Preterm

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preterm neonate

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Preterm

  1. 1. PRETERM NEONATE ARUNA. A P I BATCH MSC NURSING
  2. 2. DEFINITION <ul><li>Any neonate born before 37 weeks (<259 days) of gestation irrespective of the birth weight. </li></ul>
  3. 3. <ul><li>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 </li></ul>
  4. 4. ETIOLOGY <ul><li>Spontaneous </li></ul><ul><li>Induced </li></ul>
  5. 5. Spontaneous <ul><li>Health status of the mother (low socio economic status) </li></ul><ul><li>Multiple pregnancy: </li></ul><ul><li>Number of multiple pregnancies are increasing due to advanced parental age from delayed child bearing and ART. </li></ul><ul><li>PIH: </li></ul>
  6. 6. <ul><li>It is the most common complication of pregnancy and is occurring in 6- 10% of pregancies and is rising </li></ul><ul><li>Placental problems </li></ul><ul><li>Preterm labour and premature rupture of membrane </li></ul><ul><li>Low maternal weight </li></ul>
  7. 7. <ul><li>Chronic and acute systemic maternal disease </li></ul><ul><li>Antepartum haemorrhage </li></ul><ul><li>Cervical incompetence </li></ul><ul><li>Maternal genital colonization and infections </li></ul><ul><li>Cigarette smoking during pregnancy </li></ul><ul><li>Threatened abortion </li></ul>
  8. 8. <ul><li>Acute emotional stress </li></ul><ul><li>Physical exertion </li></ul><ul><li>Sexual activity </li></ul><ul><li>Trauma </li></ul><ul><li>Bicornuate uterus </li></ul><ul><li>Congenital malformations </li></ul>
  9. 9. Induced <ul><li>Maternal diabetes mellitus </li></ul><ul><li>Placental dysfunction as indicated by unsatisfactory fetal growth </li></ul><ul><li>Eclampsia </li></ul><ul><li>Fetal hypoxia </li></ul><ul><li>Antepartum haemorrhage </li></ul><ul><li>Severe rhesus iso immunization </li></ul>
  10. 10. CLINICAL FEATURES <ul><li>Measurements: </li></ul><ul><li>Size is small with relatively large head </li></ul><ul><li>Crown- heel length is less than 47cm </li></ul><ul><li>Head circumference is less than 33 cm </li></ul><ul><li>But exceeds the chest circumference by more than 3 cm </li></ul>
  11. 11. Activity and posture: <ul><li>General activity is poor </li></ul><ul><li>Automatic reflex response such as moro response, sucking and swallowing are sluggish or incomplete </li></ul><ul><li>Baby assumes an extended posture due to poor tone </li></ul>
  12. 12. Face and head: <ul><li>Face appears small </li></ul><ul><li>large head size </li></ul><ul><li>Sutures are widely separated </li></ul><ul><li>Fontanels are large </li></ul><ul><li>Small chin </li></ul><ul><li>Protruding eyes </li></ul>
  13. 13. <ul><li>Optic nerve is usually unmyelinated </li></ul><ul><li>Ear cartilage is deficient or absent with poor recoil </li></ul><ul><li>Hair appears woolly, and fuzzy and individual hair fibres can be seen separately </li></ul>
  14. 14. Skin and subcutaneous tissues: <ul><li>Skin is thin, gelatinous, Shiny and excessively pink </li></ul><ul><li>Abundant lanugo </li></ul><ul><li>Very little vernix caseosa </li></ul><ul><li>Edema may be present </li></ul><ul><li>Subcutaneous fat is deficient </li></ul><ul><li>Breast nodule is small or absent </li></ul><ul><li>Deep sole creases are often not present </li></ul>
  15. 15. Genitals: <ul><li>MALE: </li></ul><ul><li>testes undescended </li></ul><ul><li>scrotum poorly developed </li></ul><ul><li>FEMALES : </li></ul><ul><li>labia majora widely separated exposing labia minora </li></ul><ul><li>hypertrophied clitoris </li></ul>
  16. 16. CHARACTERISTICS OF PRETERM INFANTS
