INTRODUCTION

 Birth weight is the single most important marker of

adverse perinatal and neonatal outcome.
 Babies with a birth weight of less than 2,500g,
irrespective of their gestation are classified as low birth
weight babies.
 These include both preterm and small-for-dates babies.

HOW REPRODUCTION IS HAPPENING IN

HUMANS?
All humans undergo a sexual mode of reproduction, which
involves the production of an offspring by the fusion of male
and female gametes. In sexual reproduction, the new born
baby will be identical to their parents.
Let’s have a glance at reproduction, its process, types and its
significance.
What is Reproduction?
Reproduction is a biological process by which a living
organism gives birth to its own offspring, which is
biologically similar to their parents. This biological
process permits and assures the continuity of life on the
planet earth.
Modes of Reproduction
There are basically two modes of reproduction:
Sexual mode of Reproduction
 Sexual reproduction is a type of reproduction that
involves the production of an offspring by the fusion of
male and female gametes.

Asexual mode of Reproduction

Asexual reproduction refers to the type of reproduction

in which only a single organism gives rise to a new
individual.
Reproduction in Humans
In humans, reproduction occurs after the formations of
male and female gametes, which later fertilize to give
rise to an embryo. The complete process of fertilization
in humans is called internal fertilization as it occurs
within the body of a female.

As human beings are viviparous organisms, we give birth

directly to the young ones, instead of laying eggs.

PROCESS OF REPRODUCTION IN HUMANS

Sexual reproduction involves a set of events, which are
divided into three different stages:
Pre fertilisation >> Fertilisation >> Post fertilisation

Pre-fertilization
The different stages in Pre-Fertilization events are:
Gametogenesis

The formation of male and female gametes or sex cells

or reproductive cells.

Cell Division

During the formation of gametes, both male and female

undergo a meiotic cell division.

Transfer of Gametes

The male gametes are called sperms whereas the

female gametes are called egg or ovum. In humans, only
the male gametes are motile and female gametes are
non-motile, hence, the male gametes should be
transferred into the female’s body for the further
process of fertilization. This is done by fusion or
copulation and the process is called gametangiogamy.

Fertilization
After the transfer and fusion of male and female
gametes, fertilization occurs with the formation of a
diploid zygote.

Post-fertilization
Post-fertilization is a series of events in sexual
reproduction, which occurs after the fertilization and
development of the zygote. The different stages in post-
fertilization events are:

Development of zygote

After fertilization, the zygote is formed. The zygote

divides mitotically to form 2, 4, 8, 16 celled stages.
These cells are known as blastomeres.

Embryogenesis

This stage is also known as embryonic development or

the development of an embryo. At this stage, the actual
development of a baby begins. This period is called the
gestational period.

Between Eight to ten weeks, the embryo develops into a

foetus.

Embryogenesis - Development of an Embryo

The table provided below explains complete stages

involved from embryonic development till the delivery
of a baby.

Weeks after Fertilization and its Embryonic

Development respectively:
3rd Week: In the beginning of the third gestational
week, there is a formation of clusters of cells and three
germinal layers.

4th Week or 1st Month: Heart is the first organ to start

functioning. Along with the heart functioning, the fetal
arm buds and optic pits become visible.

5th Week: In the fifth week, the embryo grows approx.

4mm and begins to curve into a C-shape. At this stage,
the fetal liver, pancreas, gallbladder, spleen, the inner
part of the ear and the pharyngeal arches start
developing.

6th Week: In the sixth week, the embryo grows from 4

mm to 9 mm in length and the baby’s external features
begin to form – eyes and nose, leg buds and hand,
stomach and kidney also start developing.

7th Week: In the seventh week, the baby continues to

grow fast from 9mm to 13mm, along with the
lengthening of arms and legs. There is the development
of internal organs like lungs, primary sex organs and
lymphatic system.

8th Week or 2nd Month: At 7th week, the baby’s hair

follicles start developing, along with the external ear,
nipples and most of the internal and external organs
start developing by this time.
1st-trimester: By the end of the third month, all the
major organ systems are well developed and the genital
organs are visible.

5th Month: During the fifth month, the baby starts

moving and hairs start appearing on the head.

