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 Birth weight is the single most important marker of
adverse perinatal and neonatal outcome.
 Babies with a birth weight...
 Preterm infants (also called premature infants) are those
born before the beginning of 38th week of gestation.
 Moderat...
 About 10 to 12 percent of Indian babies are born
preterm ( less than 37 completed weeks) as
compared to 5 to 7 percent i...
 The mechanisms initiating normal labour are not
clearly understood and much less is known about
the triggers that initia...
 Poor socio-economic status
 Low maternal weight
 Chronic and acute systemic maternal illness
 Antepartum hemorrhage
...
 Cigarette smoking during pregnancy
 Threatened abortion
 Acute emotional stress
 Physical exertion
 Sexual activity
...
 The labour is often induced before term when there is
impending danger to mother or foetal life in-utero.
Maternal diabe...
 Their size is small with
relatively large head.
 Crown-heel length is
less than 47 cm
 Head circumference is
less than...
 The general activity is
poor
 Their automatic reflex
responses such as moro
response, sucking and
swallowing are sluggi...
 Disproportionately
large head size
 Sutures are widely
separated and the
fontanels are large
 Small chin, protruding
e...
 Optic nerve is often un-
myelinated but presence of
papillary membrane makes
its visualization difficult.
 Ear cartilag...
 skin is thin, gelatinous,
shiny and excessively
pink with abundant
lanugo and very little
vernix caseosa.
 Edema may be...
 Subcutaneous fat is
deficient and breast
nodule is small or
absent.
 Deep sole creases are
often not present.
 In male testes are
undescended and
scrotum is poorly
developed.
 In female infants, labia
majora are widely
separated exposing
labia minora and
hypertrophied clitoris.
 Immaturity of central
nervous system is
expressed as inactivity
and lethargy, poor
cough reflex and
in-coordinated sucki...
 Resuscitation difficulties at
birth and recurrent apneic
attacks.
 Retinopathy of prematurity .
 Vulnerable for intra-...
 Cuboidal alveolar lining-
poor alveolar diffusion of
gases
 Hyaline membrane
disease
 Breathing is mostly
diaphragmati...
 Pulmonary aspiration
and atelectasis
 They are vulnerable to
develop chronic
pulmonary
insufficiency
 The closure of ductus
arteriosus is delayed.
 In grossly immature
infants( less than 32
weeks) EKG shows left
ventricul...
 Due to poor and
incoordinated sucking and
swallowing.
 Animal fat is not tolerated as
well as the vegetable fat.
 Regu...
 Abdominal distention and
functional intestinal
obstruction
 Entero-colitis
 Immaturity of the glucuronyl
transferase s...
 Hypothermia is invariable.
 Excessive heat loss due to
relatively large surface area
due to paucity of brown fat
in the...
 Infections are the important
cause of neonatal mortality.
 The low levels of IgG
antibodies and inefficient
cellular im...
 The blood urea nitrogen is
high due to low glomerular
filtrate rate.
 The renal tubular ammonia
mechanism is poorly
dev...
 Preterm has to pass
4 to 5 ml of urine excrete
one milliosmole of solute
Baby gets dehydrated.
 The solute retention an...
 Poor hepatic
detoxification and
reduced renal
clearance make a
preterm baby
vulnerable to toxic
effects of drugs
 Develop anemia around 6
to 8 weeks of age.
 Deficiencies of folic acid
and vitamin E.
 Develop haemolytic
anemia, thro...
 These babies are prone
to develop :
Hypoglycaemia
Hypocalcemia
Hypoprotenemia
Acidosis and
Hypoxia.
 Bed rest and sedation.
 Tocolytic agents
Sympathomimetic agents-beta-2-adrenergic
receptors.
Isoxsuprine (duvadilan)-be...
 Maturity of fetus should be ascertained by
examination of amniotic fluid for phosphatidyl
glycerol or L/S ratio.
 Corti...
 Inj.betamethasone 12mg IM
every 24 hours --2 doses or
dexamethasone 6mg IM
every 12 hours for 4 doses.
 The optimal eff...
 Delayed clamping of cord.
 Elective intubation of extremely LBW babies (<1000g).
 Should be promptly dried, kept effec...
 Vital signs .
 Activity and behaviour.
