baby born before 37 weeks of gestation calculating from the first day of last menstural period is defined as preterm baby/ premature baby.  These babies are known as preemies

1. Premature
Baby
Prepared by
Ms. Jenisha Adhikari
BSN

2. Premature Baby
• A baby born before 37 weeks of gestation
calculating from the first day of last menstural
period is defined as preterm baby/ premature
baby.
• These babies are known as preemies

3. Age of Viability
Most neonatologist define the age of viability as
being about 24 weeks of gestation.

4. Why do premature newborns need special care?
• A premature newborn is not fully ready to deal with
our world.
• Their little bodies still have areas that need to
mature and fully develop.

5. Some of these areas include the
• Lungs
• digestive system
• immune system
• skin.

6. Sources: March of Dimes,
Updated April 08, 2018
Length of Pregnancy Likelihood of Survival
23 weeks 17 percent
24 weeks 39 percent
25 weeks 50 percent
26 weeks 80 percent
27 weeks 90 percent
28 to 31 weeks 90 to 95 percent
32 to 33 weeks 95 percent
34+ weeks Almost as likely as a full-term baby
Premature Birth and Survival Statistics

7. Causes
• Maternal factor
– Pre eclampsia
– Heart or kidney disease
– Infection (such as group B streptococcus, urinary
tract infections, vaginal infections, infections of
the fetal/placental tissues)

8. – Drug use (such as cocaine)
– Abnormal structure of the uterus
– Cervical incompetence (inability of the cervix to
stay closed during pregnancy)
– Previous preterm birth

9. • Factors involving the pregnancy:
– Abnormal or decreased function of the placenta
– Placenta previa
– Placental abruptia
– Premature rupture of membranes
– Polyhydramnios

10. • Fetal factor
– Multiple pregnancy
– IUGR
– Congenital malformation
– Rh incompatibility

11. Characteristic
• Posture :
– hypotonic,
– assume extended posture due to poor muscle tone

13. • Skin:
– thin, gelatinous, shiny and excessive pink with
abundant lanugo and
– very little vernix edema may be present.
– breast nodules are small or absent,

15. • Subcutaneous fat is deficient,

16. deep sole creases are often not present
Preterm Term

17. • Face and head : face is small and head is large
as per body.
• Sutures are widely separated and frontanels are
large.
• Protuding eye due to shallow orbit and absent
of buccal pads of fat
• Ear cartilage is deficient with poor recoil
• Hair appears wooly and fuzzy

18. • Planter creases; not so dark and very few in
number
• Nails: Bright pink colored nail beds and very
soft nails
• Activity : less activity of limbs
• Sucking : poor sucking ability
• Cry : weak cry
• Breast : no breast tissue palpable

19. • Central Nervous system
– poor reflexes
– Reflexes : moro, sucking, swallowing and other
reflexes are absent or sluggish
– Uncoordinated sucking swallowing leads to
feeding difficulties

20. •Vulnerable to develop intra ventricular/ peri
ventricular hemorrhage

21. • Respiratory system
– Period of apnea usually less that 20 seconds
– Poor cough reflex leads to increase risk of
infection
– Deficiency of surfactant leads to respiratory
distress syndrome

22. • Gastro intestinal system
– Functional immaturity of liver cause
hyperbilirubinaemia, hypoglycemia and poor
detoxification of drug
– Tendency to regurgitate to an incompetent cardio-
esophageal sphincter and small capacity of the
stomach

24. •Abdominal distension

25. •necrotizing entercolitis

26. • Temperature regulation
– Loose more heat due to large area so cause
hypothermia
– Subcutaneous fat is less, less brown fat
– Inadequate thermal response

27. • Cardio- vascular system
– Delayed closure of ductus arteriosus

28. – Inadequate peripheral circulation
– Intra cranial hemorrhage due to poor auto
regulation of cerebral blood flow

29. • Renal immaturity
– GFR and urine concentration are reduced
• Metabolic distribution
– Hypoglycemia
– Hypocalcemia
– Hypoproteinemia
– Hypoxic

30. • Nutritional deficiency
– Prone to develop anemia at 6-8 weeks because of
low iron storage
• Susceptibility of infection
– 3 to 10 times more vulnerable to infection than
term babies
– Low level of IgG

31. • Genitalia :
– in male ; testes are undescended, scortum poorly
pigmented

32. • in female; labia majora are widely separated
exposing labia minora and clitoris

33. Management
• A baby born at 24 weeks would generally
require a lot of intervention, potentially
including mechanical ventilation and other
invasive treatments followed by a lengthy stay
in a neonatal intensive care unit (NICU).

