1 - Fiafinalize Na Prema, LBW, & Sepsis

PREMATURITY, LOW BIRTH WEIGHT, AND NEONATAL SEPSIS
A CASE STUDY
PRESENTED TO
COLLEGE OF NURSING AND MIDWIFERY
OUR LADY OF THE PILLAR COLLEGE – CAUAYAN
CAUAYAN CITY, ISABELA
IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR THE DEGREE
BACHELOR OF SCIENCE IN NURSING
SUBMITTED BY:
AGACER, DANIEL JADE GULAPAN, PRINCESS MAE
AGUILAR, NICOLE MALAGUIT, ROSEGIEWEN
ALEGA, IRISH PASCUA, PATRICIA JOY
DAQUIOAG, ANNA MAE RAMIL, SAHARA
ESPOSO, PHOEBE TAGUINOD, QUEEN
SHADELAINE
Objectives
At the end of the presentation of the case study, the students will be able to:
 Understand what Prematurity, Low Birth Weight, and Neonatal Sepsis is

 Describe the types or classifications, etiology, and risk factors of Prematurity, Low Birth
Weight, and Neonatal Sepsis
 Learn what are the sign and symptoms, and possible complications of Prematurity, Low
Birth Weight, and Neonatal Sepsis
 Describe and understand the general medical and pharmacological management, as well as
the nursing responsibilities for patients with Burns
 Understand the anatomy and physiology as well as the pathophysiology of Prematurity, Low
Birth Weight, and Neonatal Sepsis
 Understand the patient's health history, patterns of functioning, level of competencies and
developmental task and relate this on the contribution or development to the patient's
condition
 Discuss the specific medical management done to the patient and as well as the nursing
management appropriate to the patient's condition
 Identify the drugs given to the patient, understand its mode of action, and provide appropriate
nursing interventions in relation to the drug to ensure patient's safety and to potentiate the
effect of drug
 Identify nursing diagnosis appropriate to the patient and discuss nursing care plans to provide
holistic care for the patient
INTRODUCTION
INTRODUCTION
A. OVERVIEW
Preterm is defined as babies born alive before 37 weeks of pregnancy are completed.
There are sub-categories of preterm birth, based on gestational age: extremely preterm (less than
28 weeks), very preterm (28 to 32 weeks), moderate to late preterm (32 to 37 weeks). Babies may
be born preterm because of spontaneous preterm labour or because there is a medical indication
to plan an induction of labour or cesarean birth early.
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.
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 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.
B. DEFINITION
According to Lynna Y. Littleton and Joan C. Engebretson’s Maternity Nursing Care, the
term PRETERM BIRTH or PREMATURITY is defined as delivery before 37 weeks’ gestation.
According to World Health Organization (WHO), PRETERM is defined as babies born

alive before 37 weeks of pregnancy are completed. There are sub-categories pf preterm birth,
based on gestational age: extreme preterm (less than 28 weeks), very preterm (28-32 weeks), and
moderate to late preterm (32-37 weeks)
According to JoAnne Silbert-Flagg’s Maternal and Child Health Nursing Care of

Childbearing and Childrearing Family, a PRETERM infant is generally defined as a live-born
neonate born before the end of week 37 of gestation.
C. INCIDENCE RATE
Global
PREMATURITY
Infant Morbidity rate per 1000 live birth
The Graph above shows that among the five (5) race/ethnicity, Black newborns had the greatest
rate of preterm birth at 14.2% globally because of Racism-related stress, followed by American
Indian/Alaska Native infants (11.6%), Hispanic infants (9.8%), White infants (9.2%), and
Asian/Pacific Islander infants (8.2%).
According to the World Health Organization, 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.
National
PREMATURITY&LOW BIRTH WEIGHT, AND SEPSIS
In 2015, approximately 2,300,000 babies were born in Philippines, or around 6,400 every day.
Among young women (aged 20-24), 8% gave birth by age 18. Approximately 81 babies will die
each day before reaching their first month; 71 stillbirths occur every day.
Neonatal mortality rate:
Philippines neonatal mortality rate (NMR)^ is 13 deaths per 1,000 live births. NMR in rural areas
is 18 deaths per 1,000 live births and 9 deaths per 1,000 live births in urban areas. NMR among
the poorest households is 19 neonatal deaths per 1,000 live births, compared to 9 deaths per 1,000
live births among the richest households.
In Philippines, the main
causes of neonatal
deaths in 2015 were
prematurity & low birth
weight (33%), birth
asphyxia and trauma
(23%) and congenital
anomalies (17%).
Others:
- Pertussis
- Tetanus
- Other NCDs
- HIV/AIDS
Local
Area
Infant Deaths
Total Deaths
Fetal Deaths
Livebirths
Maternal
Deaths
Number Number Number Number Number
REGION II - CAGAYAN VALLEY 58,490 20,952 604 143 29
Batanes 256 139 4 4 1
Cagayan 16,013 6,669 169 9 3
Isabela 19,172 6,862 167 18 16
Nueva Vizcaya 8,982 2,487 93 37 3
Quirino 3,439 936 45 9 2

Tuguegarao 2,798 1,306 47 16 2
City of Cauayan 2,402 869 23 8 1
Ilagan City 2,422 785 19 15 1
City of Santiago 3,006 899 37 27 -
Leading Causes:
 Pneumonia
 Respiratory Distress of Newborn
 Prematurity and Low Birth Weight
 Diarrhea and Gastroenteritis of Infectious Origin
 Bacterial Sepsis
 Congenital Malformation of the Heart
 Disorder related to Length of gestation and Fetal Growth
 Intrauterine Hypoxia
 Birth Asphyxia
D. ETIOLOGY/CAUSES
Preterm birth occurs for a variety of reasons. Most preterm births happen spontaneously,
but some are due to medical reasons such as infections, or other pregnancy complications that
require early induction of labour or Caesarean birth.
People can also go into premature labor due to:
 Chronic health conditions, such as diabetes or infections
 Drug or alcohol abuse
 Multiple pregnancies
 Preeclampsia (high blood pressure during pregnancy)
 Problems with their uterus or cervix
 Vaginal bleeding or infections during pregnancy
E. RISK FCTORS (MODIFIABLE & NON MODIFIALE)

MODIFIABLE
 Environment
 Poor nutritional status
 Lack of prenatal care
 use of tobacco products
 Infections (especially urinary tract infection)
 Pregnancy complications, such as premature rapture of membranes or premature separation
of the placenta
 Weight
NON-MODIFIABLE
 Age of the birthing parent (highest incidence is in birthing parents younger than age 20 years)
 Race (people of color experience a higher incidence of prematurity than White people do)
 Abnormalities of the birthing parent’s reproductive system, such as intrauterine septum
F. SIGNS AND SYMPTOMS

 Small size, with a disproportionately large head
 Sharper looking, less rounded features than a full-term baby's features, due to a lack of fat
stores
 Fine hair (lanugo) covering much of the body
 Low body temperature, especially immediately after birth in the delivery room, due to a lack
of stored body fat
 Labored breathing or respiratory distress
 Lack of reflexes for sucking and swallowing, leading to feeding difficulties
 Weight is 2500g or less
 Length is less than 44cm
 Head and abdomen are relatively large
 Skull bones are soft
 Head circumference disproportionately exceeds that of chest
 Pinnae of ears are soft and flat
 Eyes are kept closed
 Skin is red, thin and shiny
 Muscle tone poor
 Plantar creases are not visible before 34 weeks
 Testicle undescended (in Male)
 Labia minora exposed (in Female)
 Nails are not grown up to the finger tips
G. COMPLICATIONS
Short-term complications
In the first weeks, the complications of premature birth may include:
 Breathing problems. A premature baby may have trouble breathing due to an immature
respiratory system. If the baby's lungs lack surfactant — a substance that allows the
lungs to expand — he or she may develop respiratory distress syndrome because the
lungs can't expand and contract normally.
 Premature babies may also develop a lung disorder known as bronchopulmonary
dysplasia. In addition, some preterm babies may experience prolonged pauses in their
breathing, known as apnea.
 Heart problems. The most common heart problems premature babies experience are
patent ductus arteriosus (PDA) and low blood pressure (hypotension). PDA is a
persistent opening between the aorta and pulmonary artery. While this heart defect often
closes on its own, left untreated it can lead to a heart murmur, heart failure as well as
other complications. Low blood pressure may require adjustments in intravenous fluids,
medicines and sometimes blood transfusions.
 Brain problems. The earlier a baby is born, the greater the risk of bleeding in the brain,
known as an intraventricular hemorrhage. Most hemorrhages are mild and resolve with
little short-term impact. But some babies may have larger brain bleeding that causes
permanent brain injury.
 Temperature control problems. Premature babies can lose body heat rapidly. They don't
have the stored body fat of a full-term infant, and they can't generate enough heat to
counteract what's lost through the surface of their bodies. If body temperature dips too
low, an abnormally low core body temperature (hypothermia) can result.
 Hypothermia in a premature baby can lead to breathing problems and low blood sugar
levels. In addition, a premature infant may use up all of the energy gained from feedings
just to stay warm. That's why smaller premature infants require additional heat from a
warmer or an incubator until they're larger and able to maintain body temperature
without assistance.
 Gastrointestinal problems. Premature infants are more likely to have immature
gastrointestinal systems, resulting in complications such as necrotizing enterocolitis
(NEC). This potentially serious condition, in which the cells lining the bowel wall are
injured, can occur in premature babies after they start feeding. Premature babies who
receive only breast milk have a much lower risk of developing NEC.
 Blood problems. Premature babies are at risk of blood problems such as anemia and
newborn jaundice. Anemia is a common condition in which the body doesn't have
enough red blood cells. While all newborns experience a slow drop in red blood cell
count during the first months of life, the decrease may be greater in premature babies.
Newborn jaundice is a yellow discoloration in a baby's skin and eyes that occurs
because the baby's blood contains excess bilirubin, a yellow-colored substance, from the
liver or red blood cells. While there are many causes of jaundice, it is more common in
preterm babies.
 Metabolism problems. Premature babies often have problems with their metabolism.
Some premature babies may develop an abnormally low level of blood sugar
(hypoglycemia). This can happen because premature infants typically have smaller
stores of stored glucose than do full-term babies. Premature babies also have more
difficulty converting their stored glucose into more-usable, active forms of glucose.
 Immune system problems. An underdeveloped immune system, common in premature
babies, can lead to a higher risk of infection. Infection in a premature baby can quickly
spread to the bloodstream, causing sepsis, an infection that spreads to the bloodstream.
Long-term complications
In the long term, premature birth may lead to the following complications:
 Cerebral palsy. Cerebral palsy is a disorder of movement, muscle tone or posture that
can be caused by infection, inadequate blood flow or injury to a newborn's developing
brain either early during pregnancy or while the baby is still young and immature.
 Impaired learning. Premature babies are more likely to lag behind their full-term
counterparts on various developmental milestones. Upon school age, a child who was
born prematurely might be more likely to have learning disabilities.
 Vision problems. Premature infants may develop retinopathy of prematurity, a disease
that occurs when blood vessels swell and overgrow in the light-sensitive layer of nerves
at the back of the eye (retina). Sometimes the abnormal retinal vessels gradually scar the
retina, pulling it out of position. When the retina is pulled away from the back of the eye,
it's called retinal detachment, a condition that, if undetected, can impair vision and cause
blindness.
 Hearing problems. Premature babies are at increased risk of some degree of hearing loss.
All babies will have their hearing checked before going home.
 Dental problems. Premature infants who have been critically ill are at increased risk of
developing dental problems, such as delayed tooth eruption, tooth discoloration and
improperly aligned teeth.
 Behavioral and psychological problems. Children who experienced premature birth may
be more likely than full-term infants to have certain behavioral or psychological
problems, as well as developmental delays.
 Chronic health issues. Premature babies are more likely to have chronic health issues —
some of which may require hospital care — than are full-term infants. Infections,
asthma and feeding problems are more likely to develop or persist. Premature infants
are also at increased risk of sudden infant death syndrome (SIDS).
H. DIAGNOSTIC AND LABORATORY EXAMINATION

CLINICAL CHEMISTRY
 the biochemical analysis of body fluids in support of the diagnosis and treatment of disease.
Purpose
 determine the amount of biologically active substances normally contained in the blood.
Procedure
 Clinical chemistry employs chemical processes to determine the concentrations of chemical
components in bodily fluids and tissues. Blood and urine are the most commonly used
specimens in clinical chemistry. There are numerous tests available to detect and measure
almost any type of chemical component in blood or urine.
NURSING RESPONSIBILITIES
Pre Test
1. Inform the patient SO that he will feel a bit pain when needle is inserted.
2. Advise the SO of the patient that should feel relax as possible while blood is being drawn out.
3. Clean the site where the needle will pricked
Post Test
1. Assist the patient during the procedure
2. Monitor the patient’s condition
3. Provide comfort measures to divert his attention
4. Apply pressure dressing to the puncture site
5. Observed the vein punctured site for bleeding
BABYGRAM
 A radiograph that includes the whole body or just the chest and abdomen
(thoracoabdominal babygram) on a single image.
Purpose
 Babygram is done to our patient to monitor and check the chest and abdomenfor
problems.
Procedure
 The patient is positioned on an X-ray table that carefully positions the part of the body
that is to be x-rayed - between the X-ray machine and a cassette containing the X-ray film.
 Body parts not being imaged may be covered with a lead apron to avoid exposure to the
X-rays.
 The X-ray beam is then focused on the area to be photographed.
 The patient must be very still or the image will be blurred.
 The technician steps behind a protective window and the image is taken.
 Sometimes, various X-rays may have to be taken at different angles, such as the front and
side view during a chest X-ray.
Nursing Responsibilities
Pre test
 Check the Doctor's order.
 Ensure the patients comfort and safety.
 Inform the SO if available to assist the infant during the test.
 Explain the procedure to the SO.
 Assist the pt to appropriate position.
Intra test
 Inform the SO to hold the pt until the xray films are obtained.
Post test
 After the test, provide comfort to the pt.
CHEST X-RAY
 An x-ray exam is a noninvasive medical test that helps doctors diagnose and treat medical
conditions. X-ray exams use a small dose of ionizing radiation to produce pictures of the
inside of the body.
Purpose
 A chest X-ray can help doctors find any cause of a respiratory distress to our patient as
well as to check the placement of ET (endotracheal) tube.
Procedure
X-rays.
Pre test
Intra test
Post test
CRANIAL ULTRASOUND
 Ultrasound imaging of the head uses sound waves to produce pictures of the brain and
cerebrospinal fluid. It usually performed on infants whose skulls have not completely
formed.
Purpose
 Head ultrasound is a routine exam for infants who were born prematurely. The procedure
was used to our patient to screen for brain conditions associated with prematurity, such as
bleeding or brain tissue damage.
Procedure
 A head ultrasound is performed in the neonatal intensive care unit (NICU) at the infant's
bedside. The infant is positioned lying face-up.
 A clear, water-based gel is applied to the transducer to help the transducer make secure
contact with the body and eliminate air pockets that can block the sound waves from
passing into the body.
 The sonographer or radiologist then gently presses the transducer against the fontanelle
(soft spot of the infant's head, which has no bone to block the passage of the sound
waves).
Pre test
 Inform the SO that he/she needs to assist the patient upon the test.
 To ensure that the patient is comfortable during the scan, give pacifier as sucking to
provide comfort.
Intra test
 Help the patient with positioning for better visualization of the test.
Post test
 No special care after the procedure.
HEMATOLOGY
 Hematology tests are a panel of tests that yield information on the qualitative and
quantitative composition of the cellular components of the blood.
Purpose
 This tests the blood cells. It shows if our patient has enough blood cells. It also tells the
doctor how much of the oxygen-carrying substance (hemoglobin) is in the blood.
Procedure
 After cleaning the area, the health professional will prick the baby's heel with a tiny
needle to collect a small sample of blood.
 After pricking the infant’s heel with the lancet, the technician gently squeezes blood into
the vial.
 After getting blood, cover the area with cotton to stop the bleeding.
Pre test
 Inform the SO about the procedure.
 Explain to the SO that the infant may feel a bit pain when inserting the needle.
 Advice the SO that he/she needs to hold the infant.
 Clean the site where the needle will be pricked.
Intra test
 The SO will assist the patient during the procedure.
 Monitor the patient’s condition.
 Provide comfort measures to divert his attention from pain or discomfort.
Post test
 Apply pressure dressing to the puncture site.
 Observe the punctured site for bleeding.
Hematology
Test Age Range Units
Red Cell Count 0-1 month 3.90-5.90 millions/mm3
1-2 months 3.10-5.30
2-3 months 2.70-4.50
3-6 months 3.10-5.10
6 months-1 year 3.90-5.50
Hematocrit 0-1 month 42-65 %
1-2 months 33-55
2-3 months 28-41
3-6 months 29-41
6 months-1 year 31-41
Hemoglobin 0-1 month 13.4-19.9 gm/dL
1-2 months 10.7-17.1
2-3 months 9.0-14.1
3-6 months 9.5-14.1
MCH 0-1 month 31-37 pg
1-3 months 27-36
3-6 months 25-35
MCHC 0-6 months 28-36 g/dL RBC
MCV 0-1 month 88-123 femtoliters
1-3 months 91-112
3-6 months 74-108
White Cell Count 0-1 month 9000-30000 mm3
1-3 months 5000-19500
3 months-1 year 6000-17500
1-2 years 6000-17000
2-4 years 5500-15500
Differential (manual) 0-1 month 1000-20000 mm3
Neutrophils 1-3 months 1000-9000
3-6 months 1000-8500
6 months-5 years 1500-8500
5-18 years 1700-7500
Lymphocytes 0-1 month 2000-11000 mm3
1-3 months 2500-16500
3-6 months 4000-13500
6 months-1 year 4000-10500
1-2 years 3000-9500
2-5 years 2000-8000
5-18 years 1250-7000
18+ years 875-3300
Monocytes 0-1 month 540-1800 mm3
1-3 months 350-1365
3-12 months 300-875
1-2 years 300-850
2-5 years 275-775
5-18 years 28-825
18+ years 130-860
Eosinophils 0-1 month 270-900 mm3
1-3 months 150-585
1-2 years 180-510
2-5 years 165-465
5-18 years 40-650
18+ years 40-390
Basophils 0-1 month 0-400 mm3
1 month-5 years 0-140
5-18 years 7-140
18+ years 10-136
1. RBS MONITORING SHEET

