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M6 13-005

Exam 10: Pre-Term & Post-Term

Preterm infant less than 38 weeks of pregnancy
Term infant 38 to 42 weeks of pregnancy
Postterm beyond 42 weeks
The Ballard scale Age can be estimated to within two weeks based on physical and neurological characteristics.
Gestational age and infant size estimated age can be compared with the newborn’s weight, length, and head circumference to determine whether the neonate is large, average or small in size compared to other infants born at the same gestational age.
Small for gestational age (SGA) size is below the 10th percentile
Appropriate for gestational age (AGA) infant whose size is AGA falls between the 10th and 90th percentiles.
Large for gestational age (LGA) size is above the 90th percentile.
Low birth weight (LBW) weight is 2500 g (5 lb 8 oz) or less at birth and of any gestational age (not to be confused with preterm)
Very low birth weight (VLBW) weight is 1500g (3lb, 5 oz) or less at birth.
Extremely low birth weight (ELBW) weight is 1000g (2 lb 3 oz) or less at birth
intrauterine growth restriction infants are preterm, others are full term and have failed to grow normally while in utero
Physiologic Handicaps of Preterm Newborns Problems with Respiration. apneic Spells. Weak Chest Wall Muscles. Grunting.
Problems with Respiration Symptoms of respiratory distress may begin within the first hours after birth. Symptoms include tachypnea, tachycardia, nasal flaring, cyanosis, xiphoid and intercostal retractions and grunting.
Inadequate amounts of surfactant increase the risk of respiratory distress syndrome, (RDS)
Surfactant begins to appear in the alveoli at approximately 22 weeks gestation
Apneic spells last more than 20 seconds and are accompanied by cyanosis and bradycardia.
Weak chest wall muscles may interfere with full expansion of the lungs.
Grunting early sign of RDS
Respiration: Nursing Interventions frequent assessment, repositioning to mobilize secretions, oxygen administration, mechanical ventilation and suction.
Problems with Thermoregulation Little subcutaneous white fat that serves as insulation. Lack of brown fat which impairs the infant’s ability to produce heat by nonshivering thermogenesis. Larger head and greater body surface area . Immature hypothalimus.
Signs of Inadequate Thermoregulation (a) Decreased skin temperature. (b) Signs of respiratory difficulty. (c) Signs of hypoglycemia. (d) Mottled skin. (e) Lethargy, irritability, weak cry or suck. (f) Decreased muscle tone, poor weight gain.
Thrmoregulation: Nursing Intervention (1) Place infant in radiant warmer or incubator. (2) Monitor infant's skin temperature using a skin probe. (3) Avoid exposing infant to cold air currents or surfaces. (4) Provide warmed oxygen only.
Problems with Fluid and Electrolyte Balance: Preterm infants lose fluid very easily and it increases with the degree of prematurity. Skin has little protective subcutaneous white fat, greater water content, and is more permeable than term infants’ skin.
Fluid and Electrolyte Balance: Nursing interventions (a) I & O. (b) Urine specific gravity. (c) Daily weights (sometimes twice daily) (d) Signs of dehydration or fluid overload must be carefully monitored by the nurse.
Problems with Infection Incidence of infection is 3 to 10 times greater than that in full-term infants. May have one or more episodes during hospital stay. Maternal infection and immature immune system can predispose the preterm infant to sepsis.
Bronchopulmonary Dysplasia occurs in severely ill infants who have received high levels of oxygen for long periods of time or who have been on a breathing machine (ventilator).
Bronchopulmonary Dysplasia: Results in Inflammation. Atelectasis. Edema. Airway hyperactivity with loss of cilia, thickening of the walls of the alveoli & fibrotic changes.
Major sign of BPD an increased need for ventilation or an inability to be weaned from the ventilation and oxygen.
BPD Therapeutic Management (1)Use of maternal steroids to reduce prematurity and RDS. 2)Minimizing exposure to oxygen. 3)Avoidance of fluid overload. 4)Increased nutrition.