 Colour.
 Tissue perfusion.
 Fluids, electrolytes and ABG’s.
 Tolerance of f...
 The vital signs should be stable.
 The healthy baby is alert and active, looks pink
and healthy, trunk is warm to touch...
 Create a soft, comfortable,
“nestled” and cushioned bed.
 Avoid excessive stimuli.
 Effective analgesia and
sedation.
...
 Provide effective and safe
oxygenation.
 Partial parenteral nutrition
and give trophic feeds
with expressed breast milk...
 Thermo-neutral environment.
 Application of oil or liquid
paraffin on the skin.
 Should be covered with a
cellophane o...
 Oxygen should be administered
with a head box when SpO2 falls
below 85% and it should be
gradually withdrawn when SpO2
g...
 Early phototherapy is
adviced to keep the serum
bilirubin level within safe
limits in order to obviate the
need for exch...
 The handling should be bare
minimum.
 Vigilance should be
maintained on all
procedures.
 Early diagnosis and prompt
tr...
 Intra-venous dextrose solution (
10% dextrose in babies >1000g
and 5% dextrose in babies
<1000g).
 Trophic feeds with E...
Fluid requirements are higher in LBW infants due
to:
 Greater insensible water losses
 Faster breathing rates
 Decrease...
Birth weight
(g)
Fluid rate
(ml/kg/day)
500 - 600 140 - 200
601 - 800 120 - 130
801 - 1000 90 - 110
1000 - 1500 80 - 100
>...
 Fluid rate can be increased by 10-20 ml/kg/d
to gradually reach 150 ml/kg/d
 Fluid requirements need to be individualiz...
Infants with BW ≤ 1000 g
Infants with BW ≤ 1500 g, done in
conjunction with slowly advancing enteral
nutrition
Infants ...
 Glucose : 6 - 8 mg/kg/min
 Amino acids : 1.5 - 2 g/kg/d
 Lipid : 0.5 - 1 g/kg/d
 Sodium : 2 - 4 mEq/kg/d
 Potassium ...
Trophic feeding/ Gut priming
Practice of feeding very small amounts of enteral nourishment
to stimulate development of the...
 Breast milk or ½ or full strength preterm formula at
10ml/kg/d by intermittent gavage/ continuous
nasogastric drip
 Inc...
PRETERMS
 <1200 g/ <32 wks: IV fluids for first 2-3 days, once
stable start gavage feeding
 1200-1800 g/ 32-34 wks: Star...
Advantages:
 Higher concentrations of amino acids
 Higher concentrations of essential fatty acids
 Lower renal solute l...
Disadvantages:
Low concentrations of Vitamin
D, Ca, P
Inadequate iron
 Energy : 130 - 175 Kcal/kg/d
 Protein :3.4 - 4.2 g/kg/d
 Fat :6 - 8 g/kg/d
 Na :3 - 7 mEq/kg/d
 Cl :3 - 7 mEq/kg/d
...
 Multivitamin drops.
 Iron supplementation.
 Vitamin E supplementation.
 Supplements of calcium
(220mg/day) and
phosph...
 Gentle touch, massage,
cuddling, stroking and flexing.
 Rocking bed or placing a
preterm baby on inflated
gloves.
 Soo...
Kangaroo care is placing a
premature baby in an upright position on a
mother’s bare chest allowing tummy to
tummy contact...
 Body temperature
 Mothers have thermal synchrony with their baby.
 The study also concluded that when the baby was
col...
 Breastfeeding:
Kangaroo care allows easy access to the breast and
skin-to-skin contact increases milk let-down.
 Increase weight gain
Kangaroo care allows the baby to fall into a deep
sleep which allows the baby to conserve energy fo...
 Increased intimacy and attachment
 A single dose of
dexamethasone 0.2mg/kg IV at
4 hours of age.
 Inhaled steroids.
 Nosocomial infections
 Hypothermia
 Respiratory distress syndrome
 Aspiration
 Patent ductus arteriosus
 Chronic lu...
 Loss is upto a maximum of 10
to 15 percent.
 Regain their birth weight by
the end of second week of
life.
 Excessive w...
 Routine oxygenation without
monitoring.
 Intravenous immuno-globulins.
 Prophylactic antibiotics.
 Prophylactic admin...