 Blood glucose monitoring observes for patterns in the fluctuation of blood glucose levels that
occur in response to diet.
Purpose
 Random blood glucose readings can help you identify hyperglycemia and hypoglycemia.
Procedure
 baby's blood glucose is tested by a heel-prick blood test. A very small amount of blood is
needed and it can be done while you are holding your baby in skin-to-skin contact. The first
blood test should be done before the second feed (2- 4 hours after birth), and repeated until
the blood glucose levels are stable.
Pre Test
 Assess for signs and symptoms of hypoglycemia
COMPLETE BLOOD COUNT
Description:
Blood is collected by inserting a needle into a vein and allowing the blood to flow into a tube.
The blood sample is sent to the laboratory and the red blood cells, white blood cells, and platelets
are counted. The CBC is used to test for, diagnose, and monitor many different conditions. Blood
test- CBC count may be indicated with a prolonged course, severe diarrhea, or toxicity. Also, the
white blood cell (WBC) count is usually increased in Salmonella infections but normal or low
with significant left shift in Shigella infections.
A complete blood count test measures several components and features of your blood,
including:
⚫ Red blood cells, which carry oxygen
⚫ White blood cells, which fight infection
⚫ Hemoglobin, the oxygen-carrying protein in red blood cells
⚫ Hematocrit, the proportion of red blood cells to the fluid component, or plasma, in your
blood
⚫ Platelets, which help with blood clotting
Abnormal increases or decreases in cell counts as revealed in a complete blood count
may indicate that you have an underlying medical condition that calls for further evaluation.
Purpose:
A blood test used to evaluate your overall health and detect a wide range of disorders, including
anemia, infection and leukemia. A complete blood count test measures several components and
features of your blood, including: Red blood cells, which carry oxygen. Procedure:
For infants in young infants, a nurse will typically sterilize the heel of the foot and use a small
needle called a lancet to prick the area. The nurse will then gently squeeze the heel and collect a
small amount of blood in a vial for testing
Procedure:
Most blood tests take a small amount of blood from a vein. To do that:
 clean the skin
 put an elastic band (tourniquet) above the area to get the veins to swell with blood
 insert a needle into a vein (usually in the arm inside of the elbow or on the back of the
hand)
 pull the blood sample into a vial or syringe
 take off the elastic band and remove the needle from the vein
In babies, blood draws are sometimes done as a "heel stick collection." After cleaning the area,
the health professional will prick your baby's heel with a tiny needle (or lancet) to collect a small
sample of blood. Collecting a sample of blood is only temporarily uncomfortable and can feel like
a quick pinprick.
Pre Test
 Explain test procedure
 Inform the patient’s parent that slight discomfort or pain may be felt when the skin is
punctured
Intra test
 Assisst the medical technologist or whoever will get blood from the patient.
Post test
 Apply manual pressure and dressings over puncture site on removal of dinner.
 Monitor the puncture site for oozing or hematoma formation.
 Report any result to the requesting health care provider.
ECHOCARGIOGRAM
Description:
An echocardiogram, or "echo", is a scan used to look at the heart and nearby blood vessels. It's a
type of ultrasound scan, which means a small probe is used to send out high-frequency sound
waves that create echoes when they bounce off different parts of the body. These echoes are
picked up by the probe and turned into a moving image on a monitor while the scan is carried out.
An echocardiogram may be requested by a heart specialist (cardiologist) or any doctor who thinks
you might have a problem with your heart, including your GP. The test will usually be carried out
at a hospital or clinic by a cardiologist, cardiac physiologist, or a trained technician called a
sonographer. Although it has a similar name, an echocardiogram is not the same as an
electrocardiogram (ECG), which is a test used to check your heart's rhythm and electrical activity.
Purpose:
An echocardiogram can help diagnose and monitor certain heart conditions by checking the
structure of the heart and surrounding blood vessels, analyzing how blood flows through them,
and assessing the pumping chambers of the heart.
An echocardiogram can help detect:
 damage from a heart attack – where the supply of blood to the heart was suddenly
blocked
 heart failure – where the heart fails to pump enough blood around the body at the right
pressure
 congenital heart disease – birth defects that affect the normal workings of the heart
 problems with the heart valves – problems affecting the valves that control the flow of
blood within the heart
 cardiomyopathy – where the heart walls become thickened or enlarged
 endocarditis – an infection in the lining of the heart which damages the heart valves
Procedure:
An echocardiogram is done in a darkened room, with your child lying down. Small metal
stickers (electrodes) are placed on the chest. These measure the rhythm of the heart beating. Gel
put on the chest helps sounds waves travel from the echocardiogram wand (the transducer) to the
heart and back again. The person doing the test will move the wand around to get pictures of the
heart from different angles.
Nursing Responsibilities:
Pre Test
 Explain the procedure to the patient.
 No special preparation is needed.
 Ensure to empty the bladder.
 Explain the need to darkened the examination field.
 Explain that a vasodilator (amyl nitrate) may be given.
Intra test
 Inform that a conductive gel is applied to the chest area
 Position the patient on his left side.
Post test
 Remove the conductive gel from the patient’s skin.
 Inform the patient that the study will be interpreted by the physician.
ULTRASOUND SCAN
Description:
An ultrasound scan, sometimes called a sonogram, is a procedure that uses high-frequency sound
waves to create an image of part of the inside of the body. An ultrasound scan can be used to
monitor an unborn baby, diagnose a condition, or guide a surgeon during certain procedures.
Purpose:
An ultrasound scan uses high-frequency sound waves to make an image of a person's internal
body structures. Doctors commonly use ultrasound to study a developing fetus (unborn baby), a
person's abdominal and pelvic organs, muscles and tendons, or their heart and blood vessels.
Procedure:
Gel is applied to your skin over the area being examined. It helps prevent air pockets, which can
block the sound waves that create the images. This safe, water-based gel is easy to remove from
skin and, if needed, clothing.
A trained technician (sonographer) presses a small, hand-held device (transducer) against the area
being studied and moves it as needed to capture the images. The transducer sends sound waves
into your body, collects the ones that bounce back and sends them to a computer, which creates
the images. Sometimes, ultrasounds are done inside your body. In this case, the transducer is
attached to a probe that's inserted into a natural opening in your body.
Pre Test
 Explanation of the procedure to the patient
Intra test
 The nurse must help the endoscopist and, when indicated, the anesthesist.
Post test
 After the completion of the procedure, the nurse must carry-on with the reprocessing of
the endoscopic instrument and of the devices.
I. MEDICAL MANAGEMENT
 Synthetic surfactant (endotracheal in a liquid form in a vial) , a medication used to treat
respiratory distress syndrome. Surfactant are wetting agents which coat the surface of
the air sacs (alveoli) and reduce surface tension in the lungs. This helps to inflate and
expand the air sacs during breathing and prevents their collapse.
 Being placed in an incubator. Your baby will probably stay in an enclosed plastic
bassinet (incubator) that's kept warm to help your baby maintain normal body
temperature.
 Spending time under bilirubin lights. To treat infant jaundice, your baby may be placed
under a set of lights — known as bilirubin lights — for a period of time. The lights help
your baby's system break down excess bilirubin, which builds up because the liver can't
process it all. While under the bilirubin lights, your baby will wear a protective eye
mask to rest more comfortably
 Having a feeding tube. At first your baby may receive fluids and nutrients through an
intravenous (IV) tube. Breast milk may be given later through a tube passed through
your baby's nose and into his or her stomach (nasogastric, or NG, tube). When your
baby is strong enough to suck, breast-feeding or bottle-feeding is often possible. Or
your baby having OGT
 Suctioning (endotracheal/oral), a stuffy nose can make it difficult for your child to
breathe. This can make your child fussy, especially when he/she tries to eat or sleep.
Suctioning is necessary when an illness causes the body to make too much mucus.
 Perform phoototherapy as ordered. Phototherapy is treatment with a special type of light
(not sunlight). It's sometimes used to treat newborn jaundice by making it easier for
your baby's liver to break down and remove the bilirubin from your baby's blood.
Phototherapy aims to expose your baby's skin to as much light as possible.
PHARMACOLOGIC:
 amikacin - amikacin injection is used to treat serious bacterial infections in many
different parts of the body. This medicine is for short-term use only (7 to 10 days).
Amikacin belongs to the class of medicines known as aminoglycoside antibiotics. It
works by killing bacteria or preventing their growth (early antibiotic treatment is
common among premature infants given their significant risk of early-onset sepsis (EOS)
and its related consequences).
 ampicillin - ampicillin is used to treat certain infections that are caused by bacteria such
as meningitis (infection of the membranes that surround the brain and spinal cord); and
infections of the throat, sinuses, lungs, reproductive organs, urinary tract, and
gastrointestinal tract. (ampicillin is a β-lactam antibiotic and is the most widely used
systemic drug in the NICU. It is commonly used as empiric therapy for early onset
sepsis and provides coverage against pathogens including Group B Streptococcus,
Listeria monocytogenes and Escherichia coli.)
 salbutamol - Albuterol (also known as salbutamol) is used to treat wheezing and
shortness of breath caused by breathing problems such as asthma. It is a quick-relief
medication. Albuterol belongs to a class of drugs known as bronchodilators.
 budesonide - budesonide is used to help prevent the symptoms of asthma. When used
regularly every day, inhaled budesonide decreases the number and severity of asthma
attacks. However, it will not relieve an asthma attack that has already started.
Budesonide is a corticosteroid or steroid (cortisone-like medicine). (budesonide can
improve pulmonary ventilation and diffuse function in the treatment of neonatal
aspiration pneumonia. 15 For premature infants,16,17 budesonide Nebulization can
relieve mechanical ventilation induced airway inflammation and prevent the incidence
of bronchopulmonary dysplasia.)
 ceftazidime - ceftazidime injection is used to treat bacterial infections in many different
parts of the body. It belongs to the class of medicines known as cephalosporin
antibiotics. It works by killing bacteria or preventing their growth. However, this
medicine will not work for colds, flu, or other virus infections (ceftazidime is useful in
the treatment of neonatal meningitis and sepsis caused by susceptible gram-negative
organisms such as Escherichia coli, Haemophilus influenzae, Neisseria, Klebsiella
pneumoniae, Moraxella catarrhalis, Proteus mirabilis, Proteus vulgaris and Providencia
stuartii)
 dibencozide - dibencozide is a form of vitamin B12. People use it as medicine. When
taken by mouth or placed under the tongue, dibencozide is used to help the body process
protein; increase muscle mass and strength; improve mental concentration; and to treat
depression, anxiety, and panic attacks (dibencozide (Heraclene) is effective as an
appetite enhancer and is recommended for children with poor weight gain, premature,
retarded growth, poor appetite)
J. NURSING MANAGEMENT AND DIAGNOSIS

 Breathing and heart rate monitor. Your baby's breathing and heart rate are monitored on a
continuous basis. Blood pressure readings are done frequently, too.
 Perform the following assessments.
 Assess heart sounds for presence of murmurs
 Assess pulse and perfusion
 Monitor blood pressure, heart rate, and pulse pressures
 Fluid input and output. The NICU team carefully tracks how much fluid your baby takes
in through feedings and intravenous fluids and how much fluid your baby loses through wet
or soiled diapers.
 Provide adequate fluids and electrolytes and nutrition as ordered
 Maintain a neutral thermal environment
 Prevent infection (performing hand hygiene or sterile technique)
 Pulse Oximetry Testing: Pulse oximetry, or pulse ox, is a non-invasive test that measures
how much oxygen is in the blood. Infants with heart problems may have low blood oxygen
levels, and therefore, the pulse ox test can help identify babies that may have Critical
Congenital Heart Disease (CCHD). The test is done using a machine called a pulse oximeter,
using a painless sensor placed on the baby’s skin. The pulse ox test only takes a couple of
minutes and is performed after the baby is 24 hours old and before he or she leaves the
newborn nursery.
 Monitoring of your baby's vital signs. Sensors may be taped to your baby's body
to monitor blood pressure, heart rate, breathing and temperature. A ventilator may be
used to help your baby breathe.
 Replenishing fluids. Your baby needs a certain amount of fluids each day,
depending upon his or her age and medical conditions. The NICU team will closely
monitor fluids, sodium and potassium levels to make sure that your baby's fluid levels
stay on target. If fluids are needed, they'll be delivered through an IV line.
 Encourage “kangaroo” mother care with direct skin-to-skin contact with
precaution. Promote parent-newborn attachment
INTRODUCTION
A. OVERVIEW
Low birth weight infants are about 20 times more likely to die than heavier infants. Low birth
weight is more common in developing than developed countries. However, data on low birth
weight in developing countries is often limited because a significant portion of deliveries occur in
homes or small health facilities, where cases of infants with low birth weight often go unreported.
These cases are not reflected in official figures and may lead to a significant underestimation of
the prevalence of low birth weight. Infants can be classified by birthweight; some of the
classifications used are noted in the following.
A. Micropreemie. <800 g or 1.8 lb.
B. Extremely low birthweight (ELBW). <1000 g or 2.2 lb.
C. Very low birthweight (VLBW). <1500 g or 3.3 lb.
D. Low birthweight (LBW). <2500 g or 5.5 lb.
E. Normal birthweight (NBW). 2500 g (5.5 lb) to 4000 g (8.8 lb).
F. High birthweight (HBW). 4000 g (8.8 lb) to 4500 g (9.9 lb).
G. Very high birthweight (VHBW). >4500 g (9.9 lb).
About 140 million births take place every year. Globally, WHO estimates that about 30
million low birth weight babies are born annually (23.4% of all births), and they often face short
and long-term health consequence. Half of all low birth weight babies are born in South-central
Asia, where 27 percent are below 2500g at birth, while LBW levels in sub-Saharan Africa are
estimated at 15 percent.
LBW is determined by two major processes, which are the duration of gestation and
intrauterine growth rate. Several studies indicated that a baby‘s low weight at birth is either the
result of preterm birth (before 37 weeks of gestation) or restricted fetal (intrauterine) growth.
There is a strong consensus that birth weight plays an important role in infant mortality,
morbidity, development, and future health of the child. Particularly, low birth weight is the most
significant risk factor for adverse health outcomes, including common childhood diseases.
B. DEFINITION
According to Lynna Y. Littleton and Joan C. Engebretson’s Maternity Nursing Care, the
term LOW BIRTH WEIGHT (LBW) can be defined as a birth weight less than 2500 g.
According to World Health Organization (WHO), LOW BIRTH WEIGHT has been
defined as weight at birth <2500 grams (5.5 pounds).
According to JoAnne Silbert-Flagg’s Maternal and Child Health Nursing Care of
Childbearing and Childrearing Family, LOW BIRTH WEIGHT infant is one weighing less than
2500 g at brith.
C. INCIDENCE RATE
Global
The prevalence of low birthweight varied widely across regions – from 7.2 per cent in More Developed
Regions to 17.3 per cent in Asia. There were also variations across sub-regions. In Southern Asia, the
prevalence of low birthweight was 26.4 per cent in 2015 – more than five times higher than the 5.1 per cent
prevalence in Eastern Asia. In fact, these two sub-regions of Asia had respectively the highest and lowest
low birthweight prevalence of all sub-regions in the world.
National

In Philippines, the
main causes of
neonatal deaths in
2015 were
prematurity & low
birth weight (33%),
birth asphyxia and
trauma (23%) and
congenital
anomalies (17%).
Others:
- Pertussis
- Tetanus
- Other NCDs
- HIV/AIDS
Local
Area
Infant Deaths
Total Deaths
Fetal Deaths
Livebirths
Maternal
Deaths
Batanes 256 139 4 4 1
Cagayan 16,013 6,669 169 9 3
Isabela 19,172 6,862 167 18 16
Nueva Vizcaya 8,982 2,487 93 37 3
Quirino 3,439 936 45 9 2

Tuguegarao 2,798 1,306 47 16 2
Ilagan City 2,422 785 19 15 1
Leading Causes:
 Pneumonia
 Birth Asphyxia
D. ETIOLOGY/CAUSE
The primary cause of low birthweight is premature birth (being born before 37 weeks
gestation). Being born early means a baby has less time in the mother's uterus to grow and gain
weight. Much of a baby's weight is gained during the latter part of pregnancy.
Another cause of low birthweight is intrauterine growth restriction (IUGR- circulation
ang problem caused by smoking (nicotine content), caffeine intake. This occurs when a baby does
not grow well during pregnancy because of problems with the placenta, the mother's health, or the
baby's condition. A baby can have IUGR and be born at full term (37 to 41 weeks). Babies with
IUGR born at term may be physically mature but may be weak. Premature babies that have IUGR
are both very small and physically immature.
E. RISK FACTORS (MODIFIABLE & NON MODIFIABLE)

MODIFIABLE
 Mother's health. Babies of mothers who are exposed to illicit drugs, alcohol, and cigarettes
are more likely to have low birthweight. Mothers of lower socioeconomic status are also
more likely to have poorer pregnancy nutrition, inadequate prenatal care, and pregnancy
complications--all factors that can contribute to low birthweight.
NON-MODIFIABLE
 Race. African-American babies are two times more likely to have low birthweight than white
babies.
 Age of the birthing parent (highest incidence is in birthing parents younger than age 20 years)
 Multiple birth. Multiple birth babies are at increased risk for low birthweight because they
often are premature. Over half of twins and other multiples have low birthweight.