  17. 17. Skin <ul><li>Bright pink, often translucent, depending on the degree of maturity </li></ul><ul><li>Smooth and shiny ( may be edematous) </li></ul><ul><li>Small blood vessels clearly visible underneath the thin epidermis </li></ul><ul><li>Fine lanugo hair is abundant </li></ul><ul><li>Hair is sparse, fine and fuzzy on the head </li></ul>
  18. 18. <ul><li>Ear cartilage </li></ul><ul><li>Soft and pliable </li></ul><ul><li>Soles and palms </li></ul><ul><li>Minimal creases </li></ul><ul><li>Smooth appearance </li></ul>
  19. 19. Male genitalia <ul><li>Male infant’s scrotum is undeveloped and not pendulous </li></ul><ul><li>Minimal rugae are present </li></ul><ul><li>Testes may be in the inguinal canal or in the abdominal cavity </li></ul>
  20. 20. Female genitalia <ul><li>Clitoris is prominent </li></ul><ul><li>Labia majora are poorly developed and gaping </li></ul>
  21. 21. Scarf sign <ul><li>Elbow may be easily brought across the chest with little or no resistance </li></ul>
  22. 22. 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
  23. 23. Ear <ul><li>Preterm </li></ul><ul><li>Ear Cartilages are poorly developed </li></ul><ul><li>Ear may fold easily </li></ul><ul><li>Hair is fine and feathery </li></ul><ul><li>Lanugo may cover the back and face </li></ul><ul><li>Term </li></ul><ul><li>The mature infants ear cartilages are well formed </li></ul><ul><li>Hair is more likely to form firm , separate strands </li></ul>
  24. 24. Sole <ul><li>preterm </li></ul><ul><li>More rigid </li></ul><ul><li>Fine wrinkles </li></ul><ul><li>term </li></ul><ul><li>Well and deeply creased </li></ul>
  25. 25. Female genitalia <ul><li>preterm </li></ul><ul><li>Clitoris is prominent . Labia majora are poorly developed and gaping </li></ul><ul><li>term </li></ul><ul><li>Labia majora fully developed </li></ul><ul><li>Clitoris not prominent </li></ul>
  26. 26. Male genitalia <ul><li>preterm </li></ul><ul><li>Male infant’s scrotum is undeveloped and not pendulous </li></ul><ul><li>Minimal rugae are present </li></ul><ul><li>Testes may be in the inguinal canal or in the abdominal cavity </li></ul><ul><li>term </li></ul><ul><li>Scrotum well developed </li></ul><ul><li>Pendulous </li></ul><ul><li>Rugated </li></ul><ul><li>Testes well down in the scrotal sac </li></ul>
  27. 27. Scarf sign <ul><li>preterm </li></ul><ul><li>Elbow may be easily brought across the chest with little or no resistance </li></ul><ul><li>term </li></ul><ul><li>resisting attempt to bring the elbow past the midline </li></ul>
  28. 28. 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
  29. 29. COMPLICATIONS OF PRETERM BIRTH <ul><li>Central nervous system: </li></ul><ul><li>immaturity of central nervous system </li></ul><ul><li>Poor cough reflex </li></ul><ul><li>Incoordinated sucking and swallowing </li></ul><ul><li>Retrolental fibroplasias </li></ul><ul><li>Intra ventricular and periventricular hemorrhage </li></ul><ul><li>brain damage </li></ul>
  30. 30. Respiratory system <ul><li>Resuscitation difficulties at birth </li></ul><ul><li>Hyaline membrane disease </li></ul><ul><li>Breathing is periodic and associated with intercostal recessions due to soft rib </li></ul><ul><li>Pulmonary aspiration </li></ul><ul><li>Atlectasis </li></ul><ul><li>broncho pulmonary dysplasia </li></ul>
  31. 31. Cardio vascular system <ul><li>The closure of ductus arteriosus is delayed among preterm infants </li></ul>
  32. 32. G I system <ul><li>Regurgitations and aspirations </li></ul><ul><li>Abdominal distention and functional intestinal obstruction </li></ul><ul><li>Enterocolitis </li></ul><ul><li>Hyperbilirubinemia </li></ul><ul><li>Hypoglycemia </li></ul>
  33. 33. <ul><li>Thermo-regulation </li></ul><ul><ul><li>Excess heat loss </li></ul></ul><ul><li>Infections </li></ul><ul><li>Renal immaturity </li></ul><ul><li>The blood urea nitrogen is high </li></ul><ul><li>Acidosis </li></ul><ul><li>Edema </li></ul>