 It is desirable to administer 0-
day vaccines(BCG, OPV,
HBV) on the day of
discharge from the hospital.
 If mother is H...
 Live vaccines should be
avoided in symptomatic HIV-
positive mothers.
 WHO recommends that BCG
and oral polio vaccine c...
 The family dynamics are
greatly disturbed.
 The problems and issues
should be handled with
equanimity, compassion,
conc...
 A baby who is feeding from the
bottle or cup and is reasonably
active with a stable body
temperature, irrespective of hi...
 The mother should be
mentally prepared and
provided with essential
training and skills.
 The mother- baby dyad
should b...
 At the time of discharge,
the baby should be having
daily steady weight gain
velocity of at least 10g/kg.
 The home con...
 Common infective illnesses,
reactive airway disease,
hypertension, renal dysfunction,
gastro-oesophageal reflux.
 Feedi...
 Neuro-motor development,
cognition and seizures.
 Eyes: Retinopathy of
prematurity, vision, strabismus.
 Hearing.
 Be...
 She must be explained
about the importance of
asepsis.
 Keeping the baby warm
and ensuring satisfactory
feeding routine...
 The infant should be effectively covered taking care to
avoid smothering.
 Woollen cap, socks and mittens should be wor...
 The cot of the mother and infant should be located
away from the walls .
 The mother and health worker should be traine...
 Whenever feasible, breast feeding is ideal and
must be encouraged.
 When infant is unable to suck from the breast, EBM
...
 The risk of neurodevelopmental
handicaps is increased 3-fold for LBW
babies and 10-fold for very LBW
babies(<1500g).
 T...
 15 to 20 % incidence of
neurological handicaps in the
form of CP, seizures, ROP,
hydrocephalus, deafness and
MR.
 There...
 Obtain detailed antenatal, intra-
natal history.
 Assess the gestational age and
birth weight of the baby.
 Assess the...
1. Impaired gas exchange related to immaturity of
lungs and deficiency of surfactant
 Assess the respiratory pattern and ...
2.Impaired breathing pattern : distress related to
immaturity and surfactant deficiency
 Assess the respiratory rate, hea...
3. Activity intolerance related to increased work of
breathing secondary to distress
 Arrange to provide routine care
 S...
4. Ineffective airway clearance related to excessive
trachea-bronchial secretions
 Assess the child’s breathing pattern
...
5. Hypothermia related to immature thermoregulation
system
 Monitor vital signs frequently
 Wrap the baby well and keep ...
6. Imbalanced nutrition less than body requirement
related to feeding difficulty, respiratory distress, or
NPO status
 As...
7. Fatigue related to increased demand for nutrients
and deterioration of the general condition of the
baby
 Assess the g...
8. Risk for complications hypotension, shock, cerebral
hypoxia related to progression of the disease condition
 Assess th...
9. Anxiety of parents related to the outcome of the
newborn condition
 Assess the mental status, anxiety and knowledge of...
10. Interrupted mother-child bonding related to
infectious process
 Assess the breast feeding ability including sucking
a...
11. Interrupted family process related to
hospitalization of the newborn
 Assess the mental status, anxiety and knowledge...
12. Knowledge deficit regarding care of the baby
and treatment modalities
 Assess the knowledge level of the care giver
...
 Definition and incidence
 Causes of prematurity
 Clinical features
 Physiological handicaps
 Management
 Care of pr...
Preterm babies..............
Preterm babies..............
Preterm babies..............
Preterm babies..............
Preterm babies..............
Preterm babies..............
Preterm babies..............
Preterm babies..............
Preterm babies..............
Preterm babies..............
Preterm babies..............
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Preterm babies..............

  1. 1.  Birth weight is the single most important marker of adverse perinatal and neonatal outcome.  Babies with a birth weight of less than 2,500g, irrespective of their gestation are classified as low birth weight babies. These include both preterm and small-for-dates babies.
  2. 2.  Preterm infants (also called premature infants) are those born before the beginning of 38th week of gestation.  Moderately preterm infants are those born between 32 and 36 completed weeks of gestation.  Late preterm infants fall in the moderately preterm group.  Very preterm infants are those born before 32 completed weeks of gestation. (Mehrban Singh, 2010)
  3. 3.  About 10 to 12 percent of Indian babies are born preterm ( less than 37 completed weeks) as compared to 5 to 7 percent incidence in the west.  These infants are anatomically and functionally immature and therefore their neonatal mortality is high.