 Low oxygen levels at birth
 Inability to maintain body temperature
 Difficulty feeding and gaining weight
 Head are large
 Weight less than 2500g
G. COMPLICATIONS
 Low oxygen levels at birth
 Trouble staying warm
 Trouble feeding and gaining weight
 Infection
 Breathing problems because of immature lungs (respiratory distress syndrome)
 Nervous system problems, such as bleeding inside the brain or damage to the brain’s white
matter
 Serious digestive problems, such as necrotizing enterocolitis
 Sudden infant death syndrome (SIDS)
Almost all very-low-birth-weight babies need special care in the NICU until they can gain weight
and are well enough to go home. Risks for long-term problems and disability are increased for
babies with VLBW. Long-term complications may include:
 Cerebral palsy
 Blindness
 Deafness
CLINICAL CHEMISTRY
Purpose
Procedure
Pre Test
Post Test
BABYGRAM
 A radiograph that includes the whole body or just the chest and abdomen
(thoracoabdominal babygram) on a single image.
Purpose
 Babygram is done to our patient to monitor and check the chest and abdomenfor
problems.
Procedure
X-rays.
Pre test
Intra test
Post test
CHEST X-RAY
 An x-ray exam is a noninvasive medical test that helps doctors diagnose and treat medical
conditions. X-ray exams use a small dose of ionizing radiation to produce pictures of the
inside of the body.
Purpose
 A chest X-ray can help doctors find any cause of a respiratory distress to our patient as
well as to check the placement of ET (endotracheal) tube.
Procedure
X-rays.
Pre test
Intra test
Post test
CRANIAL ULTRASOUND
 Ultrasound imaging of the head uses sound waves to produce pictures of the brain and
cerebrospinal fluid. It usually performed on infants whose skulls have not completely
formed.
Purpose
 Head ultrasound is a routine exam for infants who were born prematurely. The procedure
was used to our patient to screen for brain conditions associated with prematurity, such as
bleeding or brain tissue damage.
Procedure
 A head ultrasound is performed in the neonatal intensive care unit (NICU) at the infant's
bedside. The infant is positioned lying face-up.
 A clear, water-based gel is applied to the transducer to help the transducer make secure
contact with the body and eliminate air pockets that can block the sound waves from
passing into the body.
 The sonographer or radiologist then gently presses the transducer against the fontanelle
(soft spot of the infant's head, which has no bone to block the passage of the sound
waves).
Pre test
 Inform the SO that he/she needs to assist the patient upon the test.
 To ensure that the patient is comfortable during the scan, give pacifier as sucking to
provide comfort.
Intra test
 Help the patient with positioning for better visualization of the test.
Post test
 No special care after the procedure.
HEMATOLOGY
Purpose
Procedure
the vial.
Pre test
Intra test
Post test
Hematology
1-2 months 3.10-5.30
2-3 months 2.70-4.50
3-6 months 3.10-5.10
1-2 months 33-55
2-3 months 28-41
3-6 months 29-41
1-2 months 10.7-17.1
2-3 months 9.0-14.1
3-6 months 9.5-14.1
1-3 months 27-36
3-6 months 25-35
1-3 months 91-112
3-6 months 74-108
1-3 months 5000-19500
3 months-1 year 6000-17500
1-2 years 6000-17000
2-4 years 5500-15500
3-6 months 1000-8500
5-18 years 1700-7500
1-3 months 2500-16500
3-6 months 4000-13500
6 months-1 year 4000-10500
1-2 years 3000-9500
2-5 years 2000-8000
5-18 years 1250-7000
18+ years 875-3300
1-3 months 350-1365
3-12 months 300-875
1-2 years 300-850
2-5 years 275-775
5-18 years 28-825
18+ years 130-860
1-3 months 150-585
1-2 years 180-510
2-5 years 165-465
5-18 years 40-650
18+ years 40-390
5-18 years 7-140
18+ years 10-136
2. RBS MONITORING SHEET

 Blood glucose monitoring observes for patterns in the fluctuation of blood glucose levels that
occur in response to diet.
Purpose
 Random blood glucose readings can help you identify hyperglycemia and hypoglycemia.
Procedure
 baby's blood glucose is tested by a heel-prick blood test. A very small amount of blood is
needed and it can be done while you are holding your baby in skin-to-skin contact. The first
blood test should be done before the second feed (2- 4 hours after birth), and repeated until
the blood glucose levels are stable.
Pre Test
 Assess for signs and symptoms of hypoglycemia

Description:
including:
blood
Purpose:
Procedure:
 clean the skin
hand)
a quick pinprick.
Pre Test
punctured
Intra test
Post test
ECHOCARGIOGRAM
Description:
An echocardiogram, or "echo", is a scan used to look at the heart and nearby blood vessels. It's a
type of ultrasound scan, which means a small probe is used to send out high-frequency sound
waves that create echoes when they bounce off different parts of the body. These echoes are
picked up by the probe and turned into a moving image on a monitor while the scan is carried out.
An echocardiogram may be requested by a heart specialist (cardiologist) or any doctor who thinks
you might have a problem with your heart, including your GP. The test will usually be carried out
at a hospital or clinic by a cardiologist, cardiac physiologist, or a trained technician called a
sonographer. Although it has a similar name, an echocardiogram is not the same as an
electrocardiogram (ECG), which is a test used to check your heart's rhythm and electrical activity.
Purpose:
An echocardiogram can help diagnose and monitor certain heart conditions by checking the
structure of the heart and surrounding blood vessels, analyzing how blood flows through them,
and assessing the pumping chambers of the heart.
An echocardiogram can help detect:
 damage from a heart attack – where the supply of blood to the heart was suddenly
blocked
 heart failure – where the heart fails to pump enough blood around the body at the right
pressure
 congenital heart disease – birth defects that affect the normal workings of the heart
 problems with the heart valves – problems affecting the valves that control the flow of
blood within the heart
 cardiomyopathy – where the heart walls become thickened or enlarged
 endocarditis – an infection in the lining of the heart which damages the heart valves
Procedure:
An echocardiogram is done in a darkened room, with your child lying down. Small metal
stickers (electrodes) are placed on the chest. These measure the rhythm of the heart beating. Gel
put on the chest helps sounds waves travel from the echocardiogram wand (the transducer) to the
heart and back again. The person doing the test will move the wand around to get pictures of the
heart from different angles.
Pre Test
 Explain the procedure to the patient.
 No special preparation is needed.
 Ensure to empty the bladder.
 Explain the need to darkened the examination field.
 Explain that a vasodilator (amyl nitrate) may be given.
Intra test
 Inform that a conductive gel is applied to the chest area
 Position the patient on his left side.
Post test
 Remove the conductive gel from the patient’s skin.
 Inform the patient that the study will be interpreted by the physician.
ULTRASOUND SCAN
Description:
An ultrasound scan, sometimes called a sonogram, is a procedure that uses high-frequency sound
waves to create an image of part of the inside of the body. An ultrasound scan can be used to
monitor an unborn baby, diagnose a condition, or guide a surgeon during certain procedures.
Purpose:
An ultrasound scan uses high-frequency sound waves to make an image of a person's internal
body structures. Doctors commonly use ultrasound to study a developing fetus (unborn baby), a
person's abdominal and pelvic organs, muscles and tendons, or their heart and blood vessels.
Procedure:
Gel is applied to your skin over the area being examined. It helps prevent air pockets, which can
block the sound waves that create the images. This safe, water-based gel is easy to remove from
skin and, if needed, clothing.
A trained technician (sonographer) presses a small, hand-held device (transducer) against the area
being studied and moves it as needed to capture the images. The transducer sends sound waves
into your body, collects the ones that bounce back and sends them to a computer, which creates
the images. Sometimes, ultrasounds are done inside your body. In this case, the transducer is
attached to a probe that's inserted into a natural opening in your body.
Pre Test
 Explanation of the procedure to the patient
Intra test
 The nurse must help the endoscopist and, when indicated, the anesthesist.
Post test
 After the completion of the procedure, the nurse must carry-on with the reprocessing of
the endoscopic instrument and of the devices.
 Synthetic surfactant (endotracheal in a liquid form in a vial) , a medication used to treat

respiratory distress syndrome. Surfactant are wetting agents which coat the surface of
the air sacs (alveoli) and reduce surface tension in the lungs. This helps to inflate and
expand the air sacs during breathing and prevents their collapse.
 Being placed in an incubator. Your baby will probably stay in an enclosed plastic
bassinet (incubator) that's kept warm to help your baby maintain normal body
temperature.
 Spending time under bilirubin lights. To treat infant jaundice, your baby may be placed
under a set of lights — known as bilirubin lights — for a period of time. The lights help
your baby's system break down excess bilirubin, which builds up because the liver can't
process it all. While under the bilirubin lights, your baby will wear a protective eye
mask to rest more comfortably
 Having a feeding tube. At first your baby may receive fluids and nutrients through an
intravenous (IV) tube. Breast milk may be given later through a tube passed through
your baby's nose and into his or her stomach (nasogastric, or NG, tube). When your
baby is strong enough to suck, breast-feeding or bottle-feeding is often possible. Or
your baby having OGT
 Suctioning (endotracheal/oral), a stuffy nose can make it difficult for your child to
breathe. This can make your child fussy, especially when he/she tries to eat or sleep.
Suctioning is necessary when an illness causes the body to make too much mucus.
 Perform phoototherapy as ordered. Phototherapy is treatment with a special type of light
(not sunlight). It's sometimes used to treat newborn jaundice by making it easier for
your baby's liver to break down and remove the bilirubin from your baby's blood.
Phototherapy aims to expose your baby's skin to as much light as possible.
PHARMACOLOGIC:
 amikacin - amikacin injection is used to treat serious bacterial infections in many
different parts of the body. This medicine is for short-term use only (7 to 10 days).
Amikacin belongs to the class of medicines known as aminoglycoside antibiotics. It
works by killing bacteria or preventing their growth (early antibiotic treatment is
common among premature infants given their significant risk of early-onset sepsis (EOS)
and its related consequences).
 ampicillin - ampicillin is used to treat certain infections that are caused by bacteria such
as meningitis (infection of the membranes that surround the brain and spinal cord); and
infections of the throat, sinuses, lungs, reproductive organs, urinary tract, and
gastrointestinal tract. (ampicillin is a β-lactam antibiotic and is the most widely used
systemic drug in the NICU. It is commonly used as empiric therapy for early onset
sepsis and provides coverage against pathogens including Group B Streptococcus,
Listeria monocytogenes and Escherichia coli.)
 salbutamol - Albuterol (also known as salbutamol) is used to treat wheezing and
shortness of breath caused by breathing problems such as asthma. It is a quick-relief
medication. Albuterol belongs to a class of drugs known as bronchodilators.
 budesonide - budesonide is used to help prevent the symptoms of asthma. When used
regularly every day, inhaled budesonide decreases the number and severity of asthma
attacks. However, it will not relieve an asthma attack that has already started.
Budesonide is a corticosteroid or steroid (cortisone-like medicine). (budesonide can
improve pulmonary ventilation and diffuse function in the treatment of neonatal
aspiration pneumonia. 15 For premature infants,16,17 budesonide Nebulization can
relieve mechanical ventilation induced airway inflammation and prevent the incidence
of bronchopulmonary dysplasia.)
 ceftazidime - ceftazidime injection is used to treat bacterial infections in many different
parts of the body. It belongs to the class of medicines known as cephalosporin
antibiotics. It works by killing bacteria or preventing their growth. However, this
medicine will not work for colds, flu, or other virus infections (ceftazidime is useful in
the treatment of neonatal meningitis and sepsis caused by susceptible gram-negative
organisms such as Escherichia coli, Haemophilus influenzae, Neisseria, Klebsiella
pneumoniae, Moraxella catarrhalis, Proteus mirabilis, Proteus vulgaris and Providencia
stuartii)
 dibencozide - dibencozide is a form of vitamin B12. People use it as medicine. When
taken by mouth or placed under the tongue, dibencozide is used to help the body process
protein; increase muscle mass and strength; improve mental concentration; and to treat
depression, anxiety, and panic attacks (dibencozide (Heraclene) is effective as an
appetite enhancer and is recommended for children with poor weight gain, premature,
retarded growth, poor appetite)
J. NURSING MANAGEMENT AND DIAGNOSIS

