Preterm is the one who all are born before 37 weeks of gestation they require special care because of their immature body system and immunity

1. CARE OF PRE-TERM
HARSHITA
M.SC PEDIATRIC NURSING

2. INTRODUCTION
Pediatrics is the branch of medicine that involves the medical care of
infants, children, and adolescents.
NEONATE – A INFANT LESSTHAN 28 DAYS OLD

3. NEONATE
TERM NEONATE
▪ BORN AFTER COMPLETION
OF 37WEEKS OF GESTATION
PRE-TERM NEONATE
▪ BORN BEFORE COMPLETOIN
OF 37WEEKS OF GESTATION

4. PHYSICAL CHARACTERISTICS

5. Well-curved pinna, cartilage reaching up to
periphery;
flat and soft pinna, cartilage not reaching up to
periphery

6. well pigmented and pendulous scrotal sacs, with fully
descended testes
light pigmentation and not yet descended testes

7. deep transverse creases on the soles;
faint marks on the sole, no deep creases

8. Well formed breast bud (>5 mm);
Poorly developed breast bud;

9. silky hair, where individual strands can be made out;
fuzzy hair

10. labia majora covering clitoris and labia minora;
prominent labia minora and clitoris

11. WHY SPECIAL CARE?

12. Pre-mature/ Pre-term infant
Infants who are born premature need special care as compared to those who are born term.
Premature babies face trouble in maintaining their
▪ temperature and feeding. (failure to thrive)
▪ Normal breathing
▪ Can also suffer from other complications including infections related to the immature body
system.
PREMATURE INFANTS ARE MORE PRONE TO INFECTIONS.

13. TEMPRATURE
▪ Warmth is one of the basic needs of a new-born baby. It is critical
for a baby’s survival and wellbeing.
▪ A newborn is more prone to hypothermia because of large surface area
per unit of body weight / brown adipose tissues .
▪ NORMAL TEMPERATURE IN A NEWBORN IS 36.5-37.5-DEGREE C.
▪ Baby’s temperature can be assessed with reasonable precision by
touching his/her abdomen, hands, and feet with the dorsum of the
hand.
▪ In new born, abdominal temperature is representative of the core
temperature.
▪ WHEN FEET ARE COLD AND THE ABDOMEN IS WARM, IT INDICATES THAT THE
BABY IS IN COLD STRESS. IN HYPOTHERMIA, BOTH FEET AND ABDOMEN ARE
COLD TO TOUCH.

15. METHOD OF HEAT LOSS?????

18. HOW TO PREVENT HEAT LOSS????
▪ Keep delivery room warm (25°C)
▪ Newborn care corner temperature to be maintained at 28°C-30°C
▪ Drying immediately. Dry with one towel. Remove the wet towel and cover
with another pre-warmed towel
▪ Skin-to-skin contact between mother and baby
▪ Ensure baby is kept on mother's chest or abdomen , well covered with
cloth and head covered with cap
▪ Promote breast feeding
▪ Avoid giving bath in hospital (never before 24 hours), use moist clean
cloth to ensure hygiene.

20. FEEDING
Optimum nutrition is critical in the management of LBW and Preterm
infants because of the poor nutritional store.
A normal infant should be feed at least 8-12 times a day but demand
feeding should be provided to the infant.
▪ Preterm milk is the milk of a mother who delivers before 37 weeks. It
contains more proteins, sodium, iron, immunoglobulins, and calories
as per the requirement of a preterm baby.
▪ For maximum benefits, breastfeeding should be initiated soon after
the birth of the child and should be maintained exclusively for six
months, until weaning is initiated.