34. Management
• Optimal management at birth
– Give vitamin K 1mg to prevent hemorrhage
– Promptly dry and kept warm with gentle handling
– The cord is to be clamped quickly to prevent
hypervolemia and development of
hyperbilirubinaemia

35. • Maintain body temperature
– Keep the baby in incubator with temperature and
humidity maintained

36. • Positioning
– Change the baby’s position from prone position; it
relives abdominal discomfort by passage of flatus
and prevent aspiration
– Change position 2 hourly

37. • Kangaroo mother care
– Encourage KMC and exclusive breastfeeding

38. • Oxygen therapy
– It should be administered only when indicated
– O2 should administer with head box when O2
saturation falls below 85%

39. • Feeding and nutrition
– Babies < 1.2 kg gestation <30 weeks and sick babies
should start IV dextrose solution
– 10-20 ml EBM
2-3 hourly through NG can
be started to all babies
irrespective of age and
weight 2 hourly <1 kg and
3 hourly > 12kg

40. • Nutritional supplement
– When the baby is stable and tolerate eternal
feeding, EBM fortified multivitamin and folic acid
can be given
– Iron supplementation (2-3mg/kg elemental iron )
after 2-3 weeks
– Calcium supplementation (220mg/day ) and
phosphorus (100 mg/day) to prevent osteopenia for
< 1.5 kg

41. • Gentle rhythmic stimulation
– Gentle tactile stimuli by the mother
– Soothing auditory stimuli as family voice, music
– Eye to eye contact, colored object provide visual
inputs

42. • Prevention of nosocomial infection
• Strict handing washing before and after
touching the baby
• Minimal handeling

43. • Phototherapy
– Early phototherapy is advice to keep the serum
bilirubin level within safe limit to prevent need for
exchange transfusion usually premature develops
hyperbilirubinaemia

44. Factor to be avoid for pre term babies
– Routine O2 administration without monitoring
– Prophylaxis antibiotics
– Formula feeding
– Rough handling
– Excessive light and sound

45. Possible Complications
• Anemia Possible long-time complications
• Bronchopulmonary dysplasia (BPD)
• Mental or physical disability or delay Infection
or
• neonatal sepsis
• Retinopathy of prematurity,
• Risk of Disabilities

46. • Low blood sugar (hypoglycemia)
• Neonatal respiratory distress syndrome
• pulmonary hemorrhage
• Kernicterus
• Patent ductus arteriosus
• Severe intestinal inflammation(necrotizing
enterocolitis)

47. Nursing Diagnosis
• Impaired Gas exchange related to immature
pulmonary functioning
• Ineffective thermoregulation related to lack
of subcutaneous fat
• Altered nutrition : less than body requirements
related to weak feeding reflexes

48. Impaired Gas exchange related to
immature pulmonary functioning
• Assess respiratory status, noting signs
of respiratory distress(e.g., tachypnea, nasal
flaring, grunting, retractions, rhonchi, or
crackles)
• Assess skin color for cyanosis
• Promote rest,minimize stimulation& energy
expenditure.

49. Ineffective thermoregulation related to
lack of subcutaneous fat
• Assess Vital signs (especially temperature)
• Place infant in a warmer, incubator, or open
bed with radiant warmer or open crib where in
infant also has appropriate clothing
• Use heat lamps during certain procedures &
warm objects coming in contact with the
infants body such as clothing

50. Altered nutrition : less than body
requirements related to weak feeding
reflexes
• Assess presence of reflexes associatedwith
feeding (i.e swallowing, sucking & coughing)
• Breast feeding or KS feeding 2 hourly
• Initiate intermittent or tube feedings as
indicated

51. Prevention
• Identifying mothers at risk for preterm labor
• Prenatal education of the symptoms of preterm
labor
• Avoiding heavy or repetitive work or standing
for long periods of time that can increase the
risk of preterm labor
• Early identification and treatment of preterm
labor

52. Thank
you