PREMATURITY

THE MULAS
MANSA SCHOOL OF
NURSING - 2011
 INTRODUCTION
• Prematurity accounts for the largest number
of admissions in NICU.
• It places the infant not only to neonatal
complications but also other high risk factors
such as congenital anomalies
• The incidence is lower in women in middle
and high socioeconomic class who are
generally in good health, well nourished,
prompt to seek health care and
comprehensive pre-natal care
 Introduction
• Pre term babies have an increased risk of
death in the first year of life (infant mortality)
with most of this occurring in the first month
of life (neonatal mortality)
• Prematurity accounts for 10% of neonatal
mortality or 500,000 deaths per year
• The earliest gestational age at which the
infant has atleast 50% chance of survival is
refered to as the limit of viability
 Prematurity
• Def : it is birth of a baby after 28 weeks of
gestation but before 37 complete weeks
calculated from the first day of the last
normal menstrual period with the weight of
2.5kg or below.
• Premature infant is one that has not yet
reached the level of featal development that
generally allows life outside the uterus.
• In human featus, several organ system
mature btn 34th and 37th week, and reaches
adequate maturity by the end of this period
 Prematurity
• One of the main organ mostly affected
by premature birth is the lungs.
• Prematurity can be reduced to a small
extent by preventing pre term birth
 Prematurity
• Low birth weight or small for gestational
age- baby born with 2.5kg or less regardless
of the period of gestation
• Light for date – this is a baby born with a
birth weight of less than 10% for estimated
period of gestation
• Post mature – baby born after 42 weeks of
gestation calculated from the last normal
menstrual period
 Predisposing factors
• The cause of premature labour remains
elusive but four different pathways have
been identified that can result in premature
labour
- Precocious featal endocrine activation
- Uterine over distension
- Decidual bleeding
- Intra uterine inflammation/infections
NB: Activation of one or more of this may
happen gradually over weeks/months
 Predisposing factors
• The following factors have been
identified to be associated with pre
term birth
- Maternal related
- Featal related
- Placenta related
- others
 Predisposing factors
• Maternal related factors includes
- Cervical incompetence
- Severe maternal illness e.g. TB,
HIV,STIs,diabete mellitus,malaria,anaemia
and infections of the urinary tract
- Age :outside optimum child bearing age i.e.
below 18 years and above 35years ( height
and weight of the mother)
- Pre eclampsia
 Predisposing factors
• Featal related factors includes
- Rhesus factor incompatility
- Multiple pregnancy
- IUGR
- multiparity
 Predisposing factors
• Placenta related factors includes
- Placenta insufficiency
- APH: this includes placenta abruptio and
placenta previa
Other causes: - drugs such as quinine,
alcohol and narcotics
- Socio economic class leading to malnutrition
- Teenage pregnancy
- Trauma
- Social habits such as smoking
 Characteristics of a premature
baby
• Pre term babies are imature and not be able
to adapt to extra uterine life. Its
characteristic features is related to its
gestational age
• Head :
• its large in proportion to the body with a
triangular face, pointed chin and a worried
expression
• Sutures and fontanelles are widely
separated and the skull bones are soft
 Characteristics of a
premature baby
• Skin :
• Its very thin and appears brick red due to
absence of the subcutaneous fat.
• Surface veins are absent and the skin is
covered by varied amount of soft hair
(lanugo)
• Upper and lower limbs:
• They are thin and the nails are soft
• Palm and planter creases are not well
formed
 Characteristics of a
premature baby
• Chest :
• It is small and narrow i.e less than
33cm
• Breast tissue is not palpable
• Abdomen :
• It is large and often distended and
umbilicus appears to be low set
 Characteristics of a
premature baby
• Genitalia :
• It is small and female the labia majora does
not cover the labia minora hence the minora
appears more prominent
• In males the testes may not have been
descended into the scrotum
• The scrotum will have very few rugae
- Muscle tone is very poor
- The baby appears feeble, drowsy and
sucking reflex is poor or entirely absent
 Nursing management
• Aims
- To initiate and maintain respiration
- To prevent hypothermia
- To prevent infections
- To prevent hypoglycaemia
 Immediate preparation
• Pregnant women threatened to have
pre mature labour should be
transferred to the hospital were there
are NICU and skilled personnel
• Great care must taken during labour
and avoid drugs that depresses the
respiratory system
• No nursery can provide care
equivalent to the uterus, but efforts can
be made to have simillar environment
 Immediate preparation
• Delivery room should be prepared and
should have a room temperature of
between 24 to 36 degrees
• Resuscitative equipment such as IV
set tray, incubator, oxygen cylinder,
suction apparatus, intubation tray and
drugs should be readily available such
as sodium bicarbonate, vitamin K,
adrenaline, naloxine hydrochloride and
 Immediate care
• An episiotomy may be performed to shorten
the second stage of labour thus reducing the
risk of intracranial injury
• As soon as the baby is delivered the cord is
clumped and baby wiped
• The baby is covered and received in a warm
incubator
• Suctioning should be done or a fine mucus
extractor may be used
• Oxygen 1/litre should be given until
respiration is well established
 Immediate care
• If the baby is severely asphyxiated
early intubation and positive pressure
ventilation should be done
• Injection Vitamin K 0.5mls may be
given to prevent bleeding
 Initiate and maintain respiration

