ch 34

• Preterm Infants

  • Majority are born in less than 37 weeks
  • Poor muscle tone
  • Minimal subcutaneous fat
  • Plentiful lanugo
  • Abundant Vernix caseosa
  • Fused eyelids
  • Poorly formed ear pinna with soft, pliable cartilage
  • Thin, transparent skin
  • Absent to a few creases in the soles and palms
• Care Management for Preterm Infants

  1. Maintaining body temperature

  2. Respiratory care

  3. Surfactant administration as needed

  4. Weaning from respiratory assistance

  5. Nutritional Care
• Maintaining body temperature

  • High risk infant susceptible to heat loss
  • Unable to increase metabolic rate
  • Transepidermal water loss is greater
  • Should be transferred from delivery in a pre-warmed incubator
  • Rapid changes in body temperature may cause apnea
• Complications in High Risk Infants

  • Respiratory distress syndrome (RDS)
  • Retinopathy of prematurity (ROP)
  • Bronchopulmonary dysplasia (BPD)
  • Pulmonary fibrosis
  • Intraventricular hemorrhage (GMH-IVH)
  • Necrotizing Entercolitis (NEC)
  • Patent Ductus Arteiosus (PDA)
• Retinopathy of prematurity (ROP)

  Eye disorder caused by abnormal blood vessel growth
• Bronchopulmonary dysplasia (BPD)

  A long-term (chronic) lung condition
• Pulmonary fibrosis

  A lung disease that occurs when lung tissue becomes damaged and scarred, making it more difficult for lungs to work properly
• Intraventricular hemorrhage (GMH-IVH)

  • Usually occurs in infants less than 34 weeks
  • History of hypoxia, birth asphyxia
  • The most common and most important neurologic injuries in preterm Neonates; resulting in significant neurologic sequelae, including cerebral palsy, mental retardation, and seizures
• Necrotizing Entercolitis (NEC)

  • Affects the intestines of preterm infants, causing local infection and inflammation that can destroy the wall of the bowel
  • Intestinal ischemia
  • Bacterial colonization : heavy growth of bacteria
  • In particular formula feeding
• Patent Ductus Arteiosus (PDA)

  • Murmur
  • May spontaneously close – premature infants may take weeks to close!
  • O2 & blood transfusions to increase perfusion
  • Indomethacin –close blood vessel/
  • Digoxin, diuretics & fluid restriction (if CHF)
  • Surgical ligation
• Care of Preterm Gastrointestinal Difficulties

  • Poor gag reflex and suck effort- danger of aspiration
  • High caloric needs and limited ability to take in nutrition
  • Increased basal metabolic rate and oxygen
• Care of the Preterm Renal Difficulties

  • Decreased glomerular filtration rate
  • Inability to concentrate urine
  • Delayed drug excretion time
  • Inability to excrete drugs (due to oliguria/anuria – monitor output)
• Inserting a gavage tube feeding

  1. Measure length: Nose to earlobe to the midpoint between the xiphoid process and the umbilicus

  2. Chest x-ray
• IUGR (Intrauterine Growth Restriction)

  • Symmetrical (Chronic HTN & type 1 diabetes) –head is larger than abdomen (preeclampsia, placental infarcts)
  • Asymmetric (disproportional) IUGR - Caused by acute compromise of uteroplacental blood flow, Weight decreased but normal length and head circumference
• Common Complications of LGA (Large for Gestational Age) Newborn

  • Hypoglycemia
  • Hyperbilirubinemia
  • Clavicle fractures
  • Respiratory distress syndrome
  • Congenital birth defects
• Characteristics of Infant of Diabetic Mother Newborn

  • Macrosomia, reddish, Excessive adipose tissue (fatty tissue), Large umbilical cord and placenta, high levels of maternal glucose
  • Infant can be small for gestational age (Chronic DM)/ Macrosomic infant (GDM)
• Postterm Newborn

  • 42 weeks gestation
  • Potential problems: CPD- Cephalopelvic disproprtion
• Postmaturity Syndrome

  • Fetus exposed to poor placental function
  • Hypoglycemia
  • Asphyxia: Poor O2 supply
  • meconium aspiration/pneumonia, cold stress, dry skin