This document discusses preterm or low birth weight babies. It defines preterm as birth before 37 weeks of gestation and low birth weight as 2500g or less. The causes of preterm birth are then outlined as spontaneous (e.g. infection, premature rupture of membranes) or elective (e.g. preeclampsia, antepartum hemorrhage). Features of preterm babies are also listed, such as hypotonia and soft skull bones. Finally, the management of preterm babies is summarized, including temperature regulation, nutrition via breastfeeding or tube, and preventing infection through handwashing and immunizations.

1. BY – RAVI
SHANKAR

2. Pre term or low birth weight baby
➢Pre – mature – a baby birth before 37 weeks of gestation.
▪ Birth before 34 weeks – early pre term.
▪ Birth in between 34-37 weeks – late pre term.
➢ LBW (low birth weight): - a low birth baby is considered to be one who
weight 2500 gm (5 pound, 8 ounces) or less of body weight.
➢SFD (small for date) :- fetus looks smaller than gestation period.
➢LFD (large for date) : - fetus looks larger than gestational period.

3. Pre term……….(causes).
❖Causes of pre term : -
o A. spontaneous causes : -
➢ Idiopathic – 40%
➢ Maternal infection :- TORCH & syphilis
▪ T - toxoplasmosis
▪ O - other infection
▪ R - rubella
▪ C - cytomegaly virus
▪ H - harpies simplex
➢ Prom – premature rupture of membrane
➢ Cervical incompetence
➢ Some risk factor : -
• Mother’s age less than 18 years or mother’s age more than 35 years.
• Mother’s weight less than 40 kg or more than 70 kg.
• mother’s height less than 140 cm.
• Anaemic or malnourished mother.

4. Pre term……(causes).
o B. Elective causes : -
➢ Cardiac or renal disease of mother.
➢ Pre eclampsia or eclampsia.
➢ APH (antepartum haemorrhage) : - after 24 weeks of gestation. reasons of
APH includes.
• Placenta previa
• Abruption placentae
• Pre mature separation of placenta
➢ Rh incompatibility
➢ Congenital abnormality
➢ IUGR – intrauterine growth retardation

5. Pre term………(features).
❖Features of pre term : -
 Baby hypotonic
 Weak cry
 Less sub cutaneous fat
 Soft skull bone
 Wide open fontanelle and sutures
 Ear pinna soft
 Eye ball bulged
 Small chest
 Abdomen distended
 Umbilicus below half trunk
 More vernix cassiosa
 White cord
 Planter creases absent
 Undescended testis in male (cryptorchidism)
 Labia majora fails to cover labia minora in girls.

6. Pre term………(management).
❖Management of pre term baby : -
❑Temperature regulation : -
✓ Maintain body temperature by warm chain.
✓ Immediate dry the baby.
✓ Give KMC care
✓ Start radiant warmer
✓ Maintain room temperature.
✓ Initiate breast feeding.
✓ Rooming in/ bedding in.
✓ Postpone bath up to baby become 2.5 kg.
❑Nutrition : -
▪ Before 32 weeks – by NG tube feeding.
▪ 32 weeks – 34 wks. – cup/ Katori spoon.
▪ After 34 weeks – breast feeding.

7. Pre term……..(management).
❑Maintain breathing : -
▪ When birth before 34 weeks of gestation NRDS (neonatal respiratory destress syndrome)
developed in baby due to surfactant is not developed in alveoli of lungs.
▪ Treatment of NRDS : -
➢ ANS : - antenatal steroid to pregnant women during labor pain. (pain in b/w 24 to 34 wks. of
gestation)
- injection dexamethasone 6mg – 4 doses – each 12 hrs. apart
- injection betamethasone 12mg – 2 doses – each 24 hrs. apart
➢ O2 therapy – by nasal cannula. ( ½ liter/ minute).
❑Prevention of infection :-
✓ Maintain six cleans (clean hand, clean surface, clean cord clamp, clean cord cut, clean cord
care, clean clothes for mother and baby.)
✓ Don’t allow peoples having communicable disease.
✓ No pre-lacteal feeding.
✓ Immunization – BCG, Hep. B, OPV.

8. Pre term……….(management).
❑Position
❑Environment – maintain clean and calm environment.
❑Injection vitamin K – 0.5 mg
❑FPC – family participation care
❑Counselling and follow op or check for danger signs.

9. NICU (neonatal intensive care unit)
 NICU is very specialized unit where critically ill neonates cared to reduce
the neonatal morbidity and mortality.
➢The admission to special neonatal care unit (SNCU) or NICU has some
can if the child is neonatal in critical condition, the neonate needs the
care of interne unit.
➢Mostly from labor room, OT and hospital or any other referred they will
be send to NICU.

10. NICU………..(admission criteria)
 Indication for admission in the NICU: -
▪ Low birth weight (2000gms.)
▪ Large babies (more than or equal of 4 kg.)
▪ Birth asphyxia (APGAR score less than or equals to 6)
▪ Meconium aspiration syndrome, if symptomatic.
▪ Severe jaundice.
▪ Infants of diabetic mother.
▪ Neonatal sepsis/ meningitis.
▪ Neonatal convulsion.
▪ Severe congenital malformation/ cyanotic congenital heart disease.
▪ O2 therapy/ parenteral nutrition.
▪ Immediate after surgery/ cardiological emergency.
▪ Cardio respiratory monitoring, if heart rate and respiratory rate are unstable.
▪ Exchange blood transfusion.
▪ PROM/ foul smelling liquor.

11. ❖ NURSING CARE PLAN FOR PRE TERM BABY
S.No. Nursing diagnosis Objective Nursing interventions Evaluation
1 Ineffective breathing
pattern related to
undeveloped lungs or
respiratory system.
• To maintain normal
respiratory rate.
• Assess the respiration rate.
• Monitor vital sign.
• Maintain good ventilated
environment.
• Provide appropriate position.
• Give artificial breathing by bag and
mask device or by ET tube.
• Provide O2 therapy.
• The normal
respiration rate
is maintained.
2 Altered body temperature
less than normal range
related to un-developed
hypothalamus, secondary
to less subcutaneous fat.
• To maintain normal
body temperature.
• Assess the temperature.
• Monitor vital signs.
• Maintain warm chain.
• Place the baby on radiant warmer.
• Start room heater for maintain room
temperature.
• Provide warm clothes for baby.
• Give KMC.
• Initiate breast feeding.(if baby able
to suck.)
• Give NG tube feeding.
• The normal
body
temperature
range (36.5 to
37.4ο C) is
maintained.

12. 3 Imbalanced nutrition
level less than body
requirement related to
less intake.
• To increase
nutrition level.
• To maintain normal
nutrition level.
• To increase body
weight.
• Assess body weight.
• Initiate breast feeding.
• Give NG tube feeding (if unable to
sucking.)
• Give IV fluid as per body weight or as
per directed by pediatrician.
• The normal
level of
nutrition
level is
maintained.
• Baby gained
weight.
4 Risk of infection related
to low immunity.
• To prevent
infection. Or to
reduce risk of
infection.
• Wash hands while doing procedures.
• Maintain room and surrounding
clean and germ free.
• Provide clean cloths for baby and
mother also.
• Initiate breast feeding.
• Risk of
infection is
reduced.
5 Anxiety of parents related
to child’s health
condition.
• To reduce anxiety of
child’s parents.
• Give information about child’s health
condition to his parents.
• Give psychological support to
parents.
• Maintain calm and clean
environment.
• Allow parents to meet their baby.
• The anxiety of
parents is
reduced.

13. THANK YOU