Prematurity refers to birth occurring between 22-37 weeks of gestation resulting in low birth weight babies. The main causes are spontaneous preterm labor (40-50%), preterm premature rupture of membranes (25-30%), and obstetric reasons like pre-eclampsia (30-35%). Premature babies experience physiological handicaps like respiratory distress due to surfactant deficiency, temperature instability, feeding difficulties, and increased infection risk due to immune immaturity. Nursing management focuses on thermoregulation, maintaining airway and breathing, feeding support, and infection prevention through strict hygiene and minimal handling.

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2. Prematurity
Prepared by:
Prativa Kafle
Roll no.17

3. Introduction
• Low birth weight:
A baby whose birth weight is less than 2500gm or
less than irrespective of the gestational age.
• Very low birth weight:
An infants weighing 1000gm to 1500gm.
• Extremely low birth weight:
An infants weighing 1000gm or less.

4. Definition
Preterm birth is that which occurs between 22
weeks to before completion of 37 weeks of
gestation, resulting in the birth of a premature infant
usually weighing less than 2500gm.
According to gestational age:
• Near term : 34 to 36 WOG
• Moderate prematurity : 32 to 33 WOG
• Severe prematurity : 28 to 31 WOG
• Extreme prematurity : <28 WOG

5. Incidence:
• The overall incidence of premature birth in the
United States is 6 – 7 %.
• Premature death is responsible for almost two
thirds of infant deaths.
• Three obstetric events proceed pre term birth:
- Spontaneous: 40 – 50%
- PPROM: 25 – 30 %
- Obstetrical reasons: 30 – 35% ( IUGR, infection,
pre-eclampsia)

6. Causes :
1. Maternal problem
2. Fetal abnormalities
3. Placental disorder
4. Iatrogenic causes
5. Medical factors

7. 1. Maternal problems:
• Medical disease during
pregnancy (anemia,
hypertension, pre-
eclampsia, eclampsia).
• Uterine anomalies and
tumor.
• Cervical incompetence.
• Sepsis, hyperpyrexia.
• Antepartum
hemorrhage.
• Substance abuse.

8. 2.Fetal abnormalities
• Transplacental
infection(rubella,
toxoplasmosis and
syphilis).
• Hydramnios and
premature rupture of
membrane.
• Intra uterine growth
retardation.
• Congenital anomalies.
• RH incompatibility.

9. 3.Placental
• Gross placental
abnormalities.

10. 4.Iatrogenic factors
• Premature labor can results from elective delivery
because of misjudgment of fetal maturity or
expected date of delivery.

11. 5. Medical factors
• Diabetic mellitus
• Toxemia
• Fetal hypoxia and distress

12. Characteristics
• Appearance : frail,
scrawny and weak
muscle tone.
• Posture: hypotonic,
poor reflex

13. Skin:
- Thin, shiny and excessive
pink with abundant lanugo
- very little vernix.
- Edema may be present.
- Subcutaneous fat is
deficient.
- Breast nodules are small or
absent.

15. Head and face:
- Face is small and head
is large as per body.
- Suture are widely
separated.
- Fontanels are large.
- Micrognathia and
retrognathia present

17. Eye:
- The eyelids may be
fused.
- The eyes remain close
for the most of the time.

18. Ear :
- Pinna appears flat when
folded.
- Ear are soft and return
slowly to original
position due to less
cartilage.

19. Chest:
• The chest is small and
narrow and appear
under developed.

20. Abdomen:
- Abdomen is prominent
because liver and spleen
are large and abdominal
muscle tone is poor.
- The umbilicus appears
low in the abdomen
because linear growth is
cephalocaudal.

21. Genitalia:
• Male:
- Testes are undescended.
- Scrotum poorly
pigmented and has few
rugae.

22. Female:
-Labia majora are widely
separated exposing labia
minora and clitoris.
Genitalia:

23. Extremities:
- The limbs are thin with soft nails.
- Bright pink color nail beds.
- Deep sole crease are often not present.

24. Behavior:
- Easily exhausted from noise and routine care.
Cry:
-weak and feeble.
Reflex:
- Moro reflex, sucking reflex, sucking reflex,
swallowing reflex are present and other are absent or
sluggish.

25. Physiological handicap and clinical
hazard of premature baby:
1. Central nervous system:
- Poor neonatal reflexes
- Uncoordinated sucking and swallowing leads to
feeding difficulties.
- Vulnerable to develop intra
ventricular/periventricular hemorrhage due to
vitamin K deficiency.

27. Respiratory system:
2. Respiratory system:
- Periods of apnea less
than 20 seconds.
- Deficiency of surfactant
leads to Respiratory
Distress Syndrome.