Periventricular-Intraventricular Hemorrhage bleeding into the brain's ventricular system, where the cerebrospinal fluid is produced and circulates through towards the subarachnoid space.
Periventricular-Intraventricular Hemorrhage: Most common in infants < 32 weeks or < 1500 grams.
Periventricular-Intraventricular Hemorrhage: Causes (3) Results from ruptured blood vessels in the germinal matrix located around the ventricles of the brain.
Periventricular-Intraventricular Hemorrhage: Signs lethargy, poor muscle tone, apnea, cyanosis, full or bulging fontanels, a drop in hematocrit, mild aberrations of eye position or movement and seizures.
Retinopathy of Prematurity (ROP) Damage to immature blood vessels in the retina often associated with oxygen use; may cause decreased vision or blindness in preterm infants. often in infants >30 weeks weighing 1500 g or less.
Retinopathy of Prematurity (ROP): Treatment (a)Consult with an ophthalmologist. (b)Possible laser photocoagulation surgery. (c)Cryotherapy. (d)Reattachment of the retina.
Necrotizing Enterocolitis (NEC) A serious inflammatory condition of the intestinal tract that may lead to cellular death or areas of intestinal mucosa. Mortality rate is 25% to 30%, and 25% of survivors have long-term GI problems. Ileum and proximal colon are most often affected.
Necrotizing Enterocolitis (NEC): Pathophysiology During asphyxia, blood is diverted from the GI tract to the brain, heart, and kidneys. Less common in breastfed infants.
Necrotizing Enterocolitis (NEC): Signs ABD Distention. ↑ Gastric Residual. ↓ or absent bowel sounds. Loops of bowel seen through ABD wall. Vomiting. Bile-stained emesis or residuals. Occult blood in stools. ABD tenderness. Signs of infection. Resp distress, bradycardia, temp, lethargy
Necrotizing Enterocolitis (NEC):Nursing interventions assessment including daily abdominal girth and strict I&Os. Antibiotics as prescribed Parenteral nutrition to rest the bowel. NPO. Continuous or intermittent gastric suction. Encourage mothers to provide breastmilk for their infants.
Feeding Techniques (1)Preterm infants need special formulas or fortified breast milk. Breast milk is preferred. (2)Preterm infants may need 22 or 24 kcal/oz formulas to meet their needs instead of the 20 kcal/oz formula used for full term infants.
Oral feedings often are begun when the infant reaches 32 to 34 weeks
respiratory rate before and during feedings 60 breaths per min.
Potential parent responses to a preterm infant Premies are usually emotionally tramatic to parents. Infants usually rushed to NICU. Not being able to hold children d/t hospitalization. Delayed nurturing. Extended hospital stay for the infant.
Parent-Infant Bonding Nursing Interventions ↑ risk parents tour NICU prior to birth. Touch and see newborn after birth. Father watch initial care in NICU. Kangaroo care.
Characteristics and Nursing Care for the Postterm Infant: Physical (a)Thin with loose skin and little subcutaneous fat. (b)Unusually alert and wide-eyed with a worried look. (c)Little or no lanugo and vernix; abundant hair on head. (d)Skin is wrinkled, cracked and peeling. (e)Nails are long.
postmaturity syndrome placental insufficiency that causes chronic stress and hypoxia, seen in fetuses and neonates in postterm pregnancies, characterized by decreased subcutaneous fat, skin desquamation, and long fingernails.
Problems associated with post maturity ↑ risk for asphyxia and hypoxia. ↑ risk for meconium aspiration. Poor nutrition status
Postterm Infant Nursing Care (1) Thorough assessment for injuries if infant is large. (2) Observe infant for the following: (a) Respiratory distress. (b) Hypoglycemia: check infant blood sugars per SOP. (c) Hypothermia. (d) Jaundice
Created by: jtzuetrong