  34. 34. <ul><li>Toxicity of drug </li></ul><ul><li>Nutritional problems </li></ul><ul><li>anemia </li></ul><ul><li>Deficiencies of folic acid and vit E </li></ul><ul><li>osteopenia and rickets </li></ul><ul><li>Biochemical disturbance </li></ul><ul><li>hypoglycemia, hypocalcemia, hypoxia and hypoprotinemia </li></ul>
  35. 35. MANAGEMENT <ul><li>ARREST OF PREMATURE LABOUR </li></ul><ul><ul><li>Bed rest and sedation </li></ul></ul><ul><ul><li>Tocolytic agent </li></ul></ul><ul><ul><li>Ethanol </li></ul></ul><ul><ul><li>Magnesium sulphate </li></ul></ul>
  36. 36. Tocolytic agents <ul><li>Isoxsuprine (duvadilan) </li></ul><ul><li>Retodrine </li></ul><ul><li>Salbutamol </li></ul><ul><li>Terbutaline </li></ul>
  37. 37. INDUCTION OF PREMATURE LABOUR <ul><li>L/S ratio </li></ul><ul><li>Antenatal corticosteroids: </li></ul><ul><ul><li>Betamethasone: 12mg IM q24h for 2 doses </li></ul></ul><ul><ul><li>Dexamethasone : 6mg IM every 12 hours for 4 doses </li></ul></ul>
  38. 38. ASSESSMENT
  39. 39. NEW BALLARD SCORE
  40. 41. Optimal management at birth <ul><li>The baby should be promptly dried, kept effectively covered and warm </li></ul><ul><li>Vit K 0.5mg IM </li></ul><ul><li>Shift to NICU </li></ul>
  41. 42. MONITORING <ul><li>Vital signs </li></ul><ul><li>Activity and behavior </li></ul><ul><li>Color, Tissue perfusion </li></ul><ul><li>Fluids, electrolytes and ABG’s </li></ul><ul><li>Tolerance of feeds </li></ul><ul><li>Look for development of RDS., apneic attacks, sepsis, PDA, NEC, IVH etc </li></ul><ul><li>Weight gain velocity : </li></ul>
  42. 43. CARE OF NEWBORN <ul><li>cushioned bed </li></ul><ul><li>Avoid excessive light, excessive sound, rough handling and painful procedures. Use effective analgesia and sedation for procedures </li></ul><ul><li>Provide warmth </li></ul><ul><li>Ensure asepsis </li></ul><ul><li>Cover the baby appropriately </li></ul>
  43. 44. <ul><li>Provide effective and safe oxygenation </li></ul><ul><li>Nutrition </li></ul><ul><li>tactile and kinesthetic stimulation </li></ul>
  44. 45. <ul><li>Prone position </li></ul><ul><li>Photo therapy </li></ul><ul><li>Prevention of nosocomial infection </li></ul><ul><li>Weight record </li></ul>
  45. 46. <ul><li>Immunizations </li></ul><ul><li>Family support </li></ul><ul><li>Discharge policy </li></ul><ul><li>Follow up </li></ul><ul><li>Home care of preterm babies </li></ul>
  46. 47. COMMON PROBLEMS OF PRETERM NEWBORNS <ul><li>Nosocomial infections </li></ul><ul><li>Hypothermia </li></ul><ul><li>Respiratory distress syndrome </li></ul><ul><li>Aspiration </li></ul><ul><li>Patent ductus arteriosus </li></ul><ul><li>Chronic lung disease </li></ul>
  47. 48. <ul><li>Necrotizing enterocolitis </li></ul><ul><li>Intraventricular haemorrhage </li></ul><ul><li>Retinopathy of prematurity </li></ul><ul><li>Late metabolic acidosis </li></ul><ul><li>Nutritional disorders </li></ul><ul><li>Drug toxicity </li></ul>
  48. 49. NURSING MANAGEMENT
  49. 50. <ul><li>Problem with respiration </li></ul><ul><li>Problems with thermoregulation </li></ul><ul><li>Fluid and electrolyte imbalance </li></ul><ul><li>Infection </li></ul><ul><li>Pain </li></ul><ul><li>Parental / maternal separation </li></ul>
  50. 51. NURSING DIAGNOSIS <ul><li>impaired gas exchange </li></ul><ul><li>ineffective thermoregulation related to prematurity </li></ul><ul><li>imbalanced nutrition </li></ul><ul><li>Altered growth and development related to hospitalization </li></ul><ul><li>altered parenting </li></ul><ul><li>Anxiety related to lack of knowledge </li></ul>
  51. 52. THANK YOU…

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