is
high due to low glomerular
filtrate rate.
The renal tubular ammonia
mechanism is poorly
developed thus acidosis
occurs early.
They vulnerable to develop
late metabolic acidosis
especially when fed with a
high protein milk formula.
Concentration of urine is poor.
Contd
Preterm
has to pass
4 to 5 ml of urine excrete
one milliosmole of solute
Baby gets dehydrated.
The
Toxicity of drugs
Poor
hepatic
detoxification and
reduced renal
clearance make a
preterm baby
vulnerable to toxic
effects of drugs
Nutritional handicaps
Develop haemolytic
anemia, thrombocytopenia
and edema 6 to 10 weeks
of age.
Biochemical
disturbances
These
babies are
prone to develop :
Hypoglycaemia
Hypocalcemia
Hypoprotenemia
Acidosis and
Hypoxia.
MANAGEMENT
Tocolytic agents
Sympathomimetic agents-beta-2-adrenergic
receptors.
Isoxsuprine (duvadilan)-beta-1 and beta-2 receptors.
Ritodrine
Salbutamol and terbutaline -beta-2 receptor
Magnesium sulphate
Indomethacin
Induction of premature
labour
Maturity
Antenatal
corticosteroids
Inj.betamethasone 12mg IM
every 24 hours --2 doses or
dexamethasone 6mg IM
every 12 hours for 4 doses.
CARE OF
PRETER
M
BABIES
Optimal
management at birth
Monitoring
Vital
signs .
Activity
and behaviour.
Colour.
Tissue
perfusion.
Fluids,
Tolerance
Watched
of feeds .
for development of
gain velocity.
The
a soft, comfortable,
excessive stimuli.
Effective
analgesia and
sedation.
Provide
Ensure
warmth.
asepsis.
Prevent
losses.
evaporative skin
Contd
Thermo-neutral
environment.
Provide partial
kangaroo0mother-care.
Oxygen therapy
Phototherapy
Early
phototherapy is
Prevention of nosocomial
infections
The
handling should be
bare minimum.
Vigilance
should be
maintained on all
procedures.
Early
treatment of infections.
dextrose solution (
NG tube.
Condition
feeds.
is stabilized - enteral
Fluid requirement
Fluid requirements are higher in LBW infants
due to:
Greater
Faster
breathing rates
Decreased
Greater
Greater
Rate of administration*
Birth weight
500 - 600
Fluid rate
(ml/kg/day)
140 - 200
601 - 800
120 - 130
801 - 1000
90 - 110
1000 - 1500
80 - 100
>1500
60 - 80
(g)
Rate of administration
Fluid
INDICATIONS
Infants
with BW 1000 g
Infants
: 6 - 8 mg/kg/min
Lipid
: 0.5 - 1 g/kg/d
Sodium
: 2 - 4 mEq/kg/d
Potassium
: 2 - 3 mEq/kg/d
Chloride
: 2 - 4 mEq/kg/d
Enteral nutrition
Breast
Increments
IV
On
increased
Feeding guidelines
PRETERMS
Higher
Lower
Specific
Promotes
intestinal maturation
concentrations of Vitamin
D, Ca, P
Inadequate
iron
Enteral nutrition
Energy
Protein
Fat
:6 - 8 g/kg/d
Na
:3 - 7 mEq/kg/d
Cl
:3 - 7 mEq/kg/d
:2 - 3 mEq/kg/d
Ca
Nutritional
supplements
Multivitamin
Iron
drops.
supplementation.
Vitamin
E supplementation.
Supplements
of calcium
(220mg/day) and
phosphorus (100mg/day).
Gentle rhythmic
stimulation
Gentle
touch, massage,
bed or placing a
auditory stimuli.
inputs.
Kangaroo Care
Kangaroo
care is placing a
Contd
Body
temperature
Contd
Breastfeeding:
Contd
Increase
weight gain
Contd..
Increased
Utility of
corticosteroids
A
single dose of
dexamethasone 0.2mg/kg IV at
4 hours of age.
Inhaled
steroids.
infections
Hypothermia
Respiratory distress syndrome
Aspiration
Patent ductus arteriosus
Chronic lung disease
NEC & IVH
ROP & Late metabolic acidosis
Nutritional disorders
Drug toxicity
Weight record
oxygenation without
monitoring.
Intravenous immuno-globulins.
Prophylactic antibiotics.
Prophylactic administration of
indomethacin or high doses of
vitamin E.
Unnecessary blood transfusions.
Formula feeds.
Rough handling, excessive light
and loud sound.
Immunizations
It
is desirable to administer
Contd
Live
vaccines should be
Family support
The
Discharge policy
The
mother should be
mentally prepared and
provided with essential
training and skills.
The mother- baby dyad
should be kept in stepdown nursery.
The baby should be stable,
maintaining his body
temperature and should
not have any evidences of
cold stress.
Contd..
At
Follow-up protocol
Common
infective illnesses,
and nutrition.
Immunizations.
Physical
growth, nutritional
Contd..
Neuro-motor
development,
Retinopathy of
prematurity, vision,
strabismus.
Hearing.
Behavioural
problems,
must be explained
about the importance of
asepsis.
Keeping the baby warm
and ensuring satisfactory
feeding routine.
The services of
postpartum programme
public health nurse and
social worker can be
utilized.
Environmental control
The
avoid smothering.
Woollen
The
In
or angeethi.
A
baby.
Contd..
The
The
The
The
The
The
Feeding
Whenever
Prognosis
Contd..
15 to 20 % incidence of
neurological handicaps in the
form of CP, seizures, ROP,
hydrocephalus, deafness and
MR.
Neurological prognosis is
adversely affected by degree
of immaturity.
Nursing management
Assessment of common
problems.
Nursing
diagnosis and
interventions
baby
Observe for any apneic episode.
Oxygen hood is often used for able to breathe
alone but need extra oxygen.
Oxygen also may be given by nasal cannula to
the infant who breathes alone.
Humidify the oxygen
CPAP may be necessary to keep the alveoli open
and improve expansion of lungs
Schedule
Determine
Reduce
Use
nonessential lighting
positioning devices
Provide suctioning
Provide
tolerated
Look
for hypoglycemia
Administer
Monitor
Assess
Administer
IV fluids
newborn
Assess
Monitor
Administer
Administer
preterm
Assess
Monitor
Breast
Check
Provide
top up feed
family members
Assess
Assess
Explain
Explain
Provide
Provide
If
Allow
Provide
if tolerated
members
Explain
members
Explain
giver
Explain
family members
Educate
Educate
Provide
Summary
Causes of prematurity
Clinical features
Physiological handicaps
Management
Prognosis
Nursing assessment
CONCLUSION.