24 weeks or 6 months: By the end of the 2nd trimester,

the baby’s eyelashes are formed, eyelids separate and
the body gets covered with fine hair.

9th month: By the end of the 9th month, the foetus fully
develops and is ready for birth.

PREGNANCY
Pregnancy, process and series of changes that take place
in a woman’s organs and tissues as a result of a
developing foetus. The entire process from fertilization
to birth takes an average of 266–270 days, or about nine
months. A woman must go through many life stages
before becoming a mother. Let’s look at the many
stages of childbirth, starting with pregnancy and moving
on to parturition and nursing.
The zygote is created when the sperm fertilises the egg,
which causes pregnancy. In the uterine wall, the zygote
is implanted. The zygote matures into an embryo, which
then develops into a child.
The requirement for feeding and care emerges as soon
as the implantation occurs. The placenta, a layer that
develops between the mother and the child, is in charge
of carrying out this function. Chorion and uterine tissue
combine to produce the placenta. This layer has a
variety of functions during pregnancy, which are briefly
explained below: -

Supplying the developing foetus with oxygen and

nutrition.
It also removes the waste products the foetus excretes,
taking over the job of the digestive and excretory
systems.
Hormones such as human placental lactogen,
progesterone, oestrogen, human chorionic
gonadotropin and relaxin are released by the placenta
and are essential for developing the foetus.
The umbilical cord, which joins the foetus to the
placenta, aids in the transfer of nutrients from the
mother to the foetus that is necessary for growth.
The embryo begins displaying the triploblastic nature by
splitting into three layers of cells as soon as implantation
occurs. Ectoderm, mesoderm, and endoderm are
formed during development which further gives rise to
various organs.
Following implantation, each of these phases
contributes to the baby’s development, which in
humans takes nine months. The growth is moderate and
quite gradual. The embryo’s heart develops first, then its
limbs, primary organs, the development of hair, and so
forth. The foetus is fully formed at nine months.

Parturition
At the end of pregnancy, the process of the uterus
contracting at regular intervals aids in the delivery of the
child. This begins with the foetal ejection reflex. The
term “foetal ejection reflex” refers to the signals for an
ejection that the fully formed foetus sends through the
placenta. These signals cause skeletal muscles to
contract.
The gestation period is the period from conception
through birthing.

Lactation
It is the process by which the mammary glands produce
milk at the end of pregnancy. Colostrum is the first form
of breast milk that the glands produce. This milk is
essential for the infant because it gives the new born
their initial protection against illnesses.

PREGNANCY CARE
Pregnancy care consists of prenatal (before birth) and
postpartum (after birth) healthcare for expectant
mothers.

It involves treatments and trainings to ensure a healthy

pre-pregnancy, pregnancy, and labour and delivery for
mom and baby.
Prenatal Care
Prenatal care helps decrease risks during pregnancy and
increases the chance of a safe and healthy delivery.
Regular prenatal visits can help your doctor monitor
your pregnancy and identify any problems or
complications before they become serious.

Babies born to mothers who lack prenatal care have

triple the chance of being born at a low birth weight.
New-borns with low birth weight are five times more
likely to die than those whose mothers received
prenatal care.
Prenatal care ideally starts at least three months before you
begin trying to conceive. Some healthy habits to follow
during this period include:
 quitting smoking and drinking alcohol
 taking folic acid supplements daily (400 to 800
micrograms)
 talking to your doctor about your medical conditions,
dietary supplements, and any over-the-counter or
prescription drugs that you take
 avoiding all contact with toxic substances and chemicals
at home or work that could be harmful
During Pregnancy
Once you become pregnant, you’ll need to schedule
regular healthcare appointments throughout each stage
of your pregnancy.
 A schedule of visits may involve seeing your doctor:
 every month in the first six months you are pregnant
 every two weeks in the seventh and eighth months you
are pregnant
 every week during your ninth month of pregnancy
During these visits, your doctor will check your health and
the health of your baby.
Visits may include:
 taking routine tests and screenings, such as a blood
test to check for anaemia, HIV, and your blood type
 monitoring your blood pressure
 measuring your weight gain
 monitoring the baby’s growth and heart rate
 talking about special diet and exercise
Later visits may also include checking the baby’s position and
noting changes in your body as you prepare for birth.
Your doctor may also offer special classes at different stages
of your pregnancy.
These classes will:
 discuss what to expect when you are pregnant
 prepare you for the birth
 teach you basic skills for caring for your baby