21. The breast starts to produce colostrum, a thick and yellowish gold
substance. Colostrum is higher in antibodies than breast milk and has
lower fat and higher protein content than what is found in breast milk.
These valuable proteins are essential to the development of a healthy
immune system.
Ig G is transplacental
Ig A is secreted via breast milk

22. ADVANTAGES OF BREAST MILK

23. Only after one breast is empty, the mother may offer the other breast.

24. SIGN OF GOOD ATTACHMENT
▪ Chin touching breast.
▪ Mouth wide open.
▪ Lower lip turned outward.
▪ More areola above than below the mouth.

25. EXPRESSED BREAST MILK
▪ If the mother is working or premature infant is not able to suck the
nipple, the mother can express her milk and can store in fridge up to
24 hours. and in room temperature up to 6hrs. to 8 hrs.
▪ Wash your hand well with soap and water.
▪ Wash your breast.
▪ Place clean container below your breast to collect milk.

26. EXPRESSED BREAST MILK
▪ Massage the breast gently towards the nipple.
▪ Place your thumb and index finger opposite each other just outside
the areola (Areola is the dark soft circle around the nipple).
▪ Now press back towards your chest, then gently squeeze to express
milk.
▪ Repeat above step at different positions around the areola.
▪ Expressed Breast Milk can be expressed with the help of breast pump
too.

28. PREVENTION FROM INFECTION

29. ▪ CLEANLINESS AT DELIVERY REDUCESTHE RISK OF INFECTION .
▪ CLEANLINESS REQUIRE MOTHERS; FAMILIES; AND HEALTH CARE
PROFESSIONALSTO AVOID HARMFULTRADITION.
▪ HANDWASHING ISTHE SINGLE MOST IMPORTANT STEPTO BE
EMPHASIZED .

30. CLEAN CHAIN
▪ CLEAN DELIVERY (WHO’s 6 CLEANS)
-> CLEAN ATTENDANTS HAND
-> CLEAN DELIVERY SURFACE
-> CLEAN CORD CUTTING INSTRUMENT
-> CLEAN STRINGTOTIE CORD
-> CLEAN CLOTHTO COVER BABY
-> CLEAN CLOTHTO COVER MOTHER

31. ▪ AFTER DELIVERY
-> ALL CAREGIVERS SHOULDWASH HANDS BEFORE HANDLINGTHE
BABY.
->FEED ONLY BREAST MILK
-> KEEPTHE CORD CLEAN AND DRY
-> USE CLEAN ABSORBENT CLOTH (DIAPER/NAPKIN)
->WASHYOUR HAND AFTER CHANGINGTHE DIAPERS

32. To reduce the risk of infection, it is important to follow the following: -
▪ Make sure everyone in the home knows that it is important for family members and visitors to
wash their hands properly before touching the baby.
▪ Limit the people who hold or kiss premature infant to immediate family.
▪ Ask the doctor if visitors are allowed into the home and also when no one should visit.
▪ Find out how soon premature infant can be taken out in public.
▪ •Remind family members and visitors not to smoke inside the house

33. EYE CARE
▪ DO’s
CLEAN EYE IMEDIATELY AFTER BIRTH WITH SWABS SOAKED IN
WARM STERILE WATER USING SEPRATE SWABS FOR EACH EYE ;
CLEAN FROM MEDIALTO LATERAL.
GIVE PROPHYLACTIC EYE DROPWITHIN 1 HR AFTER DELVERY AS
PER HOSPITAL POLICY.
▪ DON’TS
DO NOT APPLY ANYTHING

34. CORD CARE
Cord stump of the infant should be left untouched.
It falls off automatically in 7-21 days. Application of any type
of oil, antiseptic lotion is not recommended.

35. Until baby's umbilical cord stump falls off:
▪ Keep the umbilical cord stump clean and dry. Fold baby's diaper away from the stump. This
exposes the stump to the air and prevents contact with urine.
▪ Give premature infant sponge baths instead of tub baths.
▪ Avoid dressing premature infants in bodysuit-style undershirts.
▪ Never attempt to pull off the stump, even if it seems to be hanging by a thread.
▪ Don't use alcohol to clean the stump.

