Preterm InfantsPost term infants Third Stage Dr Moustafa Alshammari Child Health Nursing Preterm Infants Infants born before completion of 37 weeks of gestation are considered preterm or premature regardless of birth weight ID: 1044720
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1. High risk related to DysmaturityPreterm Infants-Post term infantsThird StageDr. Moustafa AlshammariChild Health Nursing
2. Preterm InfantsInfants born before completion of 37 weeks of gestation are considered preterm or premature regardless of birth weight.These newborns are the largest number to be admitted to the NICU.(neonatal intensive care unit)They have high incidence for complications and to have congenital defects
3. Majority of cases the cause is unknownIt is common in:In low socioeconomic classesMultiple pregnanciesInterrupted pregnancy due to placental accidentsHypertension relater to pregnancyIncidence
4. The premature has to adjust to extra uterine life with his immature systems that leads to problems since his systems are not physiologically readyIncidence
5. On inspection: Very small with little subcutaneous fatLarge head in proportion to bodyInactive and relaxed attitudeDiagnostic evaluation:
6. Very small, scrawny appearance Skin: Red-Pink with visible veinsFine, feathery hair, Lanugo on back and faceLittle or no evidence of subcutaneous fatHead is relatively large to bodyClinical manifestations of prematurity:(continued)
7. Lies in a relaxed attitudeLimbs extendedEar cartilage poorly developedFew fine wrinkles on palms and solesClitoris prominent in femalesScrotum undeveloped and non pendulous with and undescended testesLax, easily manipulated jointsAbsent, weak or ineffectual reflexesClinical manifestations of prematurity:(continued)
8. Other neurological signs are absent or diminished Unable to maintain body temperatureDiluted urinePliable thoraxPeriodic breathing hypoventilationFrequent episodes of apneaClinical manifestations of prematurity:
9. When a preterm delivery is expected the NICU is alerted and the team of neonatal specialists are present at the time of deliveryResuscitation is done if needed in the lobar room the infant is transferred to NICU in an incubator Measurements taken and vitamin K is givenTherapeutic Management(continued)
10. Respiratory support: Apnea mattress – Incubator – O2 monitoringTemperature regulation: Incubator, and monitoring of temperature, Humidity as recommendedTherapeutic Management(continued)
11. Complications such as hypoglycemia and hypocalcaemia are frequent in the premature infant and are managed according to specific conditions and monitored frequentlyRespiratory distress syndrome is very common and required respiratory supportTherapeutic Management
12. NURSING DIAGNOSIS: Ineffective breathing pattern related to immature respiratory system and respiratory distress as evidenced by tachypnea, nasal flaring, and sternal retractionsNursing Care Plan of a Preterm Newborn
13. Outcome Identification And EvaluationThe newborn’s respiratory status will return to an adequate level of functioning as evidenced by rate remaining within 30 to 60 breaths/min, Maintenance of acceptable oxygen saturation levels, and Minimal to absent signs of respiratory distress.Nursing Care Plan of a Preterm Newborn
14. Interventions: Promoting Optimal Breathing PatternAssess gestational age and risk factors for respiratory distress to allow early detection.Assess respiratory effort (rate, character, effort) to identify changes.Assess heart rate for tachycardia and auscultate heart sounds to determine worsening of condition.Nursing Care Plan of a Preterm Newborn
15. Interventions: Promoting Optimal Breathing PatternObserve for cues (grunting, shallow respirations, tachypnea, apnea, tachycardia, central cyanosis, increased effort) to identify need for additional oxygen.Maintain slight head elevation to prevent upper airway obstruction.Assess skin color to evaluate tissue perfusion.Monitor oxygen saturation level via pulse oximetry to provide objective indication of perfusion status.Nursing Care Plan of a Preterm Newborn
16. Interventions: Promoting Optimal Breathing PatternProvide supplemental oxygen as indicated and ordered to ensure adequate tissue oxygenation.Nursing Care Plan of a Preterm Newborn
17. Post term infantsInfant born after 42 weeks of gestationIncidence: 12% of birthsCause: Unknown
18. Post mature (post-term) delivery is much less common than premature (preterm) delivery. The reason for a pregnancy to continue beyond term is usually unknownThe placenta becomes less able to provide adequate nutrients to the fetus.Post term infants
19. To compensate, the fetus begins to use its own fat and carbohydrates to provide energy. As a result, its growth rate slowsIts weight may decrease. If the placenta shrinks sufficiently, it may not provide adequate oxygen to the fetus, particularly during labor. A lack of adequate oxygen may result in fetal distress Post term infants
20. May result in injury to the fetal brain and other organs. Fetal distress may cause the fetus to pass stools (meconium) into the amniotic fluid. The fetus inhale the meconium-containing amniotic fluid into the lungs during birth. As a result, the newborn may have difficulty breathing after delivery (meconium aspiration syndrome).Post term infants
21. A post mature newborn has dry, peeling, loose skin May appear emaciated, especially if the function of the placenta was severely reduced. The newborn often appears alert. Symptoms(continued)
22. The skin and nail beds may be stained green if meconium was present in the amniotic fluid. A post mature newborn is prone to developing low blood sugar levels (hypoglycemia) after delivery, especially if oxygen levels were low during labor.Symptoms
23. The post mature newborn who experienced low oxygen levels and fetal distress may need resuscitation at birth. If meconium has been breathed into the lungs, a ventilator may be needed. Intravenous glucose solutions or frequent breast milk or formula feedings are given to prevent hypoglycemia.If these problems do not occur, the major goal is to provide good nutrition so that the newborn can catch up to the weight that is appropriate for him. Treatment
24. Recognize common deviations from normal characteristics in the newborn?Perform a systematic assessment of a high-risk newborn?Outline a general care plan for a high-risk infant?Recognize physiologic factors that compromise the preterm infant’s health status?Contrast the physical characteristics of preterm and full-term infants?Modify a general care plan to meet the needs of an infant with specific high-risk health needs?Evaluation
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