If your pregnancy is considered high risk because of your

age or health conditions, you may require more
 frequent visits and special care. You may also need to
see a doctor who works with high-risk pregnancies.
Postpartum Care
While most attention to pregnancy care focuses on the
nine months of pregnancy, postpartum care is
important, too. The postpartum period lasts six to eight
weeks, beginning right after the baby is born.

During this period, the mother goes through many

physical and emotional changes while learning to care
for her new born. Postpartum care involves getting
proper rest, nutrition, and vaginal care.

Getting Enough Rest:

Rest is crucial for new mothers who need to rebuild
their strength. To avoid getting too tired as a new
mother, you may need to:

 sleep when your baby sleeps

 keep your bed near your baby’s crib to make night
feedings easier
 allow someone else to feed the baby with a bottle
while you sleep

Eating Right:
Getting proper nutrition in the postpartum period is
crucial because of the changes your body goes through
during pregnancy and labour.
The weight that you gained during pregnancy helps
make sure you have enough nutrition for breast-feeding.
However, you need to continue to eat a healthy diet
after delivery.
Experts recommend that breast-feeding mothers eat
when they feel hungry. Make a special effort to focus on
eating when you are actually hungry — not just busy or
tired.

 avoid high-fat snacks

 focus on eating low-fat foods that balance protein,
carbohydrates, and fruits and vegetables
 drink plenty of fluids

Vaginal Care:
New mothers should make vaginal care an essential part
of their postpartum care. You may experience:

