Preterm Infant

Case Study
INTRODUCTION
 Preterm Infant
 A live born infant born before the end of week 37 of gestation
 Another criterion used in weight of less than 2500g at birth
 This occurs in approximately 7% of live births of white infants
 When a preterm infant is recognized by gestational age assessment
 Observe closely for the specific problems of prematurity such as
 Respiratory Distress Syndrome
 Hypoglycemia
 Intracranial Hemorrhage
 Preterm Infant

 All preterm infants need intensive care from the moment of birth to give them
their best chance of survival without neurologic after effects
 A lack of surfactant makes them extremely vulnerable to respiratory distress s
yndrome
 Maturity of an infant is determined by physical findings
 Sole creases
 Skull firmness
 Ear cartilage
 And neurological findings and mothers Last Menstrual Period (LMP)
 Preterm Infant vs SGA
Preterm Infant Small Gestational Age

 Born before 37 weeks  Born full term

 Inactive and lethargic  Poor skin turgor
 Skull and ribs feel soft  Sutures widely open
 Male scrotal rugae & undescended testes
 Female labia minora and clitoris are prom
inent.

 Very small
 Very small
PREDISPOSING FACTORS
 Preterm Infant

Poverty
Multiple Gestational
Placenta Previa
Increased Parity
PATIENTS HISTORY
 Preterm Infant

 Personal Data
 Name: Patient “x”
 Age: 33 weeks
 Sex: Male
 Address: Quiapo, Manila
 Weight: 1.71 kg
 Length: 42cm
 Preterm Infant
 Past Medical History
 Mother is G4 P3
 Present Medical History
 Patient was delivered prematurely via Caesarian Section 8:14 pm
March 3, 2019; General APGAR score in the first minute is 3 related to pr
ematurity, after resuscitation APGAR score improved by 5 but still fairly lo
w that required thorough observation in the NICU
 Family Health History
 There is no history of hypertension, PTB, Diabetic Mellitus, Asthma, H
eart problem, cancer in the family.
 Preterm Infant
 Admitting Vital Signs
 HR – 0, RR – 0
 Admitting Diagnosis
 Preterm Infant 33 weeks Age of Gestation
 Final Diagnosis
 Prematurity
 Signs and Symptoms
 Low birth weight
 Complication
 Apnea
 Respiratory distress syndrome
 Sepsis Neonatorum
DIAGNOSTIC PROCEDURE
 HEMATOLOGY
Hematology Result Normal Value Interpretation
s
Hemoglobin 19,6 14 – 16 A fetus with chronically lowered oxygen l
evels responds by producing extra red bl
ood cells.

Hematocrit 0.60 0.40 – 0.57 High concentrations of red blood cells

WBC Count 21.7 4.8 – 10.8 x 10 Ascending infection caused by prematur

e rupture of membranes

RBC Count 6.53 4.5 – 6.0 x 10/ Increased to accommodate oxygenation

12 in blood
Platelet Count 297 130 – 400 x 10 Normal
ANATOMY AND PHYSIOLOGY
 ANATOMY
 Anthropometrics
 Weight – 1.71 kg
 Length – 42 cm
 Head circumference – N/A
 Chest circumference – N/A
 Abdominal girth – N/A
 Skin
 Pigmentation increases after birth
 Skin may be dry
 Acrocyanosis of extremities is normal in