28. Gastro intestinal system:
• Tendency to regurgitate due to an incomplete cardio
esophageal sphincter and small capacity of the
stomach.
• Functional immaturity of liver causes
hyperbilirubinemia, hypoglycemia, poor
detoxification of drugs.
• Abdominal distension and necrotizing enterocolitis
may occur due to hypotonia.

29. Temperature regulation:
• Loose more heat due to large surface area so cause
hypothermia.
• Subcutaneous fat is less, less brown fat.
• In adequate thermal response due to poor food
intake.

30. Cardio- vascular system:
• Delayed closure of ductus arteriosus.
• Inadequate peripheral circulation.
• Intra cranial hemorrhage due to poor auto regulation
of cerebral flow.

31. Renal immaturity:
• GFR and urine concentration are less than 20
ml/min.
Metabolic disturbance:
Hypoglycemia, hypocalcemia, hypothermia, acidosis,
hypoxia.

32. Nutritional deficiency:
• Prone to develop anemia at 6-8 weeks because of low
iron storage.
• Nutritional requirement is higher to catch up the
postnatal growth.
Susceptibility of infection:
• 3-10 times more vulnerable to infection than term
babies.
• Have low level of IgG.

33. Nursing management of
preterm baby:
Assessment
1) History Taking
a) Maternal:
History of PPROM
Any maternal disease
Substance abuse
Pre-eclampsia
Multiple Pregnancy

34. b) Fetus:
Transplacental infection
IUGR
RH- incompatibility

35. 2) Physical examination:
• Weight of baby
• Body color
• Respiratory rate and rhythm
• Body temperature

36. Nursing Diagnosis:
• Immature gas exchange related to immature
pulmonary functioning secondary to prematurity.
• Ineffective thermoregulation related to lack of
subcutaneous fat.
• Altered nutrition: less than body requirement related
to week feeding reflexes.
• Risk for infection related to deficient
immunological defenses.

37. Intervention:
Maintain body temperature:
• Monitor body temperature of baby regularly.
• Cover the baby’s head with clothes as necessary, do
not expose the body part unless and otherwise
needed for observation and assessment.
• If the baby is stable, encourage kangaroo mother
care (KMC) and exclusive breast feeding.
• Keep the baby in incubator with temperature and
humidity maintained. Alternately with baby could
be managed in radiant warmer.

38. Contd...
• Room temperature should be 25°C to 30°C in
incubator temperature according to weight.
°C °C °C °C
More than
2.5 kg
1 to 2 days More than 2
weeks

39. Contd...
• Check the temperature of warmer and room every
hour and adjust the temperature setting accordingly.
• For extremely low weight baby, covered with
cellophane to prevent heat loss through convection.

40. Maintain airway:
• Assess the baby’s skin color, warmth, and
peripheral cyanosis.
• Clear the airway and ensure proper breathing and
circulation.
• If apnea occur provide immediate tactile
stimulation, such as rubbing the back.
• Oxygen should be administer when indicated.
• Oxygen should be administer with head box or with
nasal cannula when saturation falls below 85%.
• Saturation should be maintain at 90 to 95%.
• CPAP may be necessary to keep the alveoli open
and improve expansion of lungs.

41. Contd...
• Surfactant is composed of phospholipid 80% and
protein 10% . It is produce and store in the lamellar
bodies of type II pneumocyte.
• Prophalytic therapy is given within 15 minutes of
birth in premature birth. Direct tracheal instillation
is done through a feeding tube. The dose of
survanta 4 ml (100mg/kg) per kg of body weight.

42. Feeding and nutrition:
• Daily check the weight of baby.
• If baby is stable start breast feeding as soon as
possible.
• If babies is less than 1.2kg or below 30 weeks of
gestation and sick babies should start Iv fluid.
(dextrose 10% for more than 1kg 80 ml/kg/day )
(dextrose 5% for less than 1 kg)
• Expressed breast milk can be started to all babies
irrespective of age and weight in every 2 hourly.

43. Contd...
• Gradually increase Expressed Breast
Milk(EBM) amount and decrease iv drip.
• Position post feed on right side or prone
position.
• When the baby is stable and tolerate internal
feeding then EBM with human milk fortifier
can be given.
• Maintain Intake Output chart.

44. Infection prevention:
• Strict handwashing and sanitizing before and after
touching the baby.
• Minimal handling the preterm.
• Promptly dry and kept warm with gentle handling.
• If baby is stable start KMC as soon as possible.
• effective treatment for any suspected infection.
• Continue breastfeeding every 2 hourly.
• Administer vitamin E 1 mg to prevent hemolytic
anemia.

45. Contd...
• Premature baby usually develop hyperbilirubinemia
so check the serum bilirubin level and provide early
phototherapy to prevent need for exchange
transfusion.

46. Complication:
• Pulmonary syndrome
Pulmonary edema
Intra alveolar hemorrhage
• Meningitis
• Jaundice
• Anemia

47. Explain the causes of prematurity.
Assignment:

48. 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