 vaginal soreness if you had a tear during delivery

 urination problems like pain or a frequent urge to
urinate
 discharge, including small blood clots
 contractions during the first few days after delivery
Schedule a check-up with your doctor about six weeks
after delivery to discuss symptoms and receive proper
treatment. You should abstain from sexual intercourse
for four to six weeks after delivery so that your vagina
has proper time to heal.
 The Takeaway:
It’s important to stay as healthy as possible during
pregnancy and during the postpartum period. Stay on
top of all of your healthcare appointments and follow
your doctor’s instructions for the health and safety of
you and your baby.
AIM- to study and analyse about premature babies.
WHAT IS A PREMATURE BABY?
Most pregnancies last 40 weeks. A baby born before the 37 th
week is known as a premature or pre-term baby. Medical
advances have meant that more than 9 out of 10 premature
babies survive, and most go on to develop normally.
In Australia, almost 1 in every 10 babies is born prematurely.
Most Australian premature babies are born between 32 and
36 weeks and don’t have any serious long-term problems.
Very premature babies are at a higher risk of development
problems. It is possible for babies born at 23 to 24 weeks to
survive, but it is risky.
Most babies born before 32 weeks, and those weighing 2.5
kg or less, may need help breathing and may be cared for in a
neonatal intensive care unit (NICU) until they have developed
enough to survive on their own. Babies born between 32 and
37 weeks may need care in a special care nursery (SCN).
Induction or caesarean birth should not be planned before 39
completed weeks unless medically indicated.
SUB CATEGORIES OF PREMATURE INFANTS
(BASED ON GESTATIONAL AGE)
1. extremely preterm (less than 28 weeks)
2. very preterm (28 to 32 weeks)
3. moderate to late preterm (32 to 37 weeks).
THE PROBLEM
An estimated 15 million babies are born too early every year.
That is more than 1 in 10 babies. Approximately 1 million
children die each year due to complications of preterm birth.
Many survivors face a lifetime of disability, including learning
disabilities and visual and hearing problems.
Globally, prematurity is the leading cause of death in children
under the age of 5 years. And in almost all countries with
reliable data, preterm birth rates are increasing.
Inequalities in survival rates around the world are stark. In
low-income settings, half of the babies born at or below 32
weeks (2 months early) die due to a lack of feasible, cost-
effective care, such as warmth, breastfeeding support, and
basic care for infections and breathing difficulties. In high-
income countries, almost all of these babies survive.
Suboptimal use of technology in middle-income settings is
causing an increased burden of disability among preterm
babies who survive the neonatal period.
THE SOLUTION
More than three quarters of premature babies can be saved
with feasible, cost-effective care, such as essential care
during child birth and in the postnatal period for every
mother and baby, provision of antenatal steroid injections
(given to pregnant women at risk of preterm labour and
under set criteria to strengthen the babies’ lungs), kangaroo
mother care (the baby is carried by the mother with skin-to-
skin contact and frequent breastfeeding) and antibiotics to
treat new born infections. For example, continuity of
midwifery-led care in settings where there are effective
midwifery services has been shown to reduce the risk of
prematurity by around 24%.
Preventing deaths and complications from preterm birth
starts with a healthy pregnancy. Quality care before,
between and during pregnancies will ensure all women have
a positive pregnancy experience. WHO’s antenatal care
guidelines include key interventions to help prevent preterm
birth, such as counselling on healthy diet and optimal
nutrition, and tobacco and substance use; fetal
measurements including use of ultrasound to help determine
gestational age and detect multiple pregnancies; and a
minimum of 8 contacts with health professionals throughout
pregnancy to identify and manage other risk factors, such as
infections. Better access to contraceptives and increased
empowerment could also help reduce preterm births.
WHY ARE BABIES BORN PREMATURELY? (CAUSES)
The cause of premature birth is unknown in about half of all
cases. However, some of the reasons babies are born
prematurely include:
*Problems with the cervix, when it is too weak to hold the
weight of the baby and uterus so it starts to open
prematurely and this is called cervical incompetence.
*Multiple pregnancy (twins or more).]
*The mother has a medical condition that means the baby
must be delivered early, such as preeclampsia.
*Problems with the placenta such as placental insufficiency,
placenta praevia, placenta accrete or placental abruption.
*Preterm premature rupture of membranes, when the
amniotic sac spontaneously ruptures.
*A history of premature birth.
*Poor nutrition before and during pregnancy.
*Smoking, using illegal drugs, or drinking too much alcohol
during pregnancy.
*Certain infections, such as urinary tract and amniotic
membrane infections.
*Being either obese or underweight.
WHERE AND WHEN DOES PRE-BIRTH HAPPEN?
More than 60% of preterm births occur in Africa and South
Asia, but preterm birth is truly a global problem. In the lower-
income countries, on average, 12% of babies are born too
early compared with 9% in higher-income countries. Within
countries, poorer families are at higher risk.
  The 10 countries with the greatest number of preterm
births:
1. India: 3 519 100
2. China: 1 172 300
3. Nigeria: 773 600
4. Pakistan: 748 100
5. Indonesia: 675 700
6. United States of America: 517 400
7. Bangladesh: 424 100
8. Philippines: 348 900
9. Democratic Republic of the Congo: 341 400
10. Brazil: 279 300