36. SIGNS OF AN UMBILICAL CORD STUMP INFECTION
Infections are rare but consult the baby's doctor if:
▪ Baby cries when skin is touched next to cord stump.
▪ The skin around the base of the cord is red.
▪ The stump smells foul or has a yellowish discharge.

37. ▪ MAINTAIN HYGIENE
MAINTAIN PERSONAL HYGIENE FOR MOTHERS AND CARE PROVIDER
OUT OF ALL HYGIENE IS UPPERMOST IMPERATIVE. AS WE KNOW PREMATURE ARE
MORE PRONE TO INFECTIONS.
▪ WASH HANDS
IT IS VERY IMPERATIVE FOR BOTH THE PARENTS AND CARE GIVERS TO WASH
THEIR HANDS WITH A GOOD ANTIBACTERIAL SOAP BEFORE THEY PICK UP THEIR
BABY.
IT IS ALSO VERY IMPORTANT TO WASH YOUR HANDS BEFORE PREPARING BABY’S
FOOD OR FEEDING HIM. NEVER FORGET TO WASH YOUR HANDS AFTER CHANGING THE
NAPPIES OR USING THE RESTROOM.

38. ▪ TRIM FINGERNAILS:
DIRTY NAILS ARE A SIGN OF GERMS THAT CAN ENTER BABY’S BODY AND CAUSE
HARMFUL DISEASES WHEN HE/SHE SUCKS HANDS.
ALWAYS TRY TO KEEP YOUR BABY’S FINGERNAILS WELL-TRIMMED AND CLEAN.
▪ NO PETS
PETS ARE THE SOURCE OF INFECTION. EVEN PETS ARE FULLY IMMUNIZED. THEY
SHOULD NOT BE ALLOWED NEAR THE PREMATURE INFANTS.

39. IMMUNIZATION
Immunization is the most important aspect of a child. By immunizing the
child we are providing with the strength to the child to fight against
7 killer diseases. The child is provided with an immunization card,
which should be kept safe.

40. WARNING SIGNS

41. TROUBLE FEEDING
▪ SUCKS LESS, OR POORLY OR NOT AT ALL.
▪ HE MAY NOT OPEN HIS MOUTH
▪ HE MAY NOT ACT HUNGRY
▪ MAY NOT STAY AWAKE TO EMPTY THE BREAST.
▪ MAY NOT EVEN WAKE UP TO FEED

42. LESS ENERGY
THE INFANT MAY SLEEP LONGER THAN USUAL
EVEN SLEEP WHILE FEEDING
LOOK SLUGISH AND DROWSY

43. FITS
 Abnormal movements
 Staring look; blinking of eyes
 Unusual movements of limbs
 Abnormal tightening of feet and jerking of arms

44. COLD BODY TEMPERATURE
 If belly and feet feel cold the baby is sick warm baby quickly by KMC.
 If still cold it is a warning sign

45. HOT BODY TEMPRATURE
 The baby is hot to touch
 Baby mouth is hot while feeding
 Face and body may look flush

46. JAUNDICE
 The yellow color of skin and eye’s
 Yellowish discoloration of palm, sole, cheek, chest, sclera of the eye
 Taking baby outside and pressing firmly on the sole. If yellow color is noticed its jaundice

47. TROUBLE BREATHING
 If the baby breathe too fast
 Rocking motion of chest and belly

48. UMBLICAL REDNESS
 Moist cord with redness at the base of the cord.
 There can be swelling; pus discharge and a bad odor
 Baby belly may also swell.

49. SKIN PUSTULES
 Light-yellow pus-filled blister on baby skin
 Can spread all over the body and can grow in size
 Baby may show poor feeding and lethargy

50. RED SWOLLEN EYE WITH PUS DRAINAGE
▪ Baby eyelid will appear swollen with pus drainage
▪ The eye cannot be opened fully due to swelling and pus