  4. 4.  The mechanisms initiating normal labour are not clearly understood and much less is known about the triggers that initiate labour before term. Spontaneous Induced
  5. 5.  Poor socio-economic status  Low maternal weight  Chronic and acute systemic maternal illness  Antepartum hemorrhage  Cervical incompetence  Maternal genital colonization and infections
  6. 6.  Cigarette smoking during pregnancy  Threatened abortion  Acute emotional stress  Physical exertion  Sexual activity  Trauma  Bi-cornuate uterus  Multiple pregnancy  Congenital malformations
  7. 7.  The labour is often induced before term when there is impending danger to mother or foetal life in-utero. Maternal diabetes mellitus Placental dysfunction as indicated by unsatisfactory foetal growth Eclampsia Foetal hypoxia Antepartum haemorrhage and Severe rhesus iso-immunization.
  8. 8.  Their size is small with relatively large head.  Crown-heel length is less than 47 cm  Head circumference is less than 33cm but exceeds the chest circumference by more than 3cm.
  9. 9.  The general activity is poor  Their automatic reflex responses such as moro response, sucking and swallowing are sluggish or incomplete.  The baby assumes an extended posture due to poor tone.
  10. 10.  Disproportionately large head size  Sutures are widely separated and the fontanels are large  Small chin, protruding eyes due to shallow orbits and absent buccal pad of fat.
  11. 11.  Optic nerve is often un- myelinated but presence of papillary membrane makes its visualization difficult.  Ear cartilage is deficient or absent with poor recoil.  Hair appear woolly and fuzzy and individual hair fibres can be seen separately.
  12. 12.  skin is thin, gelatinous, shiny and excessively pink with abundant lanugo and very little vernix caseosa.  Edema may be present.
  13. 13.  Subcutaneous fat is deficient and breast nodule is small or absent.  Deep sole creases are often not present.
  14. 14.  In male testes are undescended and scrotum is poorly developed.
  15. 15.  In female infants, labia majora are widely separated exposing labia minora and hypertrophied clitoris.
  16. 16.  Immaturity of central nervous system is expressed as inactivity and lethargy, poor cough reflex and in-coordinated sucking and swallowing
  17. 17.  Resuscitation difficulties at birth and recurrent apneic attacks.  Retinopathy of prematurity .  Vulnerable for intra- ventricular – periventricular hemorrhage and leuco- malacia  Inefficient blood brain barrier
  18. 18.  Cuboidal alveolar lining- poor alveolar diffusion of gases  Hyaline membrane disease  Breathing is mostly diaphragmatic, periodic and associated with intercostal recessions
  19. 19.  Pulmonary aspiration and atelectasis  They are vulnerable to develop chronic pulmonary insufficiency
  20. 20.  The closure of ductus arteriosus is delayed.  In grossly immature infants( less than 32 weeks) EKG shows left ventricular preponderance.  Risk to develop thrombo- embolic complications and hypertension.
  21. 21.  Due to poor and incoordinated sucking and swallowing.  Animal fat is not tolerated as well as the vegetable fat.  Regurgitation and aspiration are common.  Hypoglycaemia
  22. 22.  Abdominal distention and functional intestinal obstruction  Entero-colitis  Immaturity of the glucuronyl transferase system in the liver leads to hyper-bilirubinemia.  Development of kernicterus at lower serum bilirubin levels.
  23. 23.  Hypothermia is invariable.  Excessive heat loss due to relatively large surface area due to paucity of brown fat in the baby who is equipped with an inefficient thermostat.
  24. 24.  Infections are the important cause of neonatal mortality.  The low levels of IgG antibodies and inefficient cellular immunity  Excessive handling, humid and warm atmosphere, contaminated incubators and resuscitators expose them to infecting organisms.
  25. 25.  The blood urea nitrogen is high due to low glomerular filtrate rate.  The renal tubular ammonia mechanism is poorly developed thus acidosis occurs early.  They vulnerable to develop late metabolic acidosis especially when fed with a high protein milk formula.  Concentration of urine is poor.