 Breathing and heart rate monitor. Your baby's breathing and heart rate are monitored on a
continuous basis. Blood pressure readings are done frequently, too.
 Perform the following assessments.
 Assess heart sounds for presence of murmurs
 Assess pulse and perfusion
 Monitor blood pressure, heart rate, and pulse pressures
 Fluid input and output. The NICU team carefully tracks how much fluid your baby takes
in through feedings and intravenous fluids and how much fluid your baby loses through wet
or soiled diapers.
 Provide adequate fluids and electrolytes and nutrition as ordered
 Maintain a neutral thermal environment
 Prevent infection (performing hand hygiene or sterile technique)
 Pulse Oximetry Testing: Pulse oximetry, or pulse ox, is a non-invasive test that measures
how much oxygen is in the blood. Infants with heart problems may have low blood oxygen
levels, and therefore, the pulse ox test can help identify babies that may have Critical
Congenital Heart Disease (CCHD). The test is done using a machine called a pulse oximeter,
using a painless sensor placed on the baby’s skin. The pulse ox test only takes a couple of
minutes and is performed after the baby is 24 hours old and before he or she leaves the
newborn nursery.
 Monitoring of your baby's vital signs. Sensors may be taped to your baby's body
to monitor blood pressure, heart rate, breathing and temperature. A ventilator may be
used to help your baby breathe.
 Replenishing fluids. Your baby needs a certain amount of fluids each day,
depending upon his or her age and medical conditions. The NICU team will closely
monitor fluids, sodium and potassium levels to make sure that your baby's fluid levels
stay on target. If fluids are needed, they'll be delivered through an IV line.
 Encourage “kangaroo” mother care with direct skin-to-skin contact with
precaution. Promote parent-newborn attachment
INTRODUCTION
A. OVERVIEW
According to the World Health Organization, sepsis is a life-threatening condition that
arises when the body’s response to infection causes injury to its own tissues and organs. It is
frequently a final common pathway to death for many infectious diseases worldwide. It involves
organ dysfunction caused by a dysregulated host response to infection and if not recognized early
and managed promptly, it can lead to septic shock, multiple organ failure and death. Although a
precise estimate of the global epidemiological burden of sepsis is difficult to ascertain, a recent
scientific publication reported that sepsis affects an estimated 49 million people and causes 11
million deaths globally every year.
If sepsis develops during pregnancy, while or after giving birth, or after an abortion, it is
called maternal sepsis. Sepsis in newborn babies is called neonatal sepsis wherein it is classified
into two, Early-Onset Sepsis (EOS), and Late-Onset Sepsis (LOS). Despite being highly
preventable, maternal and neonatal sepsis continues to be a major cause of death for pregnant
women and newborn babies.
The incidence of neonatal sepsis varies from 1 to 4 in 1000 live births in developed
countries and 10 to 50 in 1000 live births in developing countries. The mortality rate of neonatal
sepsis remains high, especially in developing countries.
Epidemiology Research shows that an average of 2.6 million newborns dies every year
and three-quarters of these deaths occur in the first week of life. In a study conducted between
2000-2013, data of one hundred and ninety-four countries were evaluated in which the causes of
death were investigated in the neonatal period, and the mortality rate due to sepsis was found to
be 15%. In this study, it was determined that 2.8 million babies died in the neonatal period and
430.000 of these babies died due to sepsis and severe infections. Neonatal sepsis ranks third
among the causes of neonatal death following prematurity and intrapartum-related complications.
In the late neonatal period (7-27 days), the most common cause of death was sepsis, with a rate of
37.2%. Neonatal death and sepsis frequency differ between populations. In their reports that
Lawn et al. presented epidemiological data, 99% of newborn deaths occurred in low- and middle-
income countries and 1% in high-income countries.
B. DEFINITION
According to Neonatal Care Clinical Guidelines, NEONATAL SEPSIS is a clinical
syndrome of systemic illness accompanied by bacteraemia occurring in the first 28 days of life.
Bacterial or fungal invasion of blood before or after birth may spread to involve other
organs/systems leading to meningitis, pneumonia, osteomyelitis and pyelonephritis
According to Gomell’s Neonatology: Management, Procedures, On-Call Problems,
Disease, and Drugs, NEONATAL SEPSIS is a clinical syndrome of systemic illness
accompanied by bacteremia occurring in the first month of life.
According to World Health Organization, sepsis in newborn babies is called
NEONATAL SEPSIS. Despite being highly preventable, maternal and neonatal sepsis continues
to be a major cause of death for pregnant women and newborn babies. Symptoms. Sepsis is a
medical emergency and requires immediate attention to prevent further complications or death.
Neonatal sepsis can be classified into 2 relatively distinct syndromes based on the age of
presentation: early-onset and late-onset sepsis.
A. Early-onset sepsis (EOS). Presents in the first 3–5 days of life and is usually a multisystem
fulminant illness with prominent respiratory symptoms. Typically, the infant has acquired the
organism during the antepartum or intrapartum period from the maternal genital tract.
B. Late-onset sepsis (LOS). May occur as early as 5 days of age. LOS is usually more insidious
but it can be fulminant at times. It is usually not associated with early obstetric complications.
C. INCIDENCE RATE
Global
According to World Health Organization, globally 2.4 million children died in the first month of life in
2020. There are approximately 6700 newborn deaths every day, amounting to 47% of all child deaths under
the age of 5 years, up from 40% in 1990. The world has made substantial progress in child survival since
1990. Globally, the number of neonatal deaths declined from 5 million in 1990 to 2.4 million in 2020.
The chances of survival from birth varies widely depending on where a child is born. Sub-Saharan Africa
had the highest neonatal mortality rate in 2020 at 27 deaths per 1000 live births, followed by central and
southern Asia with 23 deaths per 1000 live births.
A child born in sub-Saharan Africa is 10 times more likely to die in the first month than a child born in a
high-income country. Country-level neonatal mortality rates in 2020 ranged from 1 death per 1000 live
births. Most neonatal deaths (75%) occur during the first week of life, and in 2019, about 1 million
newborns died within the first 24 hours. Preterm birth, childbirth-related complications (birth asphyxia or
lack of breathing at birth), infections and birth defects caused most neonatal deaths in 2019. From the end
of the neonatal period and through the first 5 years of life, the main causes of death are pneumonia,
diarrhoea, birth defects and malaria. Malnutrition is the underlying contributing factor, making children
even more vulnerable to severe diseases.
National
In Philippines, the
main causes of
neonatal deaths in
2015 were
prematurity & low
birth weight (33%),
birth asphyxia and
trauma (23%) and
congenital
anomalies (17%).
Others:
- Pertussis
- Tetanus
- Other NCDs
- HIV/AIDS
Local
Area
Infant Deaths
Total Deaths
Fetal Deaths
Livebirths
Maternal
Deaths
Batanes 256 139 4 4 1
Cagayan 16,013 6,669 169 9 3
Isabela 19,172 6,862 167 18 16
Nueva Vizcaya 8,982 2,487 93 37 3
Quirino 3,439 936 45 9 2

Tuguegarao 2,798 1,306 47 16 2
Ilagan City 2,422 785 19 15 1
Leading Causes:
 Pneumonia
 Birth Asphyxia
D. ETIOLOGY/CAUSE
Escherichia coli (E. coli)
Is a gram-negative bacillus known to be a part of normal intestinal flora but can also be the cause
of intestinal and extra intestinal illness in humans. In most newborn infections, E coli or other
gram-negative bacteria have usually been passed from the mother's genital tract to the newborn
during childbirth. They can also sometimes be spread through personto-person contact with
caregivers or other children. Technically, you develop an E. coli infection by ingesting (taking in
by mouth) certain strains of E. coli bacteria. The bacteria travel down your digestive tract,
releases a destructive toxin, called the Shiga toxin, which damages the lining of your small
intestine.
Staphylococcus aureus
Is a gram-positive bacterium that cause a wide variety of clinical diseases. If staph bacteria invade
your bloodstream, you may develop a type of infection that affects your entire body. Called sepsis,
this infection can lead to septic shock. This is a life threatening episode when your blood pressure
drops to an extremely low level. The baby could also become infected from contact with clothing,
bedding or other materials that have the bacteria on them. Additionally, there are some reports of
infants getting a Staph infection through expressed (pumped) breast milk that was contaminated
from pumping equipment or storage containers.
Klebsiella
Gram-negative bacteria that can cause different types of health care-associated infections,
including pneumonia, bloodstream infections, wound or surgical site infections, and meningitis.
Klebsiella bacteria are mostly spread through person-to-person contact. Less commonly, they are
spread by contamination in the environment. As with other health careassociated infections, the
bacteria can be spread in a health care setting via the contaminated hands of health care workers
Pseudomonas aeruginosa
Is a gram-negative exposure to umbilical venous catheters was associated with
bloodstream infections. Increasing age and use of artificial fingernails were risk factors
for colonization of hands of HCWs. Low birth weight preterm infants were at greater risk
of mortality from P. aeruginosa infection than older infants.
Group B Streptococcus (GBS)

Gram-positive bacteria that are common asymptomatic colonizers of healthy adults. Even if you
have tested negative for GBS, once born, babies can become infected by sources other than the
mother. It can be spread through skin-to-skin contact, so make sure everyone who comes in
contact with your baby washes their hands thoroughly
Enterobacteriaceae
Enterobacteriaceae are a large family of Gram-negative bacteria. Enterobacteriaceae strains
commonly arise from the endogenous intestinal flora of hospitalized patients but can occur in
common source outbreaks or are spread from patient to patient. Infections are especially common
in patients who have received antimicrobial therapy and in those in intensive care units.
E. RISK FACTOR (MODIFIABLE & NONN MODIFIABLE

Features of early onset sepsis include:
Modifiable:
- Maternal pyrexia (> 38 c) or overt infection such as a UTI, gastroenteritis/diarrheal
illness
Non-Modifiable:
- Preterm delivery
- Placenta Previa
- Prolonged Hospitalization
- History of GBS infection in previous infant
Features of late onset sepsis include:
Modifiable:
- Cross-infection by staff and parents.
Non-Modifiable:
- Neonatal Age
- Placenta Previa
- Malformations such as urinary tract anomalies (for example, vesico-ureteric reflux)
or neural tube defect
- Presence of foreign bodies such as intravenous catheters, endotracheal tubes
- Prolonged hospitalization such as a preterm infant in a NICU
 Temperature irregularity. Hypothermia is more common than fever as a presenting sign for
bacterial sepsis in premature infants. Hyperthermia is more common in fullterm infants
beyond the first 24 hours of life and if viral agents (eg, herpes) are involved.
 Skin. Jaundice is the yellow color seen in the skin of many newborns. Jaundice happens
when a chemical called bilirubin builds up in the baby's blood.
 Nausea and Vomiting- is an uneasiness of the stomach that often accompanies the urge to
vomit, but doesn't always lead to vomiting. Vomiting is the forcible voluntary or involuntary
emptying ("throwing up") of stomach contents through the mouth
 Cardiopulmonary. Tachypnea, respiratory distress (grunting, flaring, and retractions), apnea

within the first 24 hours of birth or of new onset (especially after 1 week of age), tachycardia,
and hypotension singularly or in combinations should suggest sepsis. Hypotension tends to
be a late sign.
 Tachycardia, bradycardia, Tachypnea, lethargy, hypotonic, irritability- (always look at trends

in the observation chart over last 24 hours).
 Diarrhea is characterized by abnormally loose or watery stools. Most cases of diarrhea are
due to bacteria, viruses, or parasites. Digestive system disorders can also cause chronic
diarrhea
 Bulging fontanelle. A tense or bulging fontanelle occurs when fluid builds up in the brain
or the brain swells, causing increased pressure inside the skull. When the infant is crying,
lying down, or vomiting, the fontanelle may look like they are bulging.
G. COMPLICATIONS
• Dehydration. Dehydration is caused by not drinking enough fluid or by losing more fluid than
you take in.
• Septic shock. Septic shock is a life-threatening condition that happens when your blood pressure
drops to a dangerously low level after an infection. Any type of bacteria can cause the infection.
Fungi such as candida and viruses can also be a cause, although this is rare. At first the infection
can lead to a reaction called sepsis.
• Acute respiratory distress - acute respiratory distress syndrome (ARDS) is a serious lung
condition that causes low blood oxygen.
• Failure to thrive. Children are diagnosed with failure to thrive when their weight or rate of
weight gain is significantly below that of other children of similar age and sex. Infants or children
that fail to thrive seem to be dramatically smaller or shorter than other children the same age.
• Acute respiratory distress - acute respiratory distress syndrome (ARDS) is a serious lung
condition that causes low blood oxygen.
• Meningitis. Meningitis is an inflammation (swelling) of the protective membranes covering the

brain and spinal cord.
• Multi-organ failure is a devastating condition most often associated with severe sepsis, but
which can occur with other conditions such as trauma, pancreatitis, and burns. It is the
inflammation from a severe infection or injury causes dysfunction in two or more organ systems.

Description:
including:
blood
Purpose:
Procedure:
 clean the skin
hand)
a quick pinprick.
Pre Test
punctured
Intra test
Post test
HEMATOLOGY
Purpose
Procedure
the vial.
Pre test
Intra test
Post test
Hematology
1-2 months 3.10-5.30
2-3 months 2.70-4.50
3-6 months 3.10-5.10
1-2 months 33-55
2-3 months 28-41
3-6 months 29-41
1-2 months 10.7-17.1
2-3 months 9.0-14.1
3-6 months 9.5-14.1
1-3 months 27-36
3-6 months 25-35
1-3 months 91-112
3-6 months 74-108
1-3 months 5000-19500
3 months-1 year 6000-17500
1-2 years 6000-17000
2-4 years 5500-15500
3-6 months 1000-8500
5-18 years 1700-7500
1-3 months 2500-16500
3-6 months 4000-13500
6 months-1 year 4000-10500
1-2 years 3000-9500
2-5 years 2000-8000
5-18 years 1250-7000
18+ years 875-3300
1-3 months 350-1365
3-12 months 300-875
1-2 years 300-850
2-5 years 275-775
5-18 years 28-825
18+ years 130-860
1-3 months 150-585
1-2 years 180-510
2-5 years 165-465
5-18 years 40-650
18+ years 40-390
5-18 years 7-140
18+ years 10-136
CLINICAL CHEMISTRY
Purpose
Procedure
Pre Test
Post Test
URINE CULTURE
Description:
A laboratory test to check for bacteria, yeast, or other microorganisms in the urine. Urine cultures can help
identify the type of microorganism that is causing an infection.
Types:
A. Uric Acid Urine Test - measures the level of uric acid in urine.
B. Diabetes Urine Test - to help determine if blood glucose levels are too high, which may be a
sign of diabetes.
C. Microalbumin Urine Test - a test to detect very small levels of a blood protein (albumin) in the
urine.
Purpose:
A urine culture is a lab test to check for bacteria or other germs in a urine sample. It can be used to check
for a urinary tract infection in adults and children.
Procedure:
1. Perform hand hygiene
2. Thoroughly wash the area around the urethra or penis of infant using soap, or cleansing wipes.
3. A wee bag to collect the urine. It will be a plastic bag with a sticky strip on one end, made to fit over
baby's genital area. Open the bag and place it on the infant.
4. For males, place the entire penis in the wee bag and attach the adhesive to the skin.
5. For females, place the bag over the two folds of skin on either side of the vagina (labia).
6. Put a diaper on the baby over the bag.
7. Check the infant often, and change the bag after the infant has urinated. (An active infant can cause
the bag to move, so it may take more than one tries to collect the sample.)
8. Empty the urine from the bag into the container provided by your provider. Do not touch the inside of
the cup or lid.
9. When finished, label the screw-top container with infant’s name, date of birth and the date preformed.
10. Thoroughly wash the area around the urethra. Clean from the front to the back on a female infant, and
from the tip of the penis down on a male infant.
11. Perform hand hygiene.
12. Over the next few days, any bacteria or yeast in the sample will multiply and grow. A lab worker will
look at the germs under the microscope. Their size, shape, and color tell which types are there.
Nursing responsibilities:
 Appropriate and proper collection
 Precise sample identification
 Up-to-date transfer to the lab
Normal findings:
Color: Pale to dark yellow
Clarity: Clear
Odor: Slightly "nutty" odor
Specific gravity: 1.005–1.030
pH level: 4.6–8.0
Protein: None
Glucose: 1–15 milligrams per deciliter (mg/dL) or 60–830 micromoles per liter (mcmol/L) in a
24-hour sample. A one-time urine collection, if normal, will be negative for glucose.
Ketones: None
Microscopic analysis: Very few or no red or white blood cells or casts are seen. No bacteria, yeast
cells, parasites, or squamous cells are present. A few crystals are normally seen.
Volume: 800–2,500 milliliters (mL) per 24 hours.
I. INTRAVENOUS (IV) FLUIDS THERAPY
 It is essential when clients are unable to take food and fluid orally.
 It is an efficient and effective method of supplying fluids directly into the intravascular fluid
compartment and replacing electrolyte losses.
 IVF therapy is usually ordered by the physician.
CLASSIFICATIONS:
 ISOTONIC SOLUTION - having the same concentration of solutes as blood plasma.
Isotonic solutions are often used to restore vascular volume.
 HYPERTONIC SOLUTION - has a greater concentration of solutes than plasma.
 HYPOTONIC SOLUTION - has a lesser concentration of solutes.
PURPOSES:
 Used to maintain the patient's hydration.
 Serves as a route for medication.
TYPE PURPOSE NURSING
RESPONSIBILITIES
Isotonic Solutions:
- 0.9%NaCl - Extracellular fluid - Caution must be exercised
(Normal saline) replacement (e.g., dehydration, in the administration of
sepsis) parenteral fluids.
- Treatment of metabolic - Assess clients carefully for
alkalosis in the presence of fluid signs of hypervolemia such
loss as bounding, pulse and
shortness of breath.
Hypertonic Solutions:
- D5IMB - For maintenance of fluid - Caution must be exercised
and electrolytes especially in in the administration of
calories and hydration. parenteral fluids.
- D5 - For replacement or - Monitor for fluid
0.9%NaCl maintenance of fluid and imbalances.
Solution (D5NSS) electrolytes. - Check for allergies
- Assess vital signs
Nursing Management
 Verify the Doctor's order,
 Inform the client/guardian and explain the purpose of IV therapy.
 Instruct the parent that the procedure may cause a little bit pain upon insertion.
 Practice aseptic technique.
 Regulate IVF at prescribed rate.
 Check IV patency.
 Observe for potential complications.
II. PHOTOTHERAPY
Bili lights
Purpose: it is a treatment with a special type of light (not sunlight). It’s sometimes used to treat
newborn jaundice by making it easier for baby’s liver to break down and remove the bilirubin
from baby’s blood. Phototherapy aims to expose baby’s skin to as much light as possible.
Risk: The short-term side effects of phototherapy may include:
 Imbalanced of thermal environment
 water loss
 electrolyte imbalance
Nursing responsibilities:
 Provide eye protection. Eyes are covered with eye-patches to prevent damage.
 Baby is turned every 2 hours or after each feed.
 Monitor for body temperature
 Baby should be placed naked 45 cm away from the tube lights in a crib or incubator
III. OXYGENATION THERAPY

