M A T U RE

P RE U RE
S T MA T
PO

CHRISTINE THERESE C. TEJADA, MAN

PREMAT
URE
Ø globally celebrated
awareness day to
increase awareness of
preterm births as well
as the deaths and
disabilities due to
prematurity and the
simple, proven, cost-
effective measures
that could prevent
them.
 A neonate Primary
born before concern relates
to immaturity of
37 weeks of
all body
gestation
systems.

a premature birth
takes place more Weight: <2500 g
than three weeks (5lb 8 oz)
before the due
date.
 Risk factors previous preterm labor or
premature birth
Pregnancy with
twins, triplets or
Problems with the uterus,
other multiples
cervix or placenta

n s, pa rt icu la rly
Some infectio
Smoking cigarettes, lu id a n d lo w e r
of the amniotic f
drinking alcohol or using genital tract
illicit drugs
 Risk factors

Som e c h ro n ic co n dit io n s,
Being underweight or
such as high blood overweight before
p res su r e a n d dia b e t es
pregnancy

Stressful life events, such as

the death of a loved one or Multiple miscarriages
domestic violence or abortions
 Clinical
Manifestations
• Shallow and Irregular respirations w/
periods of apnea
• Body temperature is below normal
• NB has poor suck & swallow reflexes
• Diminished bowel sounds
• Increased or decreased urinary output
• Extremities are thin, with minimal creasing
on soles & palms
• NB extends extremities & does not
maintain flexion
• Lanugo on skin & in the hair on the NB’s
head is present in woolly patches
• Skin is thin w/ visible blood vessels &
minimal subcutaneous fat pads
• Skin may appear jaundiced
• In boys ,testes are undescended while in
girls, Labia are narrow with enlarged clitoris
Complications
• Apnea
• Respiratory distress
syndrome
• Patent ductus arteriosus
• Intraventricular
hemorrhage
• Necrotizing enterocolitis
• Retinopathy of prematurity
• Jaundice
• Anemia
• Bronchopulmonary dysplasia
• Infections
Long Term Complications
• Autism
• Neurologic defects
• Lung problems
• Vision loss
• Auditory defects
 Alteration in Respiratory Physiology:

Preterm NB is at risk for

respiratory problems
Critical factors in the development of respiratory distress includes:
1. The preterm infant is unable to produce adequate amounts of
surfactant.
-Inadequate surfactant lessens compliance
-the inspiratory pressure needed to expand the lungs with air is
higher.
-The collapsed or atelectasis alveoli will not exchange oxygen &
carbon dioxide
-The infant becomes hypoxic, and pulmonary blood flow is not
sufficient
-The preterm NB available energy is depleted.
2. The muscular coat of pulmonary blood vessels is
incompletely developed.
- The pulmonary arterioles do not constrict as well in
response to decrease oxygen levels.
- Lower pulmonary vascular resistance leads to left to right
shunting of blood through the ductus arteriosus back into
the lungs
 Alteration in Thermoregulation:
- Major problem in preterm NBs is heat loss.
Two factors limiting heat production:
a. The availability of glycogen in the liver &
b. The amount of brown fat available for
metabolism.
Physiologic & Anatomic factors causes heat loss in the
preterm infant:
1.The preterm baby has a higher ratio of body surface to
body weight.
2.The preterm baby has very little subcutaneous fat.
3.The preterm baby has thinner, more permeable skin than
the term infant.
4.The posture of the preterm baby.
5.The preterm baby has a decreased ability to vasoconstrict
superficial blood vessels & conserve heat in the body core.
 Alteration in Gastrointestinal Physiology
Ingestion, digestive & absorption problems:
1.Aspiration
2.Difficulty in meeting high caloric & fluid needs for growth
3.Limited ability to convert certain essential amino acids to
nonessential amino acids.
4.Inability to handle the increased osmolality of formula
protein d/t kidney immaturity.
5. Difficulty absorbing saturated fats.
6. Difficulty w/ lactose digestion
7. Rickets & significant bone demineralization.
8. Increased basal metabolic rate & increased oxygen
requirement.
9. Feeding intolerance & necrotizing enterocolitis.
 Alteration in Renal Physiology:
Specific Characteristics:
1.GFR is lower because of decreased renal blood flow.
2.Preterm infant’s have limited ability to concentrate urine or to
excrete excess amounts of fluids.
3.Kidney’s of the preterm infant begin excreting glucose at a lower
serum glucose level.
4.The kidneys buffering capacity is reduced, predisposing the
infant to metabolic acidosis.
5.The immaturity of the renal system affects the preterm infant’s
ability to excrete drugs.
 Nursing
Management
 Physical characteristics:
• Color
Nursing Assessment: • Nails
Assess the physical • Skin
characteristics & • Genitals
gestational age of the • Vernix caseosa
• Resting position
preterm NB accurately
• Lanugo
to anticipate the special
• Cry
needs & problems of the • Head size
baby. • Reflexes
• Ears
• Activity
• Monitor vital signs
• Maintain cardiopulmonary functions
• Administer oxygen & humidification as prescribed
• Monitor I &O & electrolyte balance
• Monitor daily weight
• Maintain NB in a warming device
• Position every 1-2 hours & handle NB carefully
• Avoid exposure to infections
• Provide NB with appropriate stimulation
 Nursing
Diagnosis
• Impaired gas exchange
• Altered nutrition
• Ineffective
thermoregulation
• Fluid volume deficit
• Ineffective family coping
 Planning
and
Implementation
 Signs of respiratory distress:
• Cyanosis
t e n a n ce • Tachypnea
M ai n • Retractions
p ir a t o ry
of re s • Expiratory grunting

