• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
Preterm
 

Preterm

on

  • 6,912 views

preterm neonate

preterm neonate

Statistics

Views

Total Views
6,912
Views on SlideShare
6,912
Embed Views
0

Actions

Likes
2
Downloads
295
Comments
0

0 Embeds 0

No embeds

Accessibility

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

    Preterm Preterm Presentation Transcript

    • PRETERM NEONATE ARUNA. A P I BATCH MSC NURSING
    • DEFINITION
      • Any neonate born before 37 weeks (<259 days) of gestation irrespective of the birth weight.
      • Premature birth , commonly used as a synonym for preterm birth, refers to the birth of a baby before the developing organs are mature enough to allow normal postnatal survival
    • ETIOLOGY
      • Spontaneous
      • Induced
    • Spontaneous
      • Health status of the mother (low socio economic status)
      • Multiple pregnancy:
      • Number of multiple pregnancies are increasing due to advanced parental age from delayed child bearing and ART.
      • PIH:
      • It is the most common complication of pregnancy and is occurring in 6- 10% of pregancies and is rising
      • Placental problems
      • Preterm labour and premature rupture of membrane
      • Low maternal weight
      • Chronic and acute systemic maternal disease
      • Antepartum haemorrhage
      • Cervical incompetence
      • Maternal genital colonization and infections
      • Cigarette smoking during pregnancy
      • Threatened abortion
      • Acute emotional stress
      • Physical exertion
      • Sexual activity
      • Trauma
      • Bicornuate uterus
      • Congenital malformations
    • Induced
      • Maternal diabetes mellitus
      • Placental dysfunction as indicated by unsatisfactory fetal growth
      • Eclampsia
      • Fetal hypoxia
      • Antepartum haemorrhage
      • Severe rhesus iso immunization
    • CLINICAL FEATURES
      • Measurements:
      • Size is small with relatively large head
      • Crown- heel length is less than 47cm
      • Head circumference is less than 33 cm
      • But exceeds the chest circumference by more than 3 cm
    • Activity and posture:
      • General activity is poor
      • Automatic reflex response such as moro response, sucking and swallowing are sluggish or incomplete
      • Baby assumes an extended posture due to poor tone
    • Face and head:
      • Face appears small
      • large head size
      • Sutures are widely separated
      • Fontanels are large
      • Small chin
      • Protruding eyes
      • Optic nerve is usually unmyelinated
      • Ear cartilage is deficient or absent with poor recoil
      • Hair appears woolly, and fuzzy and individual hair fibres can be seen separately
    • Skin and subcutaneous tissues:
      • Skin is thin, gelatinous, Shiny and excessively pink
      • Abundant lanugo
      • Very little vernix caseosa
      • Edema may be present
      • Subcutaneous fat is deficient
      • Breast nodule is small or absent
      • Deep sole creases are often not present
    • Genitals:
      • MALE:
      • testes undescended
      • scrotum poorly developed
      • FEMALES :
      • labia majora widely separated exposing labia minora
      • hypertrophied clitoris
    • CHARACTERISTICS OF PRETERM INFANTS
    • Skin
      • Bright pink, often translucent, depending on the degree of maturity
      • Smooth and shiny ( may be edematous)
      • Small blood vessels clearly visible underneath the thin epidermis
      • Fine lanugo hair is abundant
      • Hair is sparse, fine and fuzzy on the head
      • Ear cartilage
      • Soft and pliable
      • Soles and palms
      • Minimal creases
      • Smooth appearance
    • Male genitalia
      • Male infant’s scrotum is undeveloped and not pendulous
      • Minimal rugae are present
      • Testes may be in the inguinal canal or in the abdominal cavity
    • Female genitalia
      • Clitoris is prominent
      • Labia majora are poorly developed and gaping
    • Scarf sign
      • Elbow may be easily brought across the chest with little or no resistance
    • DIFFERENCE BETWEEN PRETERM AND TERM INFANT CHARACTERISTICS PRETERM TERM Posture The preterm infant lies in a relaxed attitude , limbs more extended The body size is small Head may appear somewhat larger in proportion Term infant has more subcutaneous fat tissues and rests in a more flexed attitude
    • Ear
      • Preterm
      • Ear Cartilages are poorly developed
      • Ear may fold easily
      • Hair is fine and feathery
      • Lanugo may cover the back and face
      • Term
      • The mature infants ear cartilages are well formed
      • Hair is more likely to form firm , separate strands
    • Sole
      • preterm
      • More rigid