 The 10 countries with the highest rates of preterm birth

per 100 live births:
1. Malawi: 18.1 preterm births per 100 births
2. Comoros: 16.7
3. Congo: 16.7
4. Zimbabwe: 16.6
5. Equatorial Guinea: 16.5
6. Mozambique: 16.4
7. Gabon: 16.3
8. Pakistan: 15.8
9. Indonesia: 15.5
10. Mauritania: 15.4
Of 65 countries with reliable trend data, all but three show
an increase in preterm birth rates over the past 20 years.
Possible reasons for this include better measurement,
increases in maternal age and underlying maternal health
problems such as diabetes and high blood pressure, greater
use of infertility treatments leading to increased rates of
multiple pregnancies, and changes in obstetric practices such
as more caesarean births before term.
There is a dramatic difference in survival of premature babies
depending on where they are born. For example, more than
90% of extremely preterm babies (less than 28 weeks) born
in low-income countries die within the first few days of life;
yet less than 10% of extremely preterm babies die in high-
income settings.
INCIDENCE
*About 10 to 12 percent of Indian babies are born preterm
(less than 37 completed weeks) as compared to 5 to 7
percent incidence in the west.
*These infants are anatomically and functionally immature
and therefore their neonatal mortality is high.
TRANSFER FROM INCUBATOR TO COT
*A baby who is feeding from the bottle or cup and is
reasonably active with a stable body temperature,
irrespective of his weight, qualifies for transfer to the open
cot.
DISCHARGE POLICY
*The mother should be mentally prepared and provided with
essential training and skills
*The mother- baby dyad should be kept in step down nursery
*The baby should be stable, maintaining his body
temperature and should not have any evidences of cold
stress.
*At the time of discharge, the baby should be having daily
steady weight gain velocity of at least 10g/kg
*The home conditions should be satisfactory before the baby
is discharged
*The public health nurse should assess the home conditions
and visit the family at home every week for a month or so
FOLLOW-UP PROTOCOL
*Common infective illnesses, reactive airway disease,
hypertension, renal dysfunction, gastro-oesophageal reflux
*Feeding and nutrition
*Immunizations
*Physical growth, nutritional status, anaemia,
osteopenia/rickets.
*Neuro-motor development, cognition and seizures
*Eyes: Retinopathy of prematurity, vision, strabismus
*Hearing
*Behavioural problems, language disorders and learning
disabilities
POTENTIAL HEATH PROBLEMS IN PREMATURE
INFANTS.
 The earlier a baby is born, the more likely they are to
have medical problems. A premature infant may show
these signs soon after birth:
*Trouble breathing
*Low weight
*Low body fat
*Inability to maintain a constant body temperature
*Less activity than normal
*Movement and coordination problems
*Difficulties with feeding
*Abnormally pale or yellow skin
 Premature infants may also be born with life
threatening conditions. These can include:
*Brain haemorrhage, or bleeding in the brain
*Pulmonary haemorrhage, or bleeding in the lungs
*Hypoglycaemia, or low blood sugar
*Neonatal sepsis, a bacterial blood infection
*Pneumonia, an infection and inflammation of the lungs
*Patent ductus arteriosus, an unclosed hole in the main
blood vessel of the heart
*Anaemia, a lack of red blood cells for transporting oxygen
throughout the body
*Neonatal respiratory distress syndrome, a breathing
disorder caused by underdeveloped lungs
*Some of these problems can be resolved through proper
critical care for the new born. Others can result in long-term
disability or illness.
 Doctors perform various tests on premature infants
soon after childbirth. These tests help reduce the risk of
complications. Doctors also monitor infants
continuously during their hospital stay.
Common tests include:
*Chest X-ray to evaluate heart and lung development
blood tests to assess glucose, calcium, and bilirubin levels
blood gas analysis to determine blood oxygen levels.
CLINICAL FEATURES
1. MEASUREMENTS:
*Size is small with relatively large head.
*Crown- heel length is less than 47 cm.
*Head circumference is less than 33 cm but exceeds the
chest circumference by more than 3 cm.
*Weight less than -2.5 kg.
2. ACTIVITY AND POSTURE:
*General activity is poor.
*Autonomic reflex response such as Moro response, sucking
and swallowing are sluggish or incomplete.
*Baby extends an extended posture due to poor tone.
3. FACE AND HEAD:
*Face appears small.
*Large head size.
*Sutures are widely separated and fontanels are large.
*Optic nerve is often unmyelinated but presence of papillary
membrane makes it visualization difficult.
*Ear cartilage is deficient or absent with poor recoil.
*Hair appear woolly and fuzzy and individual hair fibres can
be seen separately.
4. SKIN AND SUBCUTANEOUS TISSUES:
*Skin is thin, gelatinous, shiny and excessively pink with
abundant lanugo and very little vernix caseosa.
*Edema may be present.
*Subcutaneous fat is deficient and breast nodule is small or
absent.
*Deep sole creases are often not present.
5. GENITALS:
*In male testes are undescended and scrotum is poorly
developed.
*In female infants, labia majora are widely separated
exposing labia minora and hypertrophied clitoris.
CARE OF PRETERM BABIES
 OPTIMAL MANAGEMENT AT BIRTH
*Delayed clamping of cord.
*Effective intubation of extremely LBW(<1000g).
*Should be promptly dried, kept effectively covered and
warm.
*Vitamin K 1 mg (0.5mg in babies< 1500g)should be given
intra-muscularly.
*Transferred by the doctor or nurse to the NICU as soon as
breathing is established.
 MONITORING
*Vital signs
*Activity and behaviour
*Colour
*Tissue perfusion
*Fluids, electrolytes and ABG’s
*Tolerance of feeds
*Watched for development of RDS, apnoeic attacks, sepsis,
PDA, NEC, IVH etc...
*Weight gain velocity
 CRITERIA FOR A HEALTHY PRETERM BABY
*The vital signs should be stable.
*The healthy baby is alert and active, looks pink and healthy,
trunk is warm to touch and extremities are reasonably warm
and pink.
*The baby is able to tolerate enteral feeds and there is no
respiratory distress or apnoeic attacks and baby is having a
steady weight gain of 1-1.5% of his body weight every day.
 PROVIDE IN-UTERO MILIEU
*Create a soft, comfortable, “nestled” and cushioned bed.
*Avoid excessive stimuli.
*Effective analgesia and sedation.
*Provide warmth
*Ensure asepsis
*Prevent evaporative skin losses
*Provide effective and safe oxygenation
*Partial parenteral nutrition and give trophic feeds with
expressed breast milk (EBM).
*Provide rhythmic gentle tactile and kinaesthetic stimulation
 POSITION OF THE BABY
*Thermo-neutral environment
*Application of oil or liquid paraffin on the skin
*Should be covered with a cellophane or thin transparent or
thin transparent plastic sheet
*Provide partial kangaroo0mother-care.
  OXYGEN THERAPY
*Oxygen should be administered with a head box when SpO2
falls below 85% and it should be gradually withdrawn when
SpO2 goes above 90%.
*The lowest ambient concentration and flow rates should be
used to maintain SpO2 between 85-95% and PaO2 between
60-80 mm Hg.