f u n c t io n • Nasal flaring
• Apneic episodes
• Presence of rales or ronchi on
auscultation
• Diminished air entry
 1.Allow skin to skin contact
between mother & NB “Kangaroo

t e n a n c e Care”
Main 2.Warm & humidify oxygen
n e u t ra l
of 3.Place the baby in a double-

t h e rm a l walled incubator
4.Avoid placing the baby in cold
o n m e n t
e n v i r surfaces
5.Used warmed ambient humidity.
6.Keep the skin dry & place a cap
on the baby’s head
 7. Keep radiant warmers, incubators & cribs

away from windows& cold external walls & out

t e n a n c e of drafts

Main 8.Open incubator portholes & doors only when

n e u t ra l
of
necessary.

9.A skin probe is used to monitor the NB

t h e rm a l temperature.

o n m e n t
i r
10.Warm formula or stored breast milk before
e n v feeding.

11.Use reflector patch over the skin temperature

probe when using a radiant warmer bed.

 Signs of Dehydration:

t e n a n c e 1. Sunken fontanelle
Main 2. Poor skin turgor

o f f l u i d & 3. Dry oral mucus membranes

4. Decreased urine output
c t ro l y t e
e le 5. Increased specific gravity

st a t u s (>1.013)
 Provision of
adequate nutrition
& prevention of
fatigue during
feeding
Treatment
Hospital neonatal intensive care units (NICUs) are
designed to provide round-the-clock care for
premature babies and full-term babies who develop
problems after birth. In the NICU, the baby will
probably be kept in an incubator — an enclosed
plastic bassinet that's kept warm to help the baby
maintain normal body temperature. Because
preemies have immature skin and very little body
fat, they often need such care to stay warm.
At first, the baby may receive fluids and nutrients
through an intravenous tube. Breast milk may be
given later through a tube passed through the
baby's nose and into his or her stomach. When the
baby is strong enough to suck, breast-feeding or
bottle-feeding is often possible. The antibodies in
breast milk are especially important for preemies.
Intensive care for
your premature
baby
POSTMA
T URE
 Near the end of a
delivered after term pregnancy,
more than 42 placental function
decreases, providing
weeks in the
fewer nutrients and
uterus less oxygen to the
fetus

have dry, peeling, require

resuscitation, but
loose skin and may
generally treatment
appear emaciated
focuses on
because they have
providing good
not received
nutrition and general
sufficient nutrition
care
Pathophysiology
 If the placenta If placental function
decreases, the fetus may not
continues to secure adequate nutrition.
function well, the The fetus will utilize its
subcutaneous fat stores for
fetus will continue
energy, and wasting of
to grow w/c results subcutaneous fat occurs,
in an LGA infant resulting in fetal dysmaturity
syndrome
 e s of F et a l
3 stag
at ur it y sy nd r o me
Dy s m

Stage 1 –Subacute Stage 2 – Acute Stage 3 – Chronic placental

placental insufficiency placental insufficiency
insufficiency • All features of stage 1 &
• Dry, cracked, peeling, 2
• All features of
loose & wrinkled skin • Green staining of skin,
stage 1 nails, cord & placental
• Malnourished
• Meconium membrane
appearance staining • A higher risk of fetal
• Open eyed & alert • Perinatal intrapartum or neonate
baby depression death
Pathophysiology

The NB is at Chronic
intrauterine Post term infants
increased risk for are susceptible to
hypoxia causes
developing
increased fetal hypoglycemia
complications erythropoietin & because of the
related to RBC production rapid use of
uteroplacental resulting in
polycythemia.
glycogen stores.
perfusion & hypoxia.
 Clinical
Manifestations
• Dry, cracked, peeling skin, over grown
nails.
• Abundant scalp hair
• Visible creases on palms and soles of
feet
• Minimal fat deposits
• Green, brown or yellow coloring of skin
Why is postmaturity a concern?
• Aging placenta
• Meconium aspiration
• Oligohydramnios
• Cephalopelvic disproportion
• Hypoglycemia
• Polycythemia
• Cold stress
Complications
1.Hypoglycemia
2.Meconium aspiration
3.Polycythemia
4.Seizure
5.Cold stress
Management
• Determining whether the due date is
accurate
Tests to determine the condition of the fetus &
placental functioning:
• Ultrasound
• Non-stress tests
• Contraction stress tests
• Biophysical profiles
Treatment
• Postmature newborns who experience low oxygen levels and
fetal distress may need resuscitation at birth.
• If meconium is present in the amniotic fluid and the newborn
is lethargic, a tube is passed into the windpipe (trachea) to
suction as much meconium as possible from the respiratory
tract.
• If meconium has been breathed into the lungs, a ventilator
may be needed to support breathing.
• Intravenous sugar (glucose) solutions or frequent breast milk
or formula feedings are given to prevent hypoglycemia.
 Nursing
Intervention
• Cardiopulmonary
monitoring
• Provide warmth
• Monitor glucose level and
initiate feeding or IV glucose
administration
• Monitor RBC, Hgb & Hct
 Nursing
Diagnosis
1.Hypothermia
2.Altered nutrition: less than
body requirement
3.Impaired gas exchange in the
lungs & at the cellular level