4. General Objective:
• At the end of the teaching learning session the BSc. Nursing 3rd year
students will be able to explain about the Dysmaturity..
5. Specific objectives:
At the end of the session BSc. Nursing 3rd year students will be able to:
• introduce Small for gestational age.
• define Dysmaturity.
• state the incidence of Dysmaturity.
• enlist the causes of Dysmaturity.
• state characteristics of Dysmaturity.
• explain the nursing management of Dysmature baby.
• state the complication of Dysmature baby.
6. Introduction :
Small for Gestational Age:
Babies whose birth weight is below the 10th percentile of the average
for the gestational age
(New Ballard Score)
7.
8. Definition :
(Small for date/ Intra uterine growth restriction/chronic placental
insufficiency )
dysmaturity is defined as the condition of a baby born after a normal or
prolonged gestation period in which there are sign of
underdevelopment.
9. Incidence:
Dysmature comprises one third of low birth weight. The overall
incidence of dysmature in developed country is 2 – 8 %. The incidence
among term babies is 5% and among post term babies is about 15%.
10. Cause :
1. Unknown (40%)
2. Maternal :
- Constitutional small women
- Poor maternal nutrition before
and during pregnancy/
malnutrition
- Diminished uterine blood flow
(pre eclampsia, eclampsia)
- heart disease
13. Characteristics of dysmature baby:
Appearance : often appear
wrinkled and old.
Posture : tonic or flexed as
term baby.
14. Skin :
- reduced subcutaneous fat
- Loose and dry skin and may be
peeling and stained with
meconium,
- Diminished muscle mass
especially over buttocks and
cheeks
- Scanty lanugo
- Lots of vernix
15.
16. Head and hair:
- Generally has normal skull
- Reduced dimension of rest of
body make skull look
inordinately large in relation to
the wasted appearance.
- Wide skull sutures
- Sparse skull hair
25. Nursing Diagnosis:
Ineffective thermoregulation related to lack of subcutaneous fat.
Ineffective breathing pattern related to immature pulmonary
development secondary to dysmaturity.
Altered nutrition less than body requirement related to poor sucking
reflexes.
Risk for infection related to deficient immunologic defenses.
26. Intervention:
Immediate management following birth:
o the cord is to be clamped quickly to prevent hypervolemia and later
on, development of hyperbilirubinemia.
oThe cord length should be keep long ( about 10 – 12 cm) in case of
exchange transfusion.
oThe air passage should be cleared off mucus promptly and gently
using a mucus suction.
oAdequate oxygenation through mask or nasal cannula if required.
oBaby should be wrapped with clean and dry towel and is laid on one
side.
oInj. Vitamin K is injected to prevent hemorrhagic manifestation.
27. Maintain warmth and body temperature
• Maintain the temperature of delivery rom at 24°c and keep overhead
warmer.
• Do not expose the baby head unnecessarily and dry it immediately.
• Do not bath the baby immediately after birth.
• Maintain body temperature at 37.2˚c.
• Maintain incubator temperature at 32˚c to 34˚c with relative humidity
maintain up to 50%.
• When incubator is not available the room temperature should be
26.6˚c to 29.4˚c for the smaller babies and 23.8˚c for larger one.
28. Maintain respiration:
• Assess the breathing rate and rhythm.
• Clear the air passage with suction machine.
• Stimulate the baby and cry by applying different measure very gently
and carefully.
• Give oxygen in the lowest concentration to relief cyanosis when
needed.
• Continuous oxygen monitoring is done by pulse oximeter to know the
status of arterial blood gas.
29. Maintain nutrition and feeding:
• Assess the sucking and swallowing reflex.
• Assess the dehydration level.
• The first feed should be given with in 1 hour after birth.
• Start feeding with 10% dextrose 5 -10 ml every 2- 4 hourly.
• If vomiting and abdominal distension do not occur; give strength milk
60ml/kg/day in every 2 hourly.
• Babies with poor sucking and swallowing abilities should be fedd by
N/G tube.
• Encourage breast feeding to larger babies who have good sucking
power.
• The feeding utensils should be cleaned regularly.
30. • Burping by gently rubbing his back ( tube feeding baby do not need
burping).
• After feeding keep the baby on lateral position to allow any vomitus
milk to run out of his mouth.
31. Prevention of infection:
• Strict hand washing before and after handling the babies.
• Nurses or doctors have any infection should not touch the baby.
• The visitors are to be restricted.
• The medical personal should wear gown, gloves and mask while
caring the baby.
• Hand washing or sanitizing between handling each baby and always
after changing napkin and before feeding.
• Each babies should have separate belongings( cloth, feeding
equipment's, blankets etc.).
• The ward should be cleaned and moped daily with antiseptic solution.
32. • Maintain good surgical aseptic
technique i.e.
- Changing slippery before going
to NICU, nursery room.
- Wearing gown and masks.
- Daily cleaning, disinfection of
the incubator thoroughly with
Dettol solution particularly on
discharge on baby.
33. • During the critical first 48 hour these babies need constant supervision
on:
- color
- Attack of apnea
- Temperature
- Amount and pattern of stool
- Edema
- Weight gain
36. References:
• Bennet, V.R. & Brown, L.K.(2001). Myles Textbook For Midwives.
13th ed. Churchill Livingstone; Sydney Toronto
• Ranabhat R. D. Niraula H. Textbook of Midwifery & Reproductive
Health Professions Education, IOM, TU
• Dutta DC. Textbook of Obstetrics, 8th ed. New Central Book Agency
(P). Ltd. Calcutta, India
• Tuitui R. , Manual of Midwifery- C. 4th edition. Kathmandu: Vidyarthi
Pustak Bhandar
