Prematurity (3) (2)

Page 1: Prematurity

• NUR 113

Page 2: Overview

• Definition of Prematurity: Birth before 37 weeks of gestation (after 20 weeks).

• Late Preterm: 34 to 36 weeks; infants can perform some normal newborn behaviors.

• Rise in Multiple Birth Rates: Accounts for 12% of all births in the U.S.

• Survival Rates: Improving at younger gestational ages.

Page 3: Risk Factors

• Maternal Factors:

  • Gestational Hypertension.

  • Closely Spaced Pregnancies.

  • Adolescent Pregnancy.

• Lifestyle Factors:

  • Lack of Prenatal Care.

  • Maternal Substance Use, including smoking.

• Medical History Factors:

  • Previous Preterm Deliveries.

  • Uterine Abnormalities.

  • Cervical Incompetence.

  • Placenta Previa.

• Other Factors:

  • Preterm Labor.

  • Premature Rupture of Membranes (PROM).

Page 4: Complications

• Respiratory Distress Syndrome (RDS):

  • Inability to produce adequate surfactant, leading to poor gas exchange and ventilator failure.

• Patent Ductus Arteriosus (PDA):

  • Condition where ductus arteriosus fails to close after birth due to neonatal hypoxia, resulting in murmur and abnormal blood pressure levels, leading to pulmonary congestion.

• Apnea of Prematurity:

  • Results from immature neurological and chemical mechanisms.

• Intraventricular Hemorrhage (IVH):

  • Bleeding between the brain and skull causing potential brain damage, leading to conditions like hydrocephalus.

Page 5: Gastrointestinal Complications

• Aspiration Risks:

  • Poor gag reflex and inability to suck or swallow effectively (common in those less than 32-34 weeks).

• Nutritional Challenges:

  • Small stomach capacity; difficulty meeting high caloric & fluid needs.

  • Potential deficiencies in lactose, calcium, and phosphorus.

• Necrotizing Enterocolitis (NEC):

  • Inflammatory disease of the gastrointestinal mucosa leading to necrosis; can necessitate surgical removal of parts of the intestines.

Page 6: Renal Complications

• Kidney Immaturity:

  • Such immaturity leads to fluid & electrolyte imbalance.

  • Lower Glomerular Filtration Rate (GFR) and reduced renal blood flow.

  • Careful dose management for medications due to immaturity affecting drug excretion.

Page 7: Newborn Infection (Sepsis)

• Definition of Newborn Sepsis:

  • Presence of microorganisms in the blood or tissues within the first month of life; signs can be subtle.

• Causes:

  • Can be contracted before, during, or after delivery; preterm infants are at higher risk due to limited immunity.

• Prevention Strategies:

  • Maternal infection screening, proper antiseptic techniques, and antibiotics for newborns.

Page 8: Newborn Infection - Data Collection

• Signs of Infection to Monitor:

  • Temperature instability, drainage (from eyes/nose), poor feeding, vomiting and diarrhea, hypo/hyperglycemia.

  • Physical Signs: Abdominal distention, apnea, nasal flaring, pallor, jaundice, tachycardia or bradycardia, hypotension, irritability, lethargy.

Page 9: Newborn Infection - Nursing Care

• Important Assessments:

  • CBC with differential, C-reactive protein, electrolytes.

• Cultures:

  • Blood, urine, and Cerebrospinal fluid cultures to identify infections.

• Monitoring:

  • Continuous vital sign monitoring and assessments of input & output, including daily weight checks.

• IV Therapy Requirements:

  • Fluids, electrolytes, and necessary antibiotics or antivirals.

Page 10: Nutrition

• Feeding Regimens:

  • Should be weight and capacity-based; early feedings are beneficial.

• High Calorie Needs:

  • Supplements may be required for weight gain of 20 to 30 g/day.

• Feeding Methods:

  • Breastfeeding, bottle feeding, and gavage methods based on gestational age and stability of the infant.

Page 11: Cue-Based Feeding

• Indicators for Readiness:

  • Self-regulation, comfort, and physiological stability.

• Parental Involvement:

  • Encouraged in feeding preterm infants to enhance bonding and feeding success.

• Assessment of Feeding Cues:

  • Monitor behaviors like rooting or hand-to-mouth motions, respiratory patterns, and vital signs.

Page 12: Long Term Complications

• Retinopathy of Prematurity (ROP):

  • Abnormal growth of retinal blood vessels causing vision impairment; associated with oxygen therapy.

• Bronchopulmonary Dysplasia (BPD):

  • Persistent lung disease requiring long-term oxygen and ventilation support.

• Developmental Delays:

  • Risk of motor, sensory, and cognitive disabilities including CP and hearing issues.

Page 13: Collaboration in Care

• Involvement of Multiple Professionals:

  • RN, LPN, PA, NP, respiratory therapist, dietitians, social workers, neonatologists, and various specialists as needed.

Page 14: Data Collection - Respiratory Assessment

• Observe for:

  • Periodic breathing and signs like retractions or nasal flaring.

• Skin:

  • Characteristics such as reddened or translucent appearance, suitable development indicators.

Page 15: Data Collection - Physical Characteristics

• Nails Soft and short; testes may not be descended. Abdominal assessments and muscle tone central to monitoring.

Page 16: Implementation - Initial Assessments

• Conduct rapid initial assessments covering respiratory status and vital signs.

• Assess for potential airway obstructions frequently.

Page 17: Implementation - Respiratory Distress Indicators

• Signs include cyanosis, retractions, nasal flaring, grunting, tachypnea, diminished air entry, apneic episodes.

Page 18: Implementation - Thermoregulation

• Strategies to minimize heat loss and maintain appropriate body temperatures in preterm infants.

Page 19: Implementation - Hydration & Nutrition Monitoring

• Focus on Signs of dehydration and adjust feeding modalities based on tolerance.

Page 20: NCLEX Question on NG Feeding

• Preferred method for verifying tube placement in nasal feedings.

Page 21: NCLEX Answer Explanation

• Answer: B. Verify gastric pH is less than 5.5 for correct placement; rationale explaining other methods.

Page 22: Implementation - Feeding Intolerance Signs

• Indicators include increased gastric residuals, abdominal distention, and abnormal stool patterns.

Page 23: NCLEX Question on Medications for GER

• Identify which medication is a proton pump inhibitor for gastroesophageal reflux.

Page 24: NCLEX Answer Explanation

• Omeprazole (Prilosec) is the proton pump inhibitor; explanations on other medications provided.

Page 25: Implementation - Attachment & Bonding

• Identify strategies to promote parent-infant bonding and encourage parental involvement.

Page 26: Implementation - NICU Experience

• Discuss the importance of a calm environment and equipment management in the NICU setting.

Page 27: eyemax

Page 28: Implementation - Parent Education

• Ensure parents are prepared for discharge, instructing them on care protocols and contact guidelines.

Page 29: Case Study - Baby James

• Relevant clinical data on Baby James, challenges faced, treatment interventions, and progress in the NICU.