A. Nasal Cannula
Purpose: A nasal cannula is a medical device to provide supplemental oxygen therapy to people
who have lower oxygen levels.
Risk: complications can occur and include drying of mucous membranes, nasal trauma, and
epistaxis.
 Perform hand hygiene.
 Assess and chart a patient's response to therapy.
B. Nebulization
Purpose: Nebulized therapy is often called a breathing treatment. You can use nebulizers
with a variety of medications, for relief right away.
Risk: The risk can be one of decontaminating a patient with his/her own bacteria,
contaminating other individuals (other patients or staff during a nebulization session from
a patient infected by an ordinary germ), or transmission via unclean equipment,
contaminated water or medicines.
 Wash your hands properly.
 Check the breath sounds, pulse rates and respiratory status.
 Then connect the hose of the nebulizer to an air compressor.
 Then fill the medicine cup with the required medication and appropriate saline solution as
prescribed by a doctor.
 Connect the hose and mouthpiece or breathing mask to the medicine cup.
 In case of nebulization being given to infants take extra care and hold the baby and the
breathing mask firmly in place.
IV antibiotics commonly used to treat neonatal sepsis include:
 AMPICILLIN
Ampicillin is the most commonly prescribed medication in the neonatal intensive care unit
(NICU), used for treatment of bacterial infections including sepsis and meningitis.
 GENTAMICIN
To treat serious bacterial infections in many different parts of the body. It works by killing
bacteria or preventing their growth.
 CEFOTAXIME
Cefotaxime is widely considered to be the antibiotic of choice for the management of neonatal
meningitis and sepsis caused by gram-negative bacteria.
 VANCOMYCIN
It is recommended intravenously as a treatment for complicated skin infections, bloodstream
infections, endocarditis, bone and joint infections, and meningitis caused by methicillin-resistant
Staphylococcus aureus.
 ERYTHROMYCIN
Erythromycin is a broad-spectrum, macrolide antibiotic with antibacterial activity. It diffuses
through the bacterial cell membrane and reversibly binds to the 50S subunit of the bacterial
ribosome. This prevents bacterial protein synthesis.
 PIPERACILLIN
Used to treat pneumonia and skin, gynecological, and abdominal (stomach area) infections caused
by bacteria.
NON- PHARMACOLOGICAL
 Extra oxygen or other forms of respiratory support, as ordered.
 Every procedure and instruments used during and after childbirth should be always sterile
such as cleaning baby’s cord.
 Practice good hygiene before and after touching the baby
 Cleaning nipple before and after breastfeeding. Pure breastfeed is necessarily.
 Let the baby feel the morning sunlight at least 10mins
 Provide well ventilated environment
 Avoid kissing the baby
J. NURSING DIAGNOSIS
 Risk for deficient Fluid Volume related to insufficient fluid intake
 Risk for impaired Gas Exchange related to altered oxygen supply–effects of endotoxins on
the respiratory center in the medulla (resulting in hyperventilation and respiratory alkalosis);
hypoventilation.
 Risk for shock related to Invasive procedures, environmental exposure (nosocomial).
ANATOMY AND
PHYSIOLOGY
ANATOMY AND PHYSIOLOGY
FETAL GROWTH AND DEVELOPMENT
Fetal growth is dynamic and serial measurements which provides guidelines for determining the well being
of a fetus.
Stages of Fetal Development
In just 38 weeks, a fertilized egg matures from a single cell carrying all the necessary genetic material to a
fully developed fetus ready to be born. Fetal growth and development is typically subdivided into three
time periods.
1. Pre-embryonic. It is also called the germinal stage which begins at conception when the sperm and egg
cell unite in one of the two fallopian tubes.
2. Embryonic. It is the beginning of the third week after conception through the eighth week.
3. Fetal. This period of development begins during the eighth week and lasts until birth. This stage is
marked by amazing change and growth.
The Stages of Fetal Development
FERTILIZATION: THE BEGINNING OF PREGNANCY

Fertilization. Fertilization is a biological process by which a male haploid reproductive cell and a female
haploid reproductive cell interact and unite to form a diploid zygote from which an organism is developed.
Corona Radiata
Nucleus
Cytoplasm
Zona Pellucida
The Female Egg Structure
The two gametes involved:
1. Eggs. These are large, symmetrical and nonmotile cells. Its function is to connect with the male sperm
cell in order to become fertilized and produce offspring.
a. Corona Radiata. The corona radiata, which encircles an egg and is made up of two or three layers
of follicular cells, serves primarily to supply the cell's essential proteins.
b. Zona Pellucida. Contains glycoproteins that protect the inner contents of the ovum until the
acrosome reaction of fertilization; helps prevent polyspermy.
c. Cytoplasm. It is a gel-like substance that holds all the cell’s other internal structures, called
organelles. It is in the cytoplasm that all the cell’s activities take place to keep it alive and
functioning properly.
d. Nucleus. The nucleus is the heart of the egg cell and it contains most of the genetic material in
the form of chromosomes.
2. Sperm. Sperm are small asymmetrical and motile cells which has three components;
a. Tail. It is also referred to as the principal piece that contains flagellar apparatus which moves
the sperm toward the egg.
b. Midpiece. The middle piece which is at the proximal portion of the tail contains mitochondria,
structures that provide energy (ATP) necessary for the beating of the tail.
c. Head. The head of the sperm contains DNA which then later on be combined with the egg's DNA
and an organelle called acrosome which has enzymes that hydrolyze the outer layers of the ovum
Head
Midpiece
Tail
Male Sperm Structure
In overview, fertilization can be described as the following steps:
1. Sperm Capacitation. It is a series of biochemical and physiological modifications associated with

removal of adherent seminal plasma proteins, reorganization of plasma membrane, lipids and proteins.
The Process of Capacitation
2. Acrosome Reaction. It is the binding of the sperm to the zona pellucida. The acrosome reaction
provides the sperm with an enzymatic drill to get through the zona pellucida which then completes the
process of fertilization.
The Process of Acrosome Reaction
IMPLANTATION
Once fertilization is complete, a zygote migrates over the next three to four days toward the body to the
uterus, aided by the currents initiated by the muscular contractions of the fallopian tubes.
Implantation or contact between the growing structure and the uterine endometrium, occurs approximately
8 to 10 days after fertilization
The Process of Implantation
Embryonic and Fetal Structures

The placenta and the membranes, which will serve as the fetal lungs, kidneys, and digestive tract in utero as
well as help provide protection for the fetus, begin growth in early pregnancy in coordination with embryo
growth.
THE DECIDUA
The decidua is the specialized layer of endometrium that forms the base of the placental bed, which plays
essential roles in protecting the embryo from being attacked by maternal immune cells and provides
nutritional support for the developing embryo prior to placenta formation.
The decidua has three separate areas:
1. Decidua basalis. The part of the endometrium lying directly under the embryo
2. Decidua capsularis. The portion of the endometrium that stretches or encapssulates the surface of the
trophoblast.
3. Decidua vera. The remaining portion of the uterine lining.
The three separate areas of Decidua
CHORIONIC VILLI
Once implantation is achieved, as early as the 11th or 12th day, miniature villi resembling probing fingers
are termed chorionic villi, reach out from the trophoblast cells into the uterine endometrium to begin
formation of the placenta. Figure The Chorionic Villi
The Chorionic Villi
THE PLACENTA
The placenta is an organ which grows from a few identifiable trophoblastic cells at the beginning of
pregnancy that serves as the fetal lungs, kidneys, and gastrointestinal tract and as a separate endocrine
organ throughout pregnancy.
The Placenta
Circulation
The fetal circulation system is distinctly different from adult circulation. This intricate system allows the
fetus to receive oxygenated blood and nutrients from the placenta. It is comprised of the blood vessels in
the placenta and the umbilical cord, which contains two umbilical arteries and one umbilical vein.
As early as the 12th day of pregnancy, the pregnant patient’s blood begins to collect in the intervillous space
of the uterine endometrium surrounding the chorionic villi.
By the thrid week, oxygen and other nutrients osmose from the maternal blood through the cell layers of
the chorionic villi capillaries. From there, nutrients are transported to the developing embryo.
Placental Circulation
ENDOCRINE FUNCTION
Besides serving as the source of oxygen and nutrients for the fetus, the syncytial layer of the chorionic villi
develops into a separate and important hormone-producing system.
The Syncytial layer of Chorionic Villi
Human Chorionic Gonadotropin

The first placental hormone produced which can be found in maternal blood and urine as early as the first
menstrual period. The purpose of of hCG is to act as fail-safe measure to the corpus luteum of the ovary
continues tp produce progesterone and estrogen so the endometrium of the uterus is maintained.
Progesterone
Progesterone is often referred to as the ‘hormone that

maintains pregnancy’ which is necessary to maintain
the endometrial lining of the uterus during pregnancy.
This hormone also appears to reduce contractility of
the uterus during pregnancy, thus preventing premature
labor.
Estrogen
Estrogen is often referred to as ‘female hormone’ which is produced as a second product of the syncytial
cells of the placenta. Estrogen contributes to the mammary gland development in preparation for lactation
and stimulates uterine growth to accommodate the developing fetus.
Human Placental Lactogen
It is also called as the Human Chorionic Somatomamotropin, which is a hormone with both growth-
promoting and lactogenic properties. It promotes mammary gland growth in preparation for lactation. It
also serves the important role of regulating parental glucose, protein, and fat levels so adequate amounts of
these nutrients are always available to the fetus.
THE AMNIOTIC MEMBRANE
The amniotic membrane, or amnion forms beneath the chorion, a second membrane lining the chorionic
membrane which not only offers support to amniotic fluid but actually produces the fluid.
THE AMNIOTIC FLUID
Amniotic fluid is a water-like substance surrounding

the fetus in the uterus.
The most important purpose of amniotic fluid is to:
• Protect the fetus against pressure.
• Protect the fetus from changes in temperature
• Aids in muscular development
• Protects the umbilical cord from pressure,

thus protecting the feral oxygen supply.
THE UMBILICAL CORD
The umbilical cord is formed from the amnion and chorion and provides a circulatory pathway connecting
the embryo to the chorionic villi. The function of the cord is to transport oxygen and nutrients to the fetus
from the placenta and to return waste products from fetus the placenta.
The Structure of Umbilical Cord
ORIGIN AND DEVELOPMENT OR ORGAN SYSTEMS
From the beginning of fetal growth, development proceeds in a cephalocaundal direction, that is head
development occurs first and is followed by development of the middle, and finally, lower body parts.
Primary Germ Layers
At the time of implantation, the blastocyst already has differentiated to a point at which three layers of
these cells are present:
GERM LAYER BODY PORTIONS FORMED
1. The Ectoderm Central Nervous System
(outer layer) Peripheral Nervous System
Skin, Hair, Nails, and tooth enamel
Sense organs
Mucous membranes of the anus, moth and nose
Mammary glands
2. The Mesoderm Supporting structures of the body
(middle layer) (connective tissue, cartilage, muscle, ligaments, and

tendons)
Upper portion of the urinary system (kidneys and

ureters)
Reproductive system
Heart, lymph, and circulatory systems and blood

cells
3. The Endoderm Lining of pericardial, pleura, and peritoneal cavities
(inner layer) Lining of the gastrointestinal tract, respiratory tract,

tonsils, parathyroid, thyroid, thymus glands
Lower urinary system (bladder and urethra)
CARDIOVASCULAR SYSTEM
The cardiovascular system is one of the first systems to be come functional in intrauterine life. Simple
blood cells joined to the walls of the yolk sac progress to a network of blood vessels, and to a single heart
tube forming as early as the 16th day of life, beating as early as the 24th day.
RESPIRATORY SYSTEM
At the third week of intrauterine life, the respiratory and digestive tracts exist as a single tube. Like all body
tubes, initially it is a solid structure, which then canalizes. By the end of the fourth week, a septum begins
to divide the esophagus from the trachea. At the same time lung buds appear on the trachea.
Until the seventh week of life, the diaphragm does not completely divide the thoracic cavity from the
abdomen which causes lung buds to extend down into the abdomen.
Fetal Circulation
NERVOUS SYSTEM
Like the circulatory system, the nervous system begins to develop extremely early in pregnancy.
A neural plate is apparent by the third week of gestation. The top portion differentiates into the neural tube,
which will form the central nervous system, and the neural crest, which will develop into the peripheral
nervous system.
All parts of the brain form in utero, although none are completely mature at birth. Brain growth continues
at high levels until 5 or 6 years of age.
ENDOCRINE SYSTEM
The function of endocrine organs being along with the neuro-system development.
The fetal pancreas produces insulin needed by the fetus (insulin is one of the few substances that does not
cross the placenta from the pregnant person to the fetus).
The thyroid and parathyroid glands play vital roles in fetal metabolic function and calcium balance.
The fetal adrenal glands supply a precursor necessary for estrogen synthesis by the placenta.
DIGESTIVE SYSTEM
The digestive tract separates from the respiratory tract at about the fourth week of intrauterine life and, after
that, begins to grow rapidly. Initially solid, the tract canalizes to become patent. Later in the pregnancy, the
endothelial cells of the gastrointestinal tract proliferate extensively, occluding the lumen once more, and
the tract must canalize again.
Because of this rapid intestinal growth, by the sixth week of intrauterine life, the intestine becomes too
large to be contained by the abdomen. A portion of the intestine, therefore, is pushed into the base of the
umbilical cord, where it remains until about the 10th week of intrauterine life.
MUSCOLOSKELETAL SYSTEM
During the first 2 weeks of fetal life, cartilage prototypes provide position and support to the fetus.
Ossification of this cartilage into bone begins at about the 12th week and contin as all through fetal life and
into adulthood. Carpals, tarsals, and sternal bones generally do not ossify until birth is imminent.
REPRODUCTIVE SYSTEM
A child's sex is determined at the moment of conception by a spermatozoon carrying an X or a Y

chromosome and can be ascertained as early as 8 weeks by chromosomal analysis or at 10 weeks with
analysis of fetal cells in the mother's bloodstream. At the week after implantation, the gonads form. If testes
form, testosterone is secreted, apparently influencing the sexually neutral genital duct to form other male
organs. In the absence of testosterone secretion, female organs will form.
URINARY SYSTEM
Although rudimentary kidneys are present as early as the end of the fourth week of intrauterine life, the
presence of kidneys does not appear to be essential for life before birth because the placenta clears the fetus
of waste products. Urine, however, is formed by the 12th week and is excreted into the amniotic fluid by
the 16th week of gestation.
INTEGUMENTARY SYSTEM
The skin of a fetus appears thin and almost translucent until subcutaneous fat begins to be deposited
underneath it at about 36 weeks. Skin is covered by soft downy hairs (lanugo) that serve as insulation to
preserve warmth in utero as well as a cream cheese-like substance, vernix caseosa, which is important for
lubrication and for keeping the skin from macerating in utero. Both lanugo and vernix are still present at
birth.
IMMUNE SYSTEM
Immunoglobulin (Ig)G maternal antibodies cross the placenta into the fetus as early as the 20th week and
certainly by the 24th week of intrauterine life to give a fetus temporary passive immunity against diseases
for which the mother has antibodies.
MILESTONES OF FETAL GROWTH AND DEVELOPMENT
Life of fetus is normally calculated from the moment of ovulation or fertilization (ovulation age), whereas
the length of a pregnancy is more commonly measured from the first day of the last menstrual period
(gestational age).
The following description of developmental milestones for a fetus is based on gestational weeks, which
begin on the first day of the last menstrual cycle.
End of Fourth Gestational Week
• The length of the embryo is about 0.75 cm; weight is about 400 mg.
• The spinal cord is formed and fused at the midpoint.
• The head is large in proportion and represents about one-third of the

entire structure.
• The rudimentary heart appears as a prominent bulge on the anterior surface. Arms and legs are
bud-like structures; rudimentary eyes, ears, and nose are discernible.
End of Eighth Gestational Week
• The length of the fetus is about 2.5 cm (1 in.); weight is about 20

g.
• Organogenesis is complete.
• The heart, with a septum and valves, beats rhythmically.
• Facial features are definitely discernible; arms and legs have

developed.
• External genitalia are forming, but sex is not yet distinguishable by simple observation.
• The abdomen bulges forward because the fetal is growing so rapidly.
End of 12th Gestational Week (First Trimester)
• The length of the fetus is 7 to 8 cm; weight is about 45g .
• Nail beds are forming on fingers and toes.
• Spontaneous movements are possible, although they are usually

too faint to be felt by the mother.
• Some reflexes, such as the Babinski reflex, are present
• Bone ossification center begin to form, Tooth buds are present
• Sex is distinguishable on outward appearance.
• Urine secretion begins but may not yet be evident in amniotic fluid.
• The heart beat is audible through Doppler technology.
End of 16th Gestational Week
• The length of the fetus is 10 to 17 cm; weight is 55 to120g
• Fetal heart sounds are audible by an ordinary stethoscope.
• Lanugo is well formed.
• Both the liver and pancreas are functioning
• The fetus actively swallows amniotic fluid, demonstrating an intact but uncoordinated swallowing
reflex: urine is present in amniotic fluid.
• Sex can be determined by ultrasonography.
• .The length of the fetus is 25 cm; weight is 223 g.
• Spontaneous fetal movements can be sensed by the mother.
• Antibody production is possible.
• Hair, including eyebrows, forms on the head; vernix caseosa begins

to cover the skin.
• Meconium is present in the upper intestine.
• Brown fat, a special fat that aids in temperature regulation, begins to
form behind the kidneys, sternum, and posterior neck.
• Passive antibody transfer from the pregnant person to fetus begins.
• Definite sleeping and activity patterns are distinguishable as the fetus develops biorhythms that
will guide sleep/wake patterns throughout life.
End of 24th Gestational Week (Second Trimester)
• .The length of the fetus is 28 to 36 cm; weight is 550 g.
• Meconium is present as far as the rectum.
• Active production of lung surfactant begins.
• Eyelids, previously fused since the 12th week, now open; pupils react
to light.
• Hearing can be demonstrated by response to sudden sound. .
• When fetuses reach 24 weeks, or 500 to 600 g, they have achieved a practical low-end age of
viability if they are cared for after birth in a modern intensive care nursery.
• The length of the fetus is 35 to 38 cm; weight is 1,200 g.
• Lung alveoli are almost mature; surfactant can be demonstrated in

amniotic fluid.
• Testes begin to descend into the scrotal sac from the lower abdominal cavity.
• The blood vessels of the retina are formed but thin and extremely susceptible to damage from high
oxygen concentrations (an important consideration when caring for preterm infants who need oxygen).
End of 32nd Gestational Week
• The length of the fetus is 38 to 43 cm; weight is 1,600 g.
• Subcutaneous fat begins to be deposited (the former stringy, "little

old man" appearance is lost).
• Fetus responds by movement to sounds outside the pregnant

person's body.
• An active Moro reflex is present.
• Iron stores, which provide iron for the time during which the neonate will ingest only breast milk
after birth, are beginning to be built.
• Fingernails reach the end of fingertips.
• The length of the fetus is 42 to 48 cm; weight is 1,800 to 2,700 g (5 to 6

lb).
• Body stores of glycogen, iron, carbohydrate, and calcium are deposited.
• Additional amounts of subcutaneous fat are deposited.
• Sole of the foot has only one or two crisscross creases compared with a
full crisscross pattern evident at term.
• Amount of lanugo begins to diminish.
• Most fetuses turn into a vertex (head down) presentation during this month.
End of 40th Gestational Week (Third Trimester)
• The length of the fetus is 48 to 52 cm (crown to rump, 35 to 37 cm); weight is 3,000 g (7 to 7.5 lb).
• Fetus kicks actively, sometimes hard enough to cause the pregnant person considerable
discomfort.
• Fetal hemoglobin begins its conversion to adult hemoglobin.