• The respiratory centre of the baby is not fully

developed, the alveoli of the lungs contains
little or no surfactant and the diaphragm
and intercostal muscle are weak
- Remove secretions immediately after
through suctioning
- Commence oxygen ( by catheter-0.5-1l/min
ute, if mask- 2l/minute)
- Intubation can be done for babies who cant
breath on their own and are severely
asphyxiated
 Maintenance of body
temperature
• In a pre-term baby the temperature
regulating centre is immature and there is a
large skin surface area through which heat
can be lost coupled with little subcutaneous
tissue, therefore the baby is prone to
hypothermia
- Put the baby in an incubator and the
temperature should be checked hourly until
the baby is stable
 Maintenance of body temperature

- In absence of the incubator, kangaroo

method is used to nurse the baby.
- Maintain the room temperature at 36.2
to 36.7
 Observation
• Observe vital signs hourly
- Temperature to monitor hypothermia and
rule out infection ( 36.2 to 36.8)
- Respiration to detect any respiratory
dificulties ( 30 to 60 breaths /minute)
- Heart rate to monitor cardiac functions ( 120 to
160 beats/min

- Check the reflex for hypotonia

- Observe the skin for colour in order to detect
cyanosis
 Observation
• Watch out for signs of jaundice
• Observe the bowel and bladder functions
• Do daily weight checks and weight gain
should be about 100g to 150 g /week
• Check the general behaviour or activity of
the baby in order to detect lethargy
• Observe the feeding pattern
 Nutrition
• Early feeding is very important to
prevent hypoglycemia. Do daily sugar
test ( 2.5mmol/L to 7.2mmol/ L) if less than
this suspect hypoglycemia
• This can lead to fits and mental
retardation
• Child is fed through NGT or by cup, if
unable 10% dextrose is given IV
• When feeding through NGT always
give expressed breast milk.
 Nutrition
• Give 60mLs/ kg body weight in the first 24
hours
• 2nd day 90mLs/ kg body weight
• 3rd day 120mLs/ kg body weight
• 4th day 150mLs/ kg body weight
• All the amount is given in divided doses.
• Usually this babies are deficient in iron and
vitamins hence are supplemented
especially two weeks after birth
 Nutrition
• Give small frequent feeds and ensure that
they are not overfed
• Record all the feeds on the feeds charts
Hygiene
- top and tail is done
- Cord care to prevent infection
- All infection preventive measures are done
- Change soiled linen and nappies for comfort
- Allow the mother to participate in the care to
promote baby mother bond
 Prevention of infections
• Keep the unit where the baby is being
nursed clean by dump dusting
• Scrupulous hand washing before and
after handling the baby
• Members of staff should be free from
infectious diseases
• Isolation of babies with infectious
conditions
• Minimize the number of visitors
 I.E.C
• Educate the mother on the importance of
hand washing and infection prevention
measures
• Educate the mother on the danger signs
such as excessive vomiting, fever, fits, and
abdominal distension.
• Stress the importance of keeping the baby
warm
• Explain the importance of feeding the baby
regularly
 I.E.C
• Explain to the mother the importance
of immunization and children’s clinic
• Stress the importance of review dates
and if any complication arises
 Criteria for removing baby
from the incubator
• When the baby is able to maintain
temp. even when the incubator is off.
• When there is no apnoeic spells in the
last 5 days
• When there is a constant weight gain
and with no difficulties in breathing
• NB: the baby should be observed
24hour and if an abnormality occur,
should be taken back in the incubator
 Criteria for discharge
• When there is a steady weight gain
• When baby is able to feed well from
the breast
• When the mother has become capable
to take care of the baby at home
 Prevention of prematurity
• Good antenatal care for early detection
and treatment of predisposing factors
• Discourage indiscriminate use of over
the counter drugs
• Discourage alcoholism
 Complications
• Respiratory distress syndrome- major
cause of death. This a condition in
which there is failure to maintain
respiration due to lack of surfactant
• Hypothermia –due to immature heat
regulating centre in the medulla and
thin subcutaneous fat
• Infection – due to premature baby born
before the IgG is passed to the baby in
the last trimester
 Complications
• Hypoglycaemia – due to poorly
developed glycogen store and poor
feeding
• Anaemia – due to low iron stores as a
result of short intra uterine period. The
capillaries are also weak and therefore
there is a tendency to bleed which may
also lead to anaemia
 Complications
• Cerebral haemorrhage- featal skull very fragile
and does not offer the needed protection to the
brain and there is also vit. K deficiency
• Oedema –due to poor muscle tone and
inadequate venous return causing accumulation
of fluids in the extremities
• Retrolential fibroplasia- condition characterized
by proliferative changes in the retinal vessels
followed by haemorrhage and peripheral
separation of the retina. It is caused by
excessive oxygen concetration
 Complications
• Jaundice – due to immature liver
leading to failure of conjugation of
bilirubin which accumulates in the
blood stream
THE END

THANK
YOU!
THE MULAS
2010-MANSA SCHOOL OF
NURSING

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