 PHOTOTHERAPY
*Early phototherapy is advised to keep the serum bilirubin
level within safe limits in order to obviate the need for
exchange blood transfusion.
 PREVENTION OF NOSOCOMIAL INFECTIONS
*The handling should be bare minimum.
*Vigilance should be maintained on all procedures.
*Early diagnosis and prompt treatment at infections.
 FEEDING AND NUTRITION
*Intra-venous dextrose solution (10% dextrose in
babies>1000g and 5% dextrose in babies <1000g).
*Trophic feeds with EBM through NG tube.
*Condition is stabilized-enteral feeds.
 FLUID REQUIREMENT
Fluid requirements are higher in LBW infants due to:
*Greater insensible water losses
*Faster breathing rates
*Decreased ability to concentrate urine
*Greater use of radiant warmers
*Greater use of phototherapy units

 RATE OF ADMINISTRATION

BIRTH WEIGHT (g) FLUID RATE (ml/kg/day)

500-600 140-200
601-800 120-130
801-1000 90-110
1000-1500 80-100
>1500 60-80
*Fluid rate can be increased by 10-20 ml/kg/d to gradually
reach 150ml/g/d.
*Fluid requirements need to be individualized for each baby.
*Enteral nutrition has to be considered once the baby is
stable.
 TOTAL PARENTAL NUTRITION
*Infants with BW</=1000g
*Infants with BW<=1500g done in conjunction with slowly
advancing enteral nutrition
*Infants with BW 1501-1800 g for whom enteral intake is not
expected for >3 days.
 GLUCOSE: 6-8 mg/g/min
 AMINO ACIDS: 1.5-2 g/kg/d
 LIPID: 0.5-1 g/kg/d
 SODIUM: 2-4 mEq/kg/d
 POTASSIUM: 2-3 mEq/kg/d
 CHLORIDE: 2-4 mEq/kg/d