• Vernix caseosa starts to decrease after the infant reaches 37 weeks gestation and may be more
apparent in the creases than the covering of the body as the infant approaches 40 weeks or more
gestational age.
• Fingernails extend over the fingertips.
• Creases on the soles of the feet cover at least two-thirds of the surface.
CIRCULATORY SYSTEM
The circulatory system is the transport system of the body by which food, oxygen, water and all
other essentials are carried to the tissue cells and their waste products are carried away.
THE FUNCTIONS OF CIRCULATORY SYSTEM INCLUDE THE FOLLOWING:
1. Carries blood. Blood vessels carry blood from the heart to all the tissues of the body and back
to the heart.
2. Exchange nutrients, waste products, and gases with tissues. Nutrients and oxygen diffuse
from blood vessels to cells in essentially all areas of the body. Waste products and carbon dioxide
diffuse from the cells, where they are produced, to blood vessels.
3. Transport substances. Blood transport hormones, components of the immune system,

molecules required for coagulation, enzymes, nutrients, gases, waste products, and other
substances to and from all areas of the body.
4. Helps regulate blood pressure. The circulatory system and the heart work together to regulate
blood pressure within a normal range.
5. Directs blood flow to the tissues. The circulatory system directs blood to tissues when
increased blood flow is required to maintain homeostasis.
IT CONSISTS OF THREE PARTS:
1. The blood. It is the fluid in which materials are carried to and from the tissue.
2. The heart. It is the driving force which propels the blood.
3. The blood vessels. The routes by which the blood travels to and through the tissues and back
to the heart.
Heart
Blood vessels containing

blood
Figure 1.A The main components of the Circulatory System
THE BLOOD
Blood is classified as a connective tissue, Like all connective tissues, it is made up of cellular
elements and an extracellular matrix. The cellular elements—referred to as the formed
elements—include red blood cells (RBCs), white blood cells (WBCs), and cell fragments called
platelets. The extracellular matrix, called plasma, makes blood unique among connective tissues
because it is fluid.
FUNCTIONS OF THE BLOOD

1. Transport of gases, nutrients, and waste products. Blood acts as a major transport medium
in the body due to the many substances that move into and out of the blood. The blood transports
ingested nutrients, ions, and water from the digestive tract to cells, and the blood transports the
waste products of the cells to the kidneys for elimination.
2. Transport of processed molecules. Many substances must be processed at multiple sites in
the body. A substance may be processed in one organ or tissue, enter the blood and move to a
new location where it is modified.
3. Transport of regulatory molecules. The blood carries many of the hormones and enzymes
that regulate body processes from one part of the body to another.
4. Regulation of pH and osmosis. Buffers which help keep the blood’s ph within its normal
limits. The osmotic composition of blood is also critical for maintaining normal fluid and ion
balance.
5. Maintenance of body temperature. As blood flows through areas of the body that are
metabolically active, the heat generated by metabolism warms the body.
6. Protection against foreign substances. Certain cells and chemicals in the blood constitute an
important part of the immune system, protecting against foreign substances, such as
microorganisms and toxins.
7. Clot formation. When blood vessels are damaged, blood clotting protects against excessive
blood loss. When tissues are damaged, the blood clot that forms is also the first step in tissue
repair and restoration of normal function.
COMPOSITION OF BLOOD
The blood is composed of two prime elements: the liquid element is called plasma; the cells and
fragments of cells are called formed elements.
THE PLASMA
The plasma is a yellow fluid that consists of about 91% of water, 7% of proteins,
and 2% other components.
Plasma Proteins
About 7 percent of the volume of plasma—nearly all that is not water—is made of proteins.
The three major groups of plasma proteins are as follows:
• Albumin. The most abundant of the plasma proteins. Manufactured by the liver, albumin
molecules serve as binding proteins—transport vehicles for fatty acids and steroid hormones.
• Globulins. The second most common plasma proteins. There are three main subgroups
known as alpha, beta, and gamma globulins.
a. The alpha and beta globulins transport iron, lipids, and the fat-soluble vitamins
A, D, E, and K to the cells; like albumin, they also contribute to osmotic pressure.
b. The gamma globulins are proteins involved in immunity and are better known as
an antibodies or immunoglobulins.
• Fibrinogen. The third of the three major groups of plasma proteins which is produced by
the liver. It is essential for blood clotting.
Other Plasma Solutes

DATE/SHIFT DOCTORS NURSES STUDENTS VITAL OBSERVATIO
ORDER NOTE NOTES SIGNS N
DECEMBER 7, >Please admit >Admitted an DECEMBER >Please admit >Admitted an
2022 10:30 PM under my alive preterm 7, 2022 10:30 under my alive preterm
service Baby boy PM service Baby boy
weak cry and >Secure delivered via >Secure delivered via CS
pale consent for CS under the weak cry and consent for under the service
CR 160’s Admission and service of Dr. pale Admission of Dr. Eclar
warm dry management Eclar CR 160’s and
suction gently >TPR of shift warm dry management >Consent of
with FEP and record >Consent of suction gently >TPR of shift Admission
>Please do the Admission with FEP and record signed and
02 sat 100% following and signed and >Please do secured
180’s record: secured 02 sat 100% the following

>Pinkish in
180’s and record:
>Pinkish in color, good and
Anthropometri
color, good and motor activity
c Anthropometr
motor activity noted >Suction
Measurements ic
noted >Suction secretions
Meds Measurement
secretions PRN >Kept baby
prophylaxis s
PRN >Kept warm and
Vit K 0.5 Meds
baby warm and dry >Cord care
mg, IM prophylaxis
dry >Cord care done aseptically;
>Hook to Vit K 0.5
done UVC
NCPAP at mg, IM
aseptically; inserted >Anthro
F102 40% >Hook to
UVC pometric
PEEP 5 NCPAP at
inserted >Anthr measurement
>Insert OGT F102 40%
opometric taken and
and to drain PEEP 5
measurement recorded
>Insert >Insert OGT
taken and
umbilical and to drain
recorded >Vit K 0.5 mg
catheter >Insert
IM
>IVF: TFR 80 umbilical
>Vit K 0.5 mg thigh >Monitore
D5W 66 cc x catheter
IM d V/S and
24 to ruin >IVF: TFR
thigh >Monitore recorded
2.7cc/hr 80
d V/S and
>Labs: CBC D5W 66 cc >WOF any
recorded
platelet x 24 to ruin untoward s/s
Blood 2.7cc/hr
typing >WOF any >Labs: CBC >Endorsed
>Meds: untoward s/s platelet

Blood
>Endorsed
Ampicillin typing
41mg TIV >Meds:
q12°
Ampicillin
Amikacin 14 41mg TIV
mg TIV q48° q12°
Aminophylline
5mg IV Amikacin 14
infusion for 30 mg TIV q48°
minutes Aminophyllin
loading dose, e 5mg IV
then 1.5 mg infusion for
slow IV push 30 minutes
q12° as loading dose,
maintenance then 1.5 mg
dose, to start slow IV push
12 hours after q12° as
the loading maintenance
dose >For dose, to start
oral colostrum 12 hours after
swab the loading
>Keep dose >For
thermoregulate oral
d at all times colostrum
(36.5° – swab
37.5°C ) >Keep
>Minimal thermoregulat
handling pls. ed at all times
>Suction (36.5° –
secretions 37.5°C )
gently, >Minimal
PRN >Refer handling pls.
>Suction
Add secretions
For babygram gently,
APL in AM PRN >Refer
Add
For babygram
APL in AM
DECEMBER DECEMBER
8,2022 >Decrease >Received 8,2022 >Decrease >Received
8:58 am F1O2 to 35 patient inside 8:58 am F1O2 to 35 patient inside the
now then after the incubator now then incubator awake.
3 hours awake. after 3 hours >Ongoing IVF
decrease again >Ongoing IVF decrease D5W ½ L 66
to 30 maintain D5W ½ L 66 again to 30 cc/ss x 24 at 2.7
O2 Sat at 90 cc/ss x 24 at 2.7 maintain O2 cc/hr via UVC
>For cc/hr via UVC Sat at 90 > (-)
colostrum > (-) >For Desaturation,
1:20 pm swab Desaturation, 1:20 pm colostrum Mild retraction
(+) Apnea >Minimal Mild retraction (+) Apnea swab (-) grunting
handly (-) grunting >Minimal OGT open beded
>Refer OGT open handly bottle (-) soft
beded bottle (-) >Refer abdomen
>Increase soft abdomen >Pinkish in
Aminophylline >Pinkish in >Increase color, good cry
4:05 pm to Q8 color, good cry 4:05 pm Aminophyllin and good motor
>Refer and good motor e to Q8 activity
activity >Refer >Assessed pt VS
>Assessed pt taken and
VS taken and recorded
recorded >Kept
>Maintain >Kept thermoregulated
present O2, thermoregulated >Maintain
F1O2 35% present O2, >Decrease F1O2
>IVF to >Decrease F1O2 35% to 35%
follow: TFR F1O2 to 35% >IVF to >Negative
90 >Negative follow: TFR desaturation
D5W 64.2 cc desaturation 90 > (+) Episode of
Na (3) 0.9 cc > (+) Episode of D5W 64.2 cc apnea c
IC (2) 0.8cc apnea c Na (3) 0.9 cc desaturation
AA (0.5) 6.5cc desaturation IC (2) 0.8cc 3:00 pm
Ca (2) 1.6cc 3:00 pm AA (0.5) >Seen and exam
= 74cc at >Seen and exam 6.5cc by Dr. Eclar
3cc/hr by Dr. Eclar Ca (2) 1.6cc >Endorsed
>Endorsed = 74cc at >Received
>Continue >Received 3cc/hr patient inside
Medications: patient inside incubator chains
incubator chains >Continue >Pinkish skin
>Pinkish skin Medications: color, good cry
>Decrease Hgt color, good cry and motor
monitoring to and motor activity
q8 activity >Decrease >(+) Mild
>Start trophic >(+) Mild Hgt retraction , (-)
feeding 0.5cc retraction , (-) monitoring to Grunting, clear
EBM of q6 Grunting, clear q8 breath sound
>Keep breath sound >Start trophic >Good pulse,
thermoregulate >Good pulse, feeding 0.5cc soft non-tender
d / Minimal soft non-tender EBM of q6 abdomen
handling abdomen >Keep >Ongoing IVF
>Refer >Ongoing IVF thermoregulat of D5W 64.2 cc
of D5W 64.2 cc ed / Minimal + Na 0.9cc, +
+ Na 0.9cc, + handling 0.8cc + 6.5cc of
0.8cc + 6.5cc of >Refer AA
AA >Kept
>Kept thermoregulated
thermoregulated >Maintained
>Maintained aseptic technique
aseptic when handling
technique when >Routine diaper
handling changes done
>Routine diaper >Kept safe
changes done >Morning care
>Kept safe done
>Morning care >Updated AP
done >All Meds given
>Updated AP >Endorsed
>All Meds
given
>Endorsed
DECEMBER 9, >HGT now >Read Pt inside DECEMBER >HGT now >Read Pt inside
2022 >Increase the incubator 9, 2022 >Increase the incubator
9:40 am Aminophylline awake 9:40 am Aminophyllin awake
2.4g IV now e 2.4g IV now
>Refer >IVF of D5W >Refer >IVF of D5W
642 + Na 0.9 + 642 + Na 0.9 +
AA 6.5 + Ca 2.6 AA 6.5 + Ca 2.6
2:00 pm >For at 74cc/ss x 2:00 pm >For at 74cc/ss x
(+) Apnea intubation 3cc/hr (+) Apnea intubation 3cc/hr
(+) O2 sat. 40- >Inform ROD (+) O2 sat. >Inform ROD

>UCV level 6 >UCV level 6
50 40-50
>OGT open >OGT open
2:06 pm >Et. 25 level >Hook at 2:06 pm >Et. 25 level >Hook at

65 NCPAP F1O2 65 NCPAP F1O2
>Hook to 35% PEEP 5, c >Hook to 35% PEEP 5, c
SIMV c the of apnea c SIMV c the of apnea c
following set desaturation. following set desaturation.
up up
> FI02 60 > FI02 60
>RR 40 >RR 40
>P/P 12/5 >P/P 12/5
>IT 0.5 >IT 0.5
>Gives PNSS >Gives PNSS
8cc SIVP for 8cc SIVP for
30 minutes 30 minutes
2:23 pm >Refer 2:23 pm >Refer
O2 sat. 100 O2 sat. 100
>May try to >May try to

decease FIO2 decease FIO2
to 40% then to 40% then
6:40 pm after 30 6:40 pm after 30
Q D2 decrease until Q D2 decrease until
F TFR 100 30% is F TFR 100 30% is
O2 sat. 98- reached if O2 sat. 98- reached if
100% without 100% without
>Refer >Refer
>Decrease RR >Decrease
now to 38, RR now to
then decrease 38, then
by 2’s of 6 decrease by
until 30 is 2’s of 6 until
reached, 30 is reached,
alternate with alternate with
decrease in decrease in
FIO2 2’s q6 FIO2 2’s q6
until 30% until 30%
>Watch out >Watch out
for signs of for signs of
respiratory respiratory
distress distress
>Hold >Hold
Aminophylline Aminophyllin
>IVF to e
follow: >IVF to
>D5W 65.7cc follow:
>Na (3) 0.9cc >D5W 65.7cc
>IC (2) 0.8cc >Na (3) 0.9cc
>AA (1) 13cc >IC (2) 0.8cc
>Ca (2) 1.6cc >AA (1) 13cc
= 82cc x 24 to >Ca (2) 1.6cc
10:08 pm run at 3.4cc/hr 10:08 pm = 82cc x 24 to
>Continue run at
Medication: 3.4cc/hr
>Continue
Medication:
10:31 pm 10:31 pm
>NPO
>Start
phototherapy >NPO
with proper >Start
10:39 pm precautions 10:39 pm phototherapy
>Keep with proper
thermoregulate precautions
d (36.5 – 37.5) >Keep
>Continue thermoregulat
Newborn Care ed (36.5 –
>Refer 37.5)
>Continue
Newborn
Care
>For CXR AP >Refer
STAT
>1/2
salbutamol
now >For CXR
>Refer AP STAT
>1/2
salbutamol
>Give now
medication >Refer
0.04mg slow
IV q2.4 for
agitation >Give
>Refer medication
0.04mg slow
IV q2.4 for
agitation
>For >Refer
reintubation
>Defer CXN
>Refer
>For
reintubation
>Defer CXN
>Refer
DECEMBER >Read pt. DECEMBER >Read pt. inside

10,2022 >Start slow IV inside the 10,2022 >Start slow the incubator
12:30 am for 30 minutes incubator 12:30 am IV for 30 awake.
as loading awake. minutes as >IVF of D5W
dose then 3mg >IVF of D5W loading dose 67.7 + Na 0.9 +
IV 24 as 67.7 + Na 0.9 + then 3mg IV Potassium 0.8 +
maintenance Potassium 0.8 + 24 as Calcium
dose Calcium maintenance Glucose 1.6 +
>Insert Glucose 1.6 + dose Aminutril 20 at
>Refer Aminutril 20 at >Insert total of 91cc/ss x
total of 91cc/ss >Refer 24° x 3.7 cc/hr c
x 24° x 3.7 40cc level.
6:44 am cc/hr c 40cc 6:44 am
>Start level.
Salbutamol ½ >Start
reb Q2 to Salbutamol ½
alternate with reb Q2 to
7:57 am ipratropium 7:57 am alternate with
Spo2 92% Salbutamol Spo2 92% ipratropium
>Refer Salbutamol
>Refer
12:05 pm >For chest 12:05 pm