      • Fine wrinkles
      • term
      • Well and deeply creased
    • Female genitalia
      • preterm
      • Clitoris is prominent . Labia majora are poorly developed and gaping
      • term
      • Labia majora fully developed
      • Clitoris not prominent
    • Male genitalia
      • preterm
      • Male infant’s scrotum is undeveloped and not pendulous
      • Minimal rugae are present
      • Testes may be in the inguinal canal or in the abdominal cavity
      • term
      • Scrotum well developed
      • Pendulous
      • Rugated
      • Testes well down in the scrotal sac
    • Scarf sign
      • preterm
      • Elbow may be easily brought across the chest with little or no resistance
      • term
      • resisting attempt to bring the elbow past the midline
    • NEUROLOGIC EVALUATION CHARACTERISTICS PRETERM TERM GP REFLEX weak Strong HEEL TO EAR MANEUVER Heel is easily brought to the ear, meeting with no resistance Not possible , since there is considerable resistance at the knee
    • COMPLICATIONS OF PRETERM BIRTH
      • Central nervous system:
      • immaturity of central nervous system
      • Poor cough reflex
      • Incoordinated sucking and swallowing
      • Retrolental fibroplasias
      • Intra ventricular and periventricular hemorrhage
      • brain damage
    • Respiratory system
      • Resuscitation difficulties at birth
      • Hyaline membrane disease
      • Breathing is periodic and associated with intercostal recessions due to soft rib
      • Pulmonary aspiration
      • Atlectasis
      • broncho pulmonary dysplasia
    • Cardio vascular system
      • The closure of ductus arteriosus is delayed among preterm infants
    • G I system
      • Regurgitations and aspirations
      • Abdominal distention and functional intestinal obstruction
      • Enterocolitis
      • Hyperbilirubinemia
      • Hypoglycemia
      • Thermo-regulation
        • Excess heat loss
      • Infections
      • Renal immaturity
      • The blood urea nitrogen is high
      • Acidosis
      • Edema
      • Toxicity of drug
      • Nutritional problems
      • anemia
      • Deficiencies of folic acid and vit E
      • osteopenia and rickets
      • Biochemical disturbance
      • hypoglycemia, hypocalcemia, hypoxia and hypoprotinemia
    • MANAGEMENT
      • ARREST OF PREMATURE LABOUR
        • Bed rest and sedation
        • Tocolytic agent
        • Ethanol
        • Magnesium sulphate
    • Tocolytic agents
      • Isoxsuprine (duvadilan)
      • Retodrine
      • Salbutamol
      • Terbutaline
    • INDUCTION OF PREMATURE LABOUR
      • L/S ratio
      • Antenatal corticosteroids:
        • Betamethasone: 12mg IM q24h for 2 doses
        • Dexamethasone : 6mg IM every 12 hours for 4 doses
    • ASSESSMENT
    • NEW BALLARD SCORE
    •  
    • Optimal management at birth
      • The baby should be promptly dried, kept effectively covered and warm
      • Vit K 0.5mg IM
      • Shift to NICU
    • MONITORING
      • Vital signs
      • Activity and behavior
      • Color, Tissue perfusion
      • Fluids, electrolytes and ABG’s
      • Tolerance of feeds
      • Look for development of RDS., apneic attacks, sepsis, PDA, NEC, IVH etc
      • Weight gain velocity :
    • CARE OF NEWBORN
      • cushioned bed
      • Avoid excessive light, excessive sound, rough handling and painful procedures. Use effective analgesia and sedation for procedures
      • Provide warmth
      • Ensure asepsis
      • Cover the baby appropriately
      • Provide effective and safe oxygenation
      • Nutrition
      • tactile and kinesthetic stimulation
      • Prone position
      • Photo therapy
      • Prevention of nosocomial infection
      • Weight record
      • Immunizations
      • Family support
      • Discharge policy
      • Follow up
      • Home care of preterm babies
    • COMMON PROBLEMS OF PRETERM NEWBORNS
      • Nosocomial infections
      • Hypothermia
      • Respiratory distress syndrome
      • Aspiration
      • Patent ductus arteriosus
      • Chronic lung disease
      • Necrotizing enterocolitis
      • Intraventricular haemorrhage
      • Retinopathy of prematurity
      • Late metabolic acidosis
      • Nutritional disorders
      • Drug toxicity
    • NURSING MANAGEMENT
      • Problem with respiration
      • Problems with thermoregulation
      • Fluid and electrolyte imbalance
      • Infection
      • Pain
      • Parental / maternal separation
    • NURSING DIAGNOSIS
      • impaired gas exchange
      • ineffective thermoregulation related to prematurity
      • imbalanced nutrition
      • Altered growth and development related to hospitalization
      • altered parenting
      • Anxiety related to lack of knowledge
    • THANK YOU…