 EARLY ENTERAL NUTRITION

Trophic feeding/Gut priming
Practice of feeding very small amounts of enteral
nutrition to stimulate development of the immature GIT
Advantages:
*Improves GI motility
*Enhances enzyme maturation
*Improves mineral absorption
*Lowers incidence of cholestasis
*Shortens time to regain birth weight
 ENTERAL NUTRITION
*Breast milk or ½ or full-strength preterm formula at
10ml/kg/d by intermittent gavage/continuous nasogastric
drip.
*Increase by 10-15 ml/kg/d to reach 150ml/kg/d
*Increments not >20ml/kg/d
*IV fluids can be stopped once 120ml/kg/d is reached
*On reaching 150ml/kg/d calorie density can be increased.
 FEEDING GUIDELINES
PRETERMS:
*<1200 g/ <32 wks: IV fluids for first 2-3 days, once stable
start gavage feeding.
*1200-1800 g/32-34 wks: Start gavage feeding, once vigorous
start spoon/breast feeding
*>1800 g/ >34 wks: Start breast feeding directly; if trial feed
takes> 20 mins or intake is less than required, switch to
gavage feeding.
 PRETERM HUMAN MILK
Advantages:
*Higher concentrations of amino acids.
*Higher concentrations of essential fatty acids.
*Lower renal solute load
*Specific bio active factors provide immunity
*Promotes intestinal maturation
Disadvantages:
*Low concentrations of vitamin D, Ca, P
*Inadequate iron
 ENTERAL NUTRITION
*ENERGY: 130-175 Kcal/kg/d
*PROTEIN: 3.4-4.2 g/kg/d
*FAT: 6-8 g/kg/d
*Na: 3-7 mEq/kg/d
*Cl: 3-7 mEq/kg/d
*K: 2-3 mEq/kg/d
*Ca: 100-220 mg/kg/d
 NUTRITIONAL SUPPLEMENTS
*Multivitamin drops
*Iron supplementation
*Vitamin E supplementation
*Supplements of calcium(220mg/day) and
phosphorus(100mg/day)
 GENTLE RHYTHMIC STIMULATION
*Gentle touch, massage, cuddling, stroking and flexing.
*Rocking bed or placing a preterm baby on inflated gloves
*Soothing auditory stimuli
*Visual inputs
 KANGAROO CARE
*Kangaroo care is placing a premature baby in a upright
position on a mothers bare chest allowing tummy to tummy
contact and placing the premature baby in between the
mothers breasts.
*The baby’s head is turned so that the ear is above the
parents’ heart.
*Mothers have thermal synchrony with their baby.
*The study also concluded that when the baby was cold, the
mothers body temperature would increase to warm the baby
up and vice versa.
*Kangaroo care allows easy access to the breast and skin-to-
skin contact increases milk let down.
*Kangaroo care allows the baby to fall into a deep sleep
which allows the baby to conserve energy for more
important things. Increased weight gain means shorter
hospital stay.
 WEIGHT RECORD
*Loss is up to a maximum of 10-15%
*Regain their birth weight by the end of second week of life
*Excessive weight loss, delay in regaining the birth weight or
slow weight gain-suggest baby is not being fed adequately or
unwell and needs immediate attention.
WHAT TO AVOID IN THE CARE OF PRETERM
BABIES?
 Routine oxygenation without monitoring
 Intravenous immune-globulins
 Prophylactic antibiotics
 Prophylactic administration of indomethacin or high
doses of vitamin E
  Unnecessary blood transfusions
 Formula feeds
 Rough handling, excessive light and loud sound.
IMMUNIZATIONS
*It is desirable to administer 0-day vaccines (BCG, OPV, HBV)
on the day of discharge from the hospital.
*If mother is HBV carrier and is e-antigen positive-hepatitis B
vaccine and hepatitis B specific immunoglobulins within 72
hours of age.
*Live vaccines should be avoided in symptomatic HIV-positive
mothers.
*WHO recommends that BCG and oral polio vaccine can be
given to asymptomatic HIV-positive infants.
FAMILY SUPPORT
*The family dynamics are greatly disturbed.
*The problems and issues should be handled with
equanimity, compassion, concern and caring attitude of the
health team.
*Encouraged to touch and talk with her baby
*Provide kangaroo-mother care
*Emotional support and guidance
TREATING A PREMATURE INFANT
Doctors often try to prevent a premature birth by giving the
mother certain medications that can delay delivery.
If premature labour can’t be stopped or a baby needs to be
delivered prematurely, doctors then prepare for a high-risk
birth. The mother may need to go to a hospital that has a
neonatal intensive care unit (NICU). This will ensure the
infant receives immediate care after birth.
In the first few days and weeks of the premature baby’s life,
hospital care focuses on supporting vital organ development.
The new born may be kept in a temperature-controlled
incubator. Monitoring equipment tracks the baby’s heart
rate, breathing, and blood oxygen levels. It may be weeks or