Sat 89% APL Sat 89% >For chest
APL
1:15 pm 1:15 pm
Still >ET Still
repositioning – >ET
done repositioning
>IVF to follow – done
5:00 pm TFR no 5:00 pm >IVF to
qD3 D5W 67.7cc qD3 follow TFR
F TFR 110 Na (3) 0.9cc F TFR 110 no
R RR 40’s- 50’s IC (2) 0.8cc R RR 40’s- D5W 67.7cc
C mallow AA (1.5) 20cc 50’s Na (3) 0.9cc
retractions Ca (2) 1.6cc C mallow IC (2) 0.8cc
I (-) Fever =91cc x 24’ to retractions AA (1.5) 20cc
H (+) bleeding run at 3.6cc/hr I (-) Fever Ca (2) 1.6cc
M Agt 135mg dl H (+) =91cc x 24’
O no: 6cc/hr bleeding to run at
N active >Resume M Agt 135mg 3.6cc/hr
D NPO feeding at dl
0.5cc EBM q6 O no: 6cc/hr
>for Repeat N active >Resume
CBC with D NPO feeding at
platelet after 0.5cc EBM
3 day of
rd
q6
> Continue >for Repeat
Medications: CBC with
>Suction platelet after
secretion 3rd day of
gently, PRN > Continue
>Keep Medications:
thermoregulate >Suction
10:38 pm d secretion
>Decrease Hgt gently, PRN
to q12, Hold >Keep
phototherapy 10:38 pm thermoregulat
>Refer ed
>Decrease
Hgt to q12,
Hold
phototherapy
>Refer
>For CBC PC
tomorrow
>Refer
>For CBC PC
tomorrow
>Refer
DECEMBER DECEMBER
11,2022 >Decrease >Received pt 11,2022 >Decrease >Received pt
9:20 am FIO2 now to inside incubator 9:20 am FIO2 now to inside incubator
qD4 35%, then c ET 2.5 level qD4 35%, then c ET 2.5 level
F TFR 110 decrease by 8 6.5 connected to F TFR 110 decrease by 8 6.5 connected to
R RR 40’s q6 until 25% is MV c set up as R RR 40’s q6 until 25% MV c set up as
(+) retractions, reached, O2 follows (+) is reached, O2 follows
GAE sat >90% >AC mode retractions, sat >90% >AC mode
>Continue RR:35 P/PEEP GAE >Continue RR:35 P/PEEP
Medications: 12/5 F1O2 30% Medications: 12/5 F1O2 30%
>Ongoing IVF >Ongoing IVF
of D5W 67.7cc of D5W 67.7cc
>Sodium 0.9cc >Sodium 0.9cc
>Increase >Potassium >Increase >Potassium
OGT feeding 0.8cc, OGT feeding 0.8cc,
to 1cc of 6 aminopterin to 1cc of 6 aminopterin
EBM 20cc, GaGluc EBM 20cc, GaGluc
>Maintain IVF 1.6 cc total of >Maintain 1.6 cc total of
>Minimal a/cc x 24 x 3.7 IVF a/cc x 24 x 3.7
Handling cc/hr via UVC. >Minimal cc/hr via UVC.
6:55 pm >Continue >All due meds Handling >All due meds
Newborn Care given 6:55 pm >Continue given
>Keep >V/S taken and Newborn >V/S taken and
Thermoregulat recorded Care recorded
ed >IVF check and >Keep >IVF check and
>Refer regulated Thermoregula regulated
>Kept ted >Kept
thermoregulated >Refer thermoregulated
>Please insert >Maintain an >Maintain an
glycerine aseptic aseptic technique
suppository technique when >Please insert when handling
1/8 supp per handling glycerine >Fed c
rectum now >Fed c suppository EMB/OGT c
then Q8 still EMB/OGT c 1/8 supp per strict aspiration
no BM. strict aspiration rectum now precaution
precaution then Q8 still >Routine diaper
>Routine diaper no BM. change done
change done >Turned Pt side
>Turned Pt side to side
to side >Nebulization
>Nebulization done; CPT after
done; CPT after >RBS release
>RBS release and recovered
and recovered >Decrease F1O2
>Decrease @ 25%, merated
F1O2 @ 25%, SPO2 @ 97-
merated SPO2 99%
@ 97-99% >All meds given
>All meds >Morning Care
given done
>Morning Care >HP updated
done >Endorsed
>HP updated
>Endorsed
DECEMBER >Recieve pt DECEMBER >Recieve pt
12,2022 >Increase inside the 12,2022 >Increase inside the
7:22 am feeding Q4 incubator 7:22 am feeding Q4 incubator
>Refer >Refer
>IVF of D5W >IVF of D5W
67.7 + Na 0.9 + 67.7 + Na 0.9 +
K 0.k8 + AA 20 K 0.k8 + AA 20
+ ca gluc 1.6 at + ca gluc 1.6 at
9cc/ss x 24 hrs 9cc/ss x 24 hrs x
6:25 pm >Decrease RR x 3.7cc/hr 6:25 pm >Decrease 3.7cc/hr
to 30 now, RR to 30
then decrease >Received now, then >Received
by q6until 10 inside decrease by inside incubator,
>IVF to incubator, q6until 10 intubated c ET
follow: TFR intubated c ET >IVF to side 2.5 level 6.5
120 side 2.5 level follow: TFR connected to
D5W 68.7cc 6.5 connected to 120 MV e set up as
Na (3) 0.9cc MV e set up as D5W 68.7cc follows
IC (2) 0.8cc follows Na (3) 0.9cc

>AC mode: RR
AA (2) 27cc IC (2) 0.8cc
>AC mode: RR 30, PEEP 5/12,
Ca (2) 1.6cc AA (2) 27cc
30, PEEP 5/12, 1time 0.5, FiO2
= 99cc x 12 x Ca (2) 1.6cc
1time 0.5, FiO2 25%
24 to run at = 99cc x 12 x
25%
4cc/hr 24 to run at
>Clear breath
>Increase 4cc/hr
>Clear breath sounds good air
feeding to >Increase
sounds good air entry
1.5cc/ogt feeding to
entry
EBM q4 1.5cc/ogt >Q edema soft
tomorrow AM >Q edema soft EBM q4 non-tender
>Continue non-tender tomorrow abdomen, c
Medications: abdomen, c AM ongoing IVF of
ongoing IVF of >Continue D5W 67.7 cc Na
D5W 67.7 cc Medications: 0.96, Potassium
Na 0.96, 0.8 cc,
>Hold Potassium 0.8 Aminosteril 20
phototherapy, cc, Aminosteril cc, CaCluc 1.6cc
watch out for 20 cc, CaCluc >Hold total of 91 cc x
jaundice 1.6cc total of 91 phototherapy, 24° x 3.7 cc/hr
>Suction cc x 24° x 3.7 watch out for via UCV intact
secretions cc/hr via UCV jaundice and infusing
gently, PRN intact and >Suction well.
>Keep infusing well. secretions
thermoregulate gently, PRN
d >Heplock on >Keep >Heplock on left
>Minimal left foot met in thermoregulat foot met in
handling distress. ed distress.
>Refer >Minimal
>Assessment >Assessment
handling
done done
>Decrease >Refer
HGT monitory
>All due meds >All due meds
to OD >Decrease
given given
HGT
>V/S taken and monitory to >V/S taken and

recorded OD recorded
>Maintain >Maintain
aseptic aseptic technique
technique when when handling
handling
>Kept
>Kept thermoregulated
thermoregulated
>Fed EBM/OGT
>Fed c strict aspiration
EBM/OGT c precaution
strict aspiration
precaution >Routine diaper
change done
>Routine diaper
change done >Nebulization
done; CPT done
>Nebulization
done; CPT done >RBS relayed
and recorded
>RBS relayed
and recorded 12:00 am
12:00 am >Decreased RR
to 25; tolerated
>Decreased RR
to 25; tolerated
>Q desaturation
>Q desaturation
>WOF any
>WOF any Untoward
Untoward
6:00 am
6:00 am
>Decrease RR to
>Decrease RR 20; Q
to 20; Q desaturation
desaturation
>Morning care
>Morning care done
done
>AP updated
>AP updated
>All meds
>All meds attended
attended
>Endorsed
>Endorsed
DECEMBER >Received pt O2-99
13,2022 >Maintain inside incubator PR-137
8:05 pm present set-up intubated E 2.5 RR-48
>Continue at 6.5 connected TEMP-36.9
IVF to mechanical
>Increase ventilator set up
feeding to 2cc as follow: AC
/ ogt EBM of 4 mode; 20,
tomorrow AM 1Time 0.5
>Continue P/P/PEEP 12/5
Medications: F1O2 25%
>E desaturation
>IVF of D5W
>Discontinue: 68.7 + Na 0.9 +
>Keep K 0.8 + AA 29
thermoregulate CaGluc 1.6=
d 99cc
>Refer >All due meds
attended
>Decrease RR
to 15
>E desaturation
>Feed tolerated
>Endorsed
>Intubates, ET
size of 2.5 at
level 6.5
connected to
mechanical
ventilator the
following set up
>AC mode; RR
10, F1O2 25%
PEEP/P/P 5/12
>Clear breath
sound good air
entry
>Non tender
abdomen, good
Pulse
>(-)
Edema/sclerema
>Ongoing IVF
of D5water
68.7cc + 0.9cc
of Na + 0.8cc of
Potassium +
27cc of AA +
1.6cc CaGluc at
4cc/hr via UVC
>Due Meds
given
>Kept
Thermoregulate
d
>Aseptic
technique when
handling
>Nebulization
done
>Morning care
done
>Meds attended
>Endorsed
DECEMBER O2-98
14,2022 >For gentle >Received pt PR-146
7:00 am rectal inside incubator RR-52
EBM stimulation intubated E 2.5 TEMP-36.9
QC until with at 16.5
BM connected to
mechanical
7:10 pm ventilator set up
>Maintain as follow: AC
present set-up mode; 20,
>IVF to 1Time 0.5
follow: TFR P/P/PEEP 12/5
130 F1O2 25%
D5W 68.7cc >E desaturation
Na (3) 0.9cc and air entry
IC (2) 0.8cc >IVF of D5W
AA (2.5) 34 cc 68.7 + Na 0.9 +
Ca (2) 1.6cc K 0.8 + AA 2%
=107cc x 24 to CaGluc 1.6 =
run at 4cc/hr 99 cc x 12 x 4
>Continue cc/hr
phototherapy, >MA UCV; HC
12 hrs on/ 12 inserted @
hrs off Right arm
>Continue >Kept
Medications: thermoregulated
at all times
>Trued pt side
to side
>Suction >Minimal
secretions handling and
gently, PRN aseptic
>Increase technique when
OGT feeding handling patient
to 25cc of 4 >Diaper
EBM changes done
tomorrow Am >All due meds
>Keep given
thermoregulate >Due RBS
d monitoring
>Refer >Episode of
desaturation
ADD >Endorsed
>Discontinue
Phenytoin
DECEMBER
15,2022 >Set-up SIMV >Received pt
11:30 am FIO2 25 RR inside
RBS: 47 10 P/P 15/5 -8 incubator;
>Suction intubated ET
secretion size 2.5 level
gently 6.5 connected
>IVF to to MV set up as
follow: TFR follow
140 >AC Mode; RR
D5W 71.7cc 10 F1O2 25%
Na (3) 0.9cc 1Time 0.5
IC (2) 0.8cc P/P/PEEP 12/5
AA (3) 40cc >Pinkish in
Ca (2) 1.6cc color, good
= 115cc x 24 motor activity,
to run at good air entry,
4.8cc/hr clear breath
>Continue sounds, OGT
Medications: for feeding.
>Ongoing IVF
>Increase of D5W 68.7
OGT feeding cc, Na 0.9cc,
to 3cc q4, Potassium
EBM 0.8cc, AA 34cc,
tomorrow AM CaGluc 1.6cc
>Extubate via UVC intact
tomorrow AM, and infusing
update me first well.
for orders >Retraction
>Keep >Edema/Sclere
thermoregulate ma
d >Desaturation
>Refer >Assessed
general
condition
>All du meds
given
>V/S taken and
recorded
>Kept
thermoregulated
>Maintain
aseptic
technique when
handling
>Fed c
EBM/OGT c
strict aspiration
precaution
>Routine diaper
change done
>Tum pt side to
side
>Nebulization
done; CPT done
>Suction
secretions
gently as
needed
>Kept safe
>Monitored
RBS and
relayed
>Minimal
handling
maintained
>Placed on
phototherapy
proper shielding
>Inform AP
thru call
10:00 am
>D10W 1.6cc
given SIVP
now
>Seen @ all
times
>AP updated
>All meds
attended
>Endorsed
DECEMBER  Please  Received O2-100

16,2022 extubate patient PR-135
7:20 am then O2 inside RR-54
cannula incubator TEMP-36.9
at 2:32  Intubated c
pm ET size
 Suction 2.5 level
secretion 6.5
s gently connected
 Epinephri to MV set
ne 0.1cc up as
in 2cc follows:
NSS Q3  SIMV RR
gentle 10, 1Time
suctionin 0.5
g for 24 P/P/PEEP
hours. 8/5 PS 8,
8:14 a  NPO for  OGT for
4hrs feeding
 Stat HGT Pinkish in
 Refer color,
good
motor
 Resume activity,
Budesoni good air
de neb entry,
Q12 clear
 Resume breath
6:30 pm feeding sounds
after 4  Soft non
hrs start tender
at 1 cc abdomen
and  Ongoing
increase IVF of
to 1 cc D5W 68.7,
every Na 0.9,
other Potassium
feeding. 0.8, AA
34,
CaGluc
 May try 1.6cc via
to UVC
decrease intact not
O2 at in distress
2LPM  Assessed
tomorrow General
AM condition
 Continue  All due
to meds
increase given
PGT  V/S taken
feeding and
0.5cc of recorded
other  Kept
feeding thermoreg
until 5cc ulated
is  Maintaine
reached d aseptic
 Continue technique
photother when
apy (12 handling
hrs on/  +desaturati
12 hrs on @ 30-
off) 50’s,
 IVF to +gasping
follow:  Inform AP
TPR 150 thru call
D5W 79.7cc  Pt
39.8 cc extubated
Na (3) 0.9cc now
0.45 cc  Suction
IC (2) 0.8cc secretion
0.4 cc stat
AA (3) 40 cc  Nebulized
20 cc Racemic
Ca (2) 1.6cc neb then
0.8 cc suction
= 123cc secretion
= 61.5 cc x12  Ongoing
for 24 to run at IVF of
5 cc/hr D5W
 For 39.8cc Na
repeat 0.45cc K
CBC 0.9cc AA
with 10cc Ca
platelet 0.8cc
tomorrow patent and
AM infusing
 Continue well
gentle connected
suctionin via UVC
g intact
 Continue  Good cry
Medicati and active
ons motor
 Start reflexes;
VCO 0.2 not in CP
ml 2x a distress
day to be  VS taken
mix and
 Keep recorded
thermore  Assessed
gulate pt general
Refer condition
 All due
meds
given
 Kept
thermoreg
ulated at
all times
 Photothera
py
maintain
proper
shield
 O2 support
maintain
 Safety
ensured
 Morning
care done
 AP
updated
 Endorsed
December 17, > Decrease 02 -Received pt SPO2: 99%
2022 at 1 lpm inside the
incubator asleep PR: 151
02: 45 PM > Maintain with ongoing
IVF RR: 50
IVF of D5W
D10 (26-27 3/7)
79.7 + Na 0.9 +
> Continue T: 37°C
K 0.8 + AA 40
F TRN 150 increments in
+ CaGluc 1.6 at
feeding by
R RU 40’s, (-) total of 123cc/hr
0.5cc of ___
retraction x 5cc/hr via
feeding until
UVC.
8cc is reached
I afebrile, (-) ____________,
sclerema with O2 support
> Continue
__ nasal
medications:
C ___ 150’s, (-) cannula at 1
___ lpm, (-)
Ampi D9
H desaturation, (-)
H (-) bleeding
__, (-)
Amk D5 retraction, soft
M Hgt 55mg/dl
abdomen,
>Discontinue pinkish in color,
O __
Salb + Ipa good cry and
4.8cc/__/hr x 12
nebulization good motor
N refuse activity,
____________.
D tolerated > Suction
feeding secretions - And pt VS
gently, PRN taken and
record
> Refer
-IVF check and
regulated.
Add: -
_____________
>May try to
___
shift O2 to O2
funnel at 5-6 -Keep
LPM thermoregulated
>Discontinue -Fed EBM/OGT

phototherapy with ___ ___
7pm-7am
-
_____________
-Ensure safety
and comfort
-_________
-____________
-_________
-_________
-_________
-Endorsed
-Received pt
inside incubator
with 02
inhalation at 1
lpm via nasal
cannula, pinkish
in color, with
soft non-tender
abdomen, with
good cry and
motor activity,
with good air
entry, clear
breath sounds,
(-)
edeme/sclerema
, with ongoing
IVF ofD5W
79.7, Na 0.9, K
0.8, AA 40,
CaGluc 1.6cc
total of 123
cc/hr x 5cc/hr
afebrile, not in
distress, with
OGT for
feeding, (-)
desaturation.
-Assessed
general
condition.
-All due meds