  26. 26.  Preterm has to pass 4 to 5 ml of urine excrete one milliosmole of solute Baby gets dehydrated.  The solute retention and low serum proteins explain occurrence of edema in preterm infants.
  27. 27.  Poor hepatic detoxification and reduced renal clearance make a preterm baby vulnerable to toxic effects of drugs
  28. 28.  Develop anemia around 6 to 8 weeks of age.  Deficiencies of folic acid and vitamin E.  Develop haemolytic anemia, thrombocytopenia and edema 6 to 10 weeks of age.  Osteopenia and rickets
  29. 29.  These babies are prone to develop : Hypoglycaemia Hypocalcemia Hypoprotenemia Acidosis and Hypoxia.
  30. 30.  Bed rest and sedation.  Tocolytic agents Sympathomimetic agents-beta-2-adrenergic receptors. Isoxsuprine (duvadilan)-beta-1 and beta-2 receptors. Ritodrine Salbutamol and terbutaline -beta-2 receptor  Magnesium sulphate  Indomethacin
  31. 31.  Maturity of fetus should be ascertained by examination of amniotic fluid for phosphatidyl glycerol or L/S ratio.  Corticosteroids should be administered to the mother to enhance fetal lung maturity.
  32. 32.  Inj.betamethasone 12mg IM every 24 hours --2 doses or dexamethasone 6mg IM every 12 hours for 4 doses.  The optimal effect is seen if delivery occurs after 24 hours of the initiation of therapy and its therapeutic effect lasts for 7 days.
  33. 33.  Delayed clamping of cord.  Elective intubation of extremely LBW babies (<1000g).  Should be promptly dried, kept effectively covered and warm.  Vitamin K 1mg ( 0.5mg in babies < 1500g) should be given intra-muscularly.  Transferred by the doctor or nurse to the NICU as soon as breathing is established.
  34. 34.  Vital signs .  Activity and behaviour.  Colour.  Tissue perfusion.  Fluids, electrolytes and ABG’s.  Tolerance of feeds .  Watched for development of RDS, apneic attacks, sepsis, PDA, NEC, IVH, etc.  Weight gain velocity.
  35. 35.  The vital signs should be stable.  The healthy baby is alert and active, looks pink and healthy, trunk is warm to touch and extremities are reasonably warm and pink.  The baby is able to tolerate enteral feeds and there is no respiratory distress or apneic attacks and baby is having a steady weight gain of 1-1.5 % of his body weight every day.
  36. 36.  Create a soft, comfortable, “nestled” and cushioned bed.  Avoid excessive stimuli.  Effective analgesia and sedation.  Provide warmth.  Ensure asepsis.  Prevent evaporative skin losses.
  37. 37.  Provide effective and safe oxygenation.  Partial parenteral nutrition and give trophic feeds with expressed breast milk (EBM).  Provide rhythmic gentle tactile and kinaesthetic stimulation.
  38. 38.  Thermo-neutral environment.  Application of oil or liquid paraffin on the skin.  Should be covered with a cellophane or thin transparent or thin transparent plastic sheet.  Provide partial kangaroo0mother-care.
  39. 39.  Oxygen should be administered with a head box when SpO2 falls below 85% and it should be gradually withdrawn when SpO2 goes above 90%.  The lowest ambient concentration and flow rates should be used to maintain SpO2 between 85-95% and PaO2 between 60-80 mm Hg.
  40. 40.  Early phototherapy is adviced to keep the serum bilirubin level within safe limits in order to obviate the need for exchange blood transfusion.
  41. 41.  The handling should be bare minimum.  Vigilance should be maintained on all procedures.  Early diagnosis and prompt treatment of infections.
  42. 42.  Intra-venous dextrose solution ( 10% dextrose in babies >1000g and 5% dextrose in babies <1000g).  Trophic feeds with EBM through NG tube.  Condition is stabilized - enteral feeds.