months before the baby is able to live without medical
support.
Many premature babies can’t eat by mouth because they
can’t yet coordinate sucking and swallowing. These babies
are fed vital nutrients either intravenously or using a tube
inserted through the nose or mouth and into the stomach.
Once the baby is strong enough to suck and swallow, breast-
feeding or bottle-feeding is usually possible.
 The premature baby may be given oxygen if their lungs
aren’t fully developed. Depending on how well the
infant can breathe on their own, one of the following
may be used to deliver oxygen:
*Ventilator, a machine that pumps air into and out of the
lungs
*Continuous positive airway pressure, a treatment that uses
mild air pressure to keep the airways open
*Oxygen hood, a device that fits over the infant’s head to
supply oxygen
 Generally, a premature infant can be released from the
hospital once they can:
*Breast-feed or bottle-feed
*Breathe without support
*Maintain body temperature and body weight
LONG TERM OUTCOME FOR PREMATURE
INFANTS
Premature infants often require special care. This is why they
usually begin their lives in an NICU. The NICU provides an
environment that limits stress to the baby. It also provides
the warmth, nutrition, and protection needed for proper
growth and development.
Due to many recent advances in care for mothers and new-
borns, survival rates for premature infants have improved. A
study published by JAMA Trusted Source found that the
survival rate for babies born before 28 weeks, which is
considered extremely premature, increased from 70 percent
in 1993 to 79 percent in 2012.
Even so, all premature infants are at risk of long-term
complications. Developmental, medical, and behavioural
problems can continue through childhood. Some may even
00cause permanent disabilities.
  Common long-term problems associated with
premature birth, especially extreme prematurity,
include:
*Hearing problems
*Vision loss or blindness
*Learning disabilities
*Physical disabilities
*Delayed growth and poor coordination
Parents of premature infants need to pay careful attention to
their child’s cognitive and motor development. This includes
the achievement of certain skills, such as smiling, sitting, and
walking.
Speech and behavioural development also are important to
monitor. Some premature infants may need speech therapy
or physical therapy throughout their childhood.
PREVENTING PREMATURE BIRTH
 Getting prompt and proper prenatal care significantly
reduces the chances of having a premature birth. Other
important preventive measures include:
*Eating a healthy diet before and during your pregnancy.
Make sure to eat lot of whole grains, lean proteins,
vegetables, and fruits. Taking folic acid and calcium
supplements is also highly recommended.
*Drinking lots of water every day. The recommended amount
is eight glasses per day, but you’ll want to drink more if you
exercise.
*Taking aspirin daily starting in the first trimester. If you have
high blood pressure or a history of premature birth, your
doctor may recommend you take 60 to 80 milligrams of
aspirin each day.
*Quitting smoking, using illegal drugs, or overusing certain
prescription drugs. These activities during pregnancy may
lead to a higher risk of certain birth defects as well as
miscarriage.
Talk to your doctor if you’re concerned about having a
premature birth. Your doctor may be able to suggest
additional preventive measures that can help lower your risk
of giving birth prematurely.
HOME CARE OF PRETERM BABIES
*She must be explained about the importance of asepsis
*Keeping the baby warm and ensuring satisfactory feeding
routine
*The services of postpartum programme public health nurse
and social worker can be utilized
ENVIRONMENTAL CONTROL
*The infant should be effectively covered taking care to
avoid smothering
*Woollen cap, socks and mittens should be worn
*The infant should be preferably lie next to the mother
*In winter, the room can be warmed with a radiant heater
*A table lamp having 100-watt bulb can be used to provide
direct radiant heat
*Hot water bottle should never come in contact with the
baby
*The cot of the mother and the infant should be located
away from the walls
*The mother and health worker should be trained to assess
the temperature of the new born baby by touch
*The visitors and handling of the infant should be restricted
to the bare minimum
*The hands must be washed before touching or feeding the
baby
*The emotional urge for kissing the baby should be curbed
*The linen should be clean and sun-dried