given.
-V/S taken and

recorded.
-Kept
thermoregulated
.
-Maintain
aseptic
technique when
handling.
-Fed with
EBM/OGT with
SAP then burp
thereafter
-Routine diaper
change done.
-Turn pt side to
side
-Kept safe.
-Nebulization
done, CPT
done.
-Suction
secretion as
needed.
-WOF any
untoward signs
and symptoms.
-Seen at all
times
-Morning care
done.
-Attending
physician
updated.
-All needs
attended.
-Endorsed.
December 18, >O2 PRN -Received pt SPO2: 99%
2022 inside the
>Continue incubator asleep PR: 151
5:27 AM IVF with ongoing
RR: 57
IVF of D5W
D11 (26-27 4/7) >Continue
79.7 + Sodium
increments in T: 36.9°C
0.9 + Potassium
T TFR 150 feeding by
0.8 + AA 40 +
0.5cc of other
RU 40’s, (-) CaGluc 1.6 at
feeding until
retraction, good total of 123
10cc feeding is
air entry cc/hr x 5cc/hr
reached
via UVC, ____
I afebrile, (-) ___ __ __, __,
> Discontinue
sclerema with o2 support
Ampicillin
via nasal
C __ 150’s, (-) cannula, (-)
> Continue
__ desaturation, (+)
Amikacin D6
soft abdomen,
H (-) bleeding
>Start good cry and
Ceftazidine good motor
M Hgt 76 mg/dl
24mg very activity, __ __
slow IV q12˚ __.
O __B 4cc/_/hr
x 12
>Discontinue -And pt V/S
Hgt taken and
N Active
monitoring recorded.
D tolerated
>Increase -IVF checked
increments in
VCO to 0.3ml and regulated.
feeding
TID
-___________
>Continue -Kept
gentle rectal thermoregulated
stimulation .
>Keep -Fed with EBM

thermoregulate via OGT then
7pm-7am
d burp thereafter.
>Refer -__________
-Monitor input
and output.
-______
-_______
- Seen at all
times.
- Seen and ___

by Dra. Eclar.
-____________
-Endorsed.
-Received pt
inside
incubator,
pinkish in
appearance,
good motor
reflexes with
soft non-tender
abdomen, __ __
__, (-)
desaturation, (-)
cyanosis, (-)
crackles, (-)
wheezes, (-)
___, (-) nasal
flaring, (-)
DOB, with
OGT intact for
feeding, __ to
pulse oximetry.
-Assessed
general
condition of pt.
-Vital signs
taken and
record.
-All due meds

given.
-Watch out for

untoward signs
and symptoms.
-Kept
monitored.
- EBM feeding
via OGT
facilitated.
-Suction
secretion as
needed.
-IVF checked
and regulated.
-Kept
thermoregulated
.
-Maintain
aseptic
technique when
handling.
-Routine diaper
change done.
-Ensure safety.
-Pt vomited,
refer to Dra.
Eclar, order _ _
and carried out.
-UVC leaked,
refer to Dra.
Eclar, (+)
abdominal
distention,
feeding hold.
-____________
-__________
-____
- AP updated.
-Endorsed.
December 19, >Hold feeding -Received pt SP02: 98%
2022 inside the
incubator asleep
12:30AM >Insert another with ongoing PR:145
line IVF of D5W
(+) Abdominal RR: 55
79.7, Na 0.9 +
distention > for daily AG
K 0.8 + AA 40
measurement T: 37°C
+ CaGluc 1.6 at
Leaking UVC
123 cc/hr x
10:30AM 5cc/hr __ __ __
>__ D10W __ __ ___, with

Hgt low 1.6cc SIVP OGT _ to __ __
now
>Repeat HGT
after 30mins.
6:50 PM
> Refer.
D12 (26-27 5/7)
F TFR 150
>Continue
IVF
R __ 40’s ,(-)
retraction, __
>For umbilical
catheter gs/cs
I afebrile, (-)
sclerema
>Please give
D10W 1.6cc
C __ 150’s, (-)
slow IV push
__
now.
H (-) bleeding
>For repeat
M Hgt 46 mg/dl Hgt after 2

hours
O __: 11mg/_/hr
x 12 ˚, (+) BM >Resume
2x feeding at 2cc
q4 ˚, EMB per
N active OGT
D NPO >Watch out
for signs of
feeding
intolerance
>Apply warm
compress over
previous IV
sites/puncture
sites
8:30 PM >Apply
Mupiracin
Hgt: 53 ointment over
the affected
area 3x a day
>Weigh
patient q other
day
>Keep
thermoregulate
d
>Refer
>Give D10W
1.6cc SIVP
now
>HGT Q6 ˚
December 20, >Give D10W SPO2: 99%
2022 1.6cc SIVP
now PR: 155
1:30 AM
>RBS 6am RR: 52
RBS:53
T: 37.1°C
6:30AM
Hgt:54 >Give D10W

1.6cc SIVP
now
>RBS 12 noon
12nn >Increase
feeding to 3cc
(+) IC
Retraction/___ _ >Increase 02
___ support to 3
lpm_ NC _ _
Hgt of 41
1.6cc SIVP
Tachycardic __
For __ CXR
December 20, >Continue

2022 IVF with same
rate
7:30PM
>Decrease 02
D13 (26-27 6/7) at 1 lpm
T TFR 100 >Increase

EBM feeding
R __40’s, with
per OGT by
shallow
0.5cc q2˚ other
intercostal
2 feeding until
retractions
8cc per
feeding is
___
reached
I afebrile ,
>Watch out
(-)sclerema
for signs of
C __ 150’s, (-) respiratory
__ distress and
feeding
H (-) bleeding
intolerance
M Hgt 64mg/dl
>Continue
medication:
O __ 12cc/_/hr
x 12˚
Amik D7 _
N active
Cefta D2 _
D tolerated 3cc
>Continue
feeding
VCO
>Replace
losses (BM)
c/c with PNSS
slow IV
>Keep
thermoregulate
d
>Refer
December >Decrease Received inside SPO2: 100%

21,2022 present IVF incubator
connected to PR: 160
6:30pm >Start pulse oximeter
dibencozide RR: 54
D14 27-28 1mg/cap, 1 cap Ongoing IVF of
T: 37.1°C
to be mix with D5W 79.9,
Uncomfortable
milk once a Sodium 0.9,
without 02
day Potassium 0.8,
AA 40cc and
__ 40’s,(-)
>Continue Calcium 1.1 cc,
retractions medications: D5 10 cc total
of 80 cc/hr x
__ Amik D8/__ 106 cc/hr
Cefta D3 __
>Continue Intact and

increments in infusing well @
feeding (L)
6:30 PM >Discontinue È OGT intact

O2 and replaced
>Continue O2 support @
monitoring 0.5
>Refer Aseptic
technique while
>Decrease
handling
RBS to q12˚
Soft abdomen
>For STAT
RBS if with All due
decrease medicines given
activity.
Kept Monitored
WOF any
untoward signs
and symptoms
7pm 7am
>IVf of D5W
79.7 + Sodium
0.9 +
Potassium0.8 +
AA 40 +
CaGluc 1.6 at
total of 123
cc/ss x 05cc/hr
Peripheral intact
and infuse well
OGT for
feeding
(+) Soft
abdomen
Pinkish on color
and motor
activity
Scherema/
Edema
(-) Desaturation
from air
Assessed pt VS
taken and
recorded
Due meds given

and recorded
Kept
thermoregulated
Fed EBM
Seen at all times
Daily Morning
Newborn care
Suction
secretion as
cold
No untoward
signs and
symptoms
Endorsed
DECEMBER O2-95
22,2022 PR-160
RR-57
7:37 am >Decrease >All due meds TEMP-37.8
dibecozine to given
0.5cc OB
>Kept
>Refer thermoregulated
7:45 pm >Continue >Maintain

increments in aseptic
feeding 0.5cc technique when
of other 2 handling
feedings until
10cc is >Routine diaper
reached changes done
>Continue >Stimulated
Medications: sucky reflex
Cefta D4 H /7 >Nebulization
Dibencozide
/VCO >Suction and
secretion
>Continue
Newborn Care >Kept safe
>Keep >Updated AP
thermoregulate
d >Endorsed
>Refer
DECEMBER O2-99
23,2022 PR-153
RR-51
7:22 am >Continue >Pinkish in TEMP-37.0
increase in appearance
feeding
>Good suck
>Give 1 cc of
EBM for >Good motor
feeding then reflexed with
the rest PV OGT intact for
OGT feeding, with
oxygen support
4:15 pm >Refer via nasal
cannula at 0.5
>Repeat CBC > (-)

PC now Desaturation,
with soft non
>HGT tender
monitoring, abdomen.
6:15 pm HGT result at
6 pm is normal > (-) Retraction
>Refer >Assessed
general
condition of pt.
>Give D10
W 1.6cc now >Vital signs
IV take and
recorded
>Continue
movements in >All due Meds
feeding until given
10 cc is
reached. >WOF
untoward signs
>Continue and symptoms
Medications:
>Tum patient
Cefta D5 +1 side to side
Dibencozide
/VCO >Routine diaper
change done
>Continue
Newborn Care >EBM feeding
via OGT done
>Keep
thermoregulate >Nebulization
d done
>Refer >HGT
monitoring
ADD done
>For Newborn
screening >Maintain
aseptic
8:00 pm >Repeat HGT technique while
RBS- 49 at 8 am handling
>Ensured safety
>Give D10 W
1.6cc 5W now >Kept
9:30 pm(+) thermoregulated
Vomiting >Hgt 12:00 am
>Pt checked and
regulate
>Decrease
feeding to 7cc >Seen examine
q4 by Dr. Eclar
>NPO for 4 >Morning Care

hours done
>Endorsed
DECEMBER O2- 99
24, 2022 PR-139
RR-55
8:00 am >HGT now >Pinkish in TEMP-36.4
Pale looking appearance,
weak cry >Hook to O2 good suck, good
Poor motor support nasal cry, good motor
activity cannula to reflex with
1Lpm OGT intact for
feeding, on
>For cranial room air,
ultrasound
> (-) DOB,
>Refer (-) Desaturation,
(-) Retraction,
HGT: 23 (-) Crackles,
>Give D10 W (-) Cyanosis
1.6 cc now with soft non
tender abdomen
>For Stat CBC
PC >With ongoing
IVF of D5W
.>Refer 79.7 + Na 0.9 +
8:26 am K 0.8 + AA 40
+ CaGluc 1.6
>Reused total of 123 x
present IVF as 5cc/hr via
follows: TFR peripheral by
150 D7 intact and
D5W 23cc infusing well.
D50 3.9
Na (3) 0.3 >Aseptic
K (2) 0.25 general
AA (3) 13 condition of the
Cag/NC (2) pt.
0.5
41 cc >Vital signs
x 8 hrs to run taken and
at 5ccLhr recorded
>Repeat HGT >All due meds

12:40 pm 1hour after given
reviewing
fluids >EBM feeding
done
>Refer
>Kept
thermoregulated
>Maintain O2
at 1-2 LPM via >Aseptic
NC technique while
handling
>Continue
IVF at same >Routine diaper
rate changes done
>Continue >Nebulization
Medications: done
Cefta >Morning care

Aminoph done
>Keep >Endorsed
thermoregulate
d
>For Hgt
monitoring q4
>For repeat
CBC with
platelet at 6
pm
>Continue
Monitoring
>Hold feeding
>For cranial
ultrasound c/o
Dra. Mallillin
>Refer
DECEMBER >Resume >received O2-98
25,2022 feeding at 2cc patient inside PR-130
Q3 incubator RR-65
7:19 am pinkish in TEMP-36.4
>minimal appearance,
handling good suck, good
cry
>maintain O2
(-) DOB
(-)Retraction
11:40 am >Maintain O2 (-)Cyanosis
Pt is not in
>Continue distress
IVF
>maintained VS
>Decrease & recorded
HgT
monitoring to >kept
q6 thermoregulated
>Continue >maintained
feeding at 2cc aseptic
q 3 with SAP technique while
handling
>Continue
Medications: >routine diaper
changed done
Cefta D7
Aminoph
>Keep
thermoregulate
d
>Refer
DECEMBER >received pt O2-99
26,2022 inside PR-134
incubator, RR-56
6:50 am >FD 86 of support via NC, TEMP-37.2
new SIVP new (-)desaturtion
(-)retraction
>For repeat soft non tender
CBC PC, NA abdomen,
& KT ongoing UF of
D5VS 23,
>Refer K 0.3
AA 13
12:27 CaGluc 0.5cc
Na: 97 >Revise D5050 3.9
present IVF as IVTA of 4cc x
follow: TFR 5cc/hr, intact
150 and infusing
D5W 34.2 cc well, fair cry
D50 5.9 cc and motor
Na 0.7 cc activity, good
K 0.4 cc air entry, clear
AA 20 cc breath sounds
Ca 0.8cc
62 cc x >assessed
12 hrs to run at general
5cc/hr condition
>Refer >all due meds

3:50 given
>continue O2 >V/S taken and

at O.T LPM recorded
> continue NF >UF checked

and regulated
>for repeat Na
after 24 >kept safe
>for insertion >maintain

of IJ catheter aseptic
care of Dr. technique when
Saure once handling
consent is
secured “cut- >fed
down” EBM/OGT,
SHP then burp
>continue thereafter
Aminophylline
>routine diaper
>discontinue change done
or shhift IV
antibiotics to >turn pt side to
Piperacillin- side
Tazobactam
70mg SIVP of > Nebulization
12 done
>suction >CPT done

secretions
abruptly, PRN
>keep
thermoregulate
d during cut-
down
>refer

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PREMATURITY, LOW BIRTH WEIGHT, AND NEONATAL SEPSIS

COLLEGE OF NURSING AND MIDWIFERY

OUR LADY OF THE PILLAR COLLEGE – CAUAYAN

CAUAYAN CITY, ISABELA

OF THE REQUIREMENTS FOR THE DEGREE

BACHELOR OF SCIENCE IN NURSING

AGACER, DANIEL JADE GULAPAN, PRINCESS MAE

AGUILAR, NICOLE MALAGUIT, ROSEGIEWEN

ALEGA, IRISH PASCUA, PATRICIA JOY

DAQUIOAG, ANNA MAE RAMIL, SAHARA

ESPOSO, PHOEBE TAGUINOD, QUEEN

 Understand what Prematurity, Low Birth Weight, and Neonatal Sepsis is

According to World Health Organization (WHO), PRETERM is defined as babies born

According to JoAnne Silbert-Flagg’s Maternal and Child Health Nursing Care of

Infant Morbidity rate per 1000 live birth

Batanes 256 139 4 4 1

Cagayan 16,013 6,669 169 9 3

Isabela 19,172 6,862 167 18 16

Nueva Vizcaya 8,982 2,487 93 37 3

Quirino 3,439 936 45 9 2

City of Cauayan 2,402 869 23 8 1

Ilagan City 2,422 785 19 15 1

City of Santiago 3,006 899 37 27 -

E. RISK FCTORS (MODIFIABLE & NON MODIFIALE)

F. SIGNS AND SYMPTOMS

H. DIAGNOSTIC AND LABORATORY EXAMINATION

1. RBS MONITORING SHEET

J. NURSING MANAGEMENT AND DIAGNOSIS

PREMATURITY&LOW BIRTH WEIGHT, AND SEPSIS

Batanes 256 139 4 4 1

Cagayan 16,013 6,669 169 9 3

Isabela 19,172 6,862 167 18 16

Nueva Vizcaya 8,982 2,487 93 37 3

Quirino 3,439 936 45 9 2

City of Cauayan 2,402 869 23 8 1

Ilagan City 2,422 785 19 15 1

City of Santiago 3,006 899 37 27 -

E. RISK FACTORS (MODIFIABLE & NON MODIFIABLE)

F. SIGNS AND SYMPTOMS

2. RBS MONITORING SHEET

COMPLETE BLOOD COUNT

 Synthetic surfactant (endotracheal in a liquid form in a vial) , a medication used to treat

J. NURSING MANAGEMENT AND DIAGNOSIS

Batanes 256 139 4 4 1

Cagayan 16,013 6,669 169 9 3

Isabela 19,172 6,862 167 18 16

Nueva Vizcaya 8,982 2,487 93 37 3

Quirino 3,439 936 45 9 2

City of Cauayan 2,402 869 23 8 1

Ilagan City 2,422 785 19 15 1

City of Santiago 3,006 899 37 27 -

Group B Streptococcus (GBS)

E. RISK FACTOR (MODIFIABLE & NONN MODIFIABLE

 Cardiopulmonary. Tachypnea, respiratory distress (grunting, flaring, and retractions), apnea

 Tachycardia, bradycardia, Tachypnea, lethargy, hypotonic, irritability- (always look at trends

• Meningitis. Meningitis is an inflammation (swelling) of the protective membranes covering the

H. DIAGNOSTIC AND LABORATORY EXAMINATION