  43. 43. Fluid requirements are higher in LBW infants due to:  Greater insensible water losses  Faster breathing rates  Decreased ability to concentrate urine  Greater use of radiant warmers  Greater use of phototherapy units
  44. 44. Birth weight (g) Fluid rate (ml/kg/day) 500 - 600 140 - 200 601 - 800 120 - 130 801 - 1000 90 - 110 1000 - 1500 80 - 100 >1500 60 - 80 *on first 2 days of life
  45. 45.  Fluid rate can be increased by 10-20 ml/kg/d to gradually reach 150 ml/kg/d  Fluid requirements need to be individualized for each baby  Enteral nutrition has to be considered once the baby is stable
  46. 46. Infants with BW ≤ 1000 g Infants with BW ≤ 1500 g, done in conjunction with slowly advancing enteral nutrition Infants with BW 1501-1800 g for whom enteral intake is not expected for > 3 days
  47. 47.  Glucose : 6 - 8 mg/kg/min  Amino acids : 1.5 - 2 g/kg/d  Lipid : 0.5 - 1 g/kg/d  Sodium : 2 - 4 mEq/kg/d  Potassium : 2 - 3 mEq/kg/d  Chloride : 2 - 4 mEq/kg/d
  48. 48. Trophic feeding/ Gut priming Practice of feeding very small amounts of enteral nourishment to stimulate development of the immature GIT Advantages: Improves GI motility Enhances enzyme maturation Improves mineral absorption Lowers incidence of cholestasis Shortens time to regain birth weight
  49. 49.  Breast milk or ½ or full strength preterm formula at 10ml/kg/d by intermittent gavage/ continuous nasogastric drip  Increase by 10-15 ml/kg/d to reach 150ml/kg/d  Increments not >20 ml/kg/d  IV fluids can be stopped once 120ml/kg/d is reached  On reaching 150ml/kg/d,calorie density can be increased
  50. 50. PRETERMS  <1200 g/ <32 wks: IV fluids for first 2-3 days, once stable start gavage feeding  1200-1800 g/ 32-34 wks: Start gavage feeding, once vigorous start spoon/ breast feeding  >1800 g/ >34 wks: Start breast feeding directly; if trial feed takes>20 mins or intake is less than required, switch to gavage feeding
  51. 51. Advantages:  Higher concentrations of amino acids  Higher concentrations of essential fatty acids  Lower renal solute load  Specific bio-active factors provide immunity  Promotes intestinal maturation
  52. 52. Disadvantages: Low concentrations of Vitamin D, Ca, P Inadequate iron
  53. 53.  Energy : 130 - 175 Kcal/kg/d  Protein :3.4 - 4.2 g/kg/d  Fat :6 - 8 g/kg/d  Na :3 - 7 mEq/kg/d  Cl :3 - 7 mEq/kg/d  K :2 - 3 mEq/kg/d  Ca :100 – 220 mg/kg/d
  54. 54.  Multivitamin drops.  Iron supplementation.  Vitamin E supplementation.  Supplements of calcium (220mg/day) and phosphorus (100mg/day).
  55. 55.  Gentle touch, massage, cuddling, stroking and flexing.  Rocking bed or placing a preterm baby on inflated gloves.  Soothing auditory stimuli.  Visual inputs.
  56. 56. Kangaroo care is placing a premature baby in an upright position on a mother’s bare chest allowing tummy to tummy contact and placing the premature baby in between the mother’s breasts. The baby’s head is turned so that the ear is above the parent’s heart.
  57. 57.  Body temperature  Mothers have thermal synchrony with their baby.  The study also concluded that when the baby was cold, the mother’s body temperature would increase to warm the baby up and vice versa.
  58. 58.  Breastfeeding: Kangaroo care allows easy access to the breast and skin-to-skin contact increases milk let-down.
  59. 59.  Increase weight gain Kangaroo care allows the baby to fall into a deep sleep which allows the baby to conserve energy for more important things. Increased weight gain means shorter hospital stay.
  60. 60.  Increased intimacy and attachment
  61. 61.  A single dose of dexamethasone 0.2mg/kg IV at 4 hours of age.  Inhaled steroids.
  62. 62.  Nosocomial infections  Hypothermia  Respiratory distress syndrome  Aspiration  Patent ductus arteriosus  Chronic lung disease  NEC & IVH  ROP & Late metabolic acidosis  Nutritional disorders  Drug toxicity
  63. 63.  Loss is upto a maximum of 10 to 15 percent.  Regain their birth weight by the end of second week of life.  Excessive weight loss, delay in regaining the birth weight or slow weight gain- suggest baby is not being fed adequately or unwell and needs immediate attention.
  64. 64.  Routine oxygenation without monitoring.  Intravenous immuno-globulins.  Prophylactic antibiotics.  Prophylactic administration of indomethacin or high doses of vitamin E.  Unnecessary blood transfusions.  Formula feeds.  Rough handling, excessive light and loud sound.
  65. 65.  It is desirable to administer 0- day vaccines(BCG, OPV, HBV) on the day of discharge from the hospital.  If mother is HBV carrier and is e-antigen positive- hepatitis B vaccine and hepatitis B specific immunoglobulins within 72 hours of age.
  66. 66.  Live vaccines should be avoided in symptomatic HIV- positive mothers.  WHO recommends that BCG and oral polio vaccine can be given to asymptomatic HIV- positive infants.
  67. 67.  The family dynamics are greatly disturbed.  The problems and issues should be handled with equanimity, compassion, concern and caring attitude of the health team.  Encouraged to touch and talk with her baby.  Provide kangaroo-mother- care.  Emotional support and guidance.
  68. 68.  A baby who is feeding from the bottle or cup and is reasonably active with a stable body temperature, irrespective of his weight, qualifies for transfer to the open cot.
  69. 69.  The mother should be mentally prepared and provided with essential training and skills.  The mother- baby dyad should be kept in step- down nursery.  The baby should be stable, maintaining his body temperature and should not have any evidences of cold stress.
  70. 70.  At the time of discharge, the baby should be having daily steady weight gain velocity of at least 10g/kg.  The home conditions should be satisfactory before the baby is discharged.  The public health nurse should assess the home conditions and visit the family at home every week for a month or so.
  71. 71.  Common infective illnesses, reactive airway disease, hypertension, renal dysfunction, gastro-oesophageal reflux.  Feeding and nutrition.  Immunizations.  Physical growth, nutritional status, anemia, osteopenia/ rickets.
  72. 72.  Neuro-motor development, cognition and seizures.  Eyes: Retinopathy of prematurity, vision, strabismus.  Hearing.  Behavioural problems, language disorders and learning disabilities.
  73. 73.  She must be explained about the importance of asepsis.  Keeping the baby warm and ensuring satisfactory feeding routine.  The services of postpartum programme public health nurse and social worker can be utilized.
  74. 74.  The infant should be effectively covered taking care to avoid smothering.  Woollen cap, socks and mittens should be worn.  The infant should preferably lie next to the mother.  In winter, the room can be warmed with a radiant heater or angeethi.  A table lamp having 100 watt bulb can be used to provide direct radiant heat.  Hot water bottle should never come in contact with the baby.
  75. 75.  The cot of the mother and infant should be located away from the walls .  The mother and health worker should be trained to assess the temperature of the newborn baby by touch.  The visitors and handling of the infant should be restricted to the bare minimum.  The hands must be washed before touching or feeding the baby.  The emotional urge for kissing the baby should be curbed.  The linen should be clean and sun-dried.
  76. 76.  Whenever feasible, breast feeding is ideal and must be encouraged.  When infant is unable to suck from the breast, EBM should be given with a bottle or dropper or spoon or paladay depending upon his maturity.  Formula for premature babies is recommended.  If cow’s or buffalo’s milk is unavoidable it should be given after 3:1 dilution.  Mother must be given detailed instructions and practical demonstration for maintenance of bottle hygiene to prevent contamination of feeds.
  77. 77.  The risk of neurodevelopmental handicaps is increased 3-fold for LBW babies and 10-fold for very LBW babies(<1500g).  The prognosis is good if no birth asphyxia, apneic attacks,RDS, hypoglycaemia and hyperbilirubinemia.  Preterm AFD babies catch up in their physical growth with term counterparts by the age of 1 to 2 years.
  78. 78.  15 to 20 % incidence of neurological handicaps in the form of CP, seizures, ROP, hydrocephalus, deafness and MR.  There is high incidence of minor neurologic disabilities.  Neurological prognosis is adversely affected by degree of immaturity.
  79. 79.  Obtain detailed antenatal, intra- natal history.  Assess the gestational age and birth weight of the baby.  Assess the features of clinical immaturity.  Assess the behaviour of preterm neonate.  Assessment of common problems.
  80. 80. 1. Impaired gas exchange related to immaturity of lungs and deficiency of surfactant  Assess the respiratory pattern and colour of the baby  Observe for any apneic episode.  Oxygen hood is often used for able to breathe alone but need extra oxygen.  Oxygen also may be given by nasal cannula to the infant who breathes alone.  Humidify the oxygen  CPAP may be necessary to keep the alveoli open and improve expansion of lungs
  81. 81. 2.Impaired breathing pattern : distress related to immaturity and surfactant deficiency  Assess the respiratory rate, heart rate and chest retractions  Position the child for maximal ventilatory efficiency and airway patency  Provide humidified oxygen  Spo2 monitoring  Provide suctioning  Provide chest physiotherapy  Administer bronchodilators  Administer anti inflammatory medications  Administer antibiotics
  82. 82. 3. Activity intolerance related to increased work of breathing secondary to distress  Arrange to provide routine care  Schedule periods of uninterrupted rest  Determine infant’s stress level  Reduce nonessential lighting  Use positioning devices
  83. 83. 4. Ineffective airway clearance related to excessive trachea-bronchial secretions  Assess the child’s breathing pattern  Check the vital signs  Provide suctioning  Provide humidified oxygen  Assess the ABG analysis  Provide C-PAP using mask /hood/nasal prongs  Observe for risks of C-PAP  Assist in CMV with PEEP if needed
  84. 84. 5. Hypothermia related to immature thermoregulation system  Monitor vital signs frequently  Wrap the baby well and keep warm  Provide small and frequent breast feeding as tolerated  Look for hypoglycemia  Administer IV fluids if not tolerating the feed  Monitor the vital signs and blood pressure  Assess the skin tone, pallor and signs of dehydration  Administer IV fluids
  85. 85. 6. Imbalanced nutrition less than body requirement related to feeding difficulty, respiratory distress, or NPO status  Assess the sucking and swallowing ability of the newborn  Assess the tolerance of the child  Monitor the blood glucose level frequently  Administer IV fluids if not tolerating oral fluids  Administer human milk fortifier if the child is preterm
  86. 86. 7. Fatigue related to increased demand for nutrients and deterioration of the general condition of the baby  Assess the general condition of the baby  Assess the level of activity  Monitor the blood glucose level  Breast fed the baby  Check for from any part of the body  Provide top up feed
  87. 87. 8. Risk for complications hypotension, shock, cerebral hypoxia related to progression of the disease condition  Assess the vital signs, respiratory rate, pulse rate, temperature and blood pressure  Check blood culture and sensitivity and sepsis screening  Monitor for any signs of dehydration  Administer IV fluids or blood as necessary  Assess the serum electrolyte values and ABG values  Closely monitor for the early signs and symptoms of complications
  88. 88. 9. Anxiety of parents related to the outcome of the newborn condition  Assess the mental status, anxiety and knowledge of family members  Assess the supporting system for the family  Assess the coping strategies of the family members  Explain the disease process to the family members  Explain each and every procedure to the care giver  Provide psychological support to the family members
  89. 89. 10. Interrupted mother-child bonding related to infectious process  Assess the breast feeding ability including sucking and swallowing ability  Keep the child with the mother if possible  Provide frequent breast feed 2 hourly  If breast feeding is not tolerated give EBM  Allow the mother to visit the child  Provide kangaroo mother care in case of pre term if tolerated
  90. 90. 11. Interrupted family process related to hospitalization of the newborn  Assess the mental status, anxiety and knowledge of family members  Encourage mother-child bonding if possible  Assess the coping strategies of the family members  Explain the disease process to the family members  Explain each and every procedure to the care giver  Allow the family members to visit the child
  91. 91. 12. Knowledge deficit regarding care of the baby and treatment modalities  Assess the knowledge level of the care giver  Explain disease condition and it’s progress to the family members  Educate regarding treatment and its prevention  Educate about the monitoring of the baby  Provide adequate explanation regarding nutritional need of the baby  Clarify their doubts and promote understanding
  92. 92.  Definition and incidence  Causes of prematurity  Clinical features  Physiological handicaps  Management  Care of preterm babies  Prognosis  Nursing assessment  Nursing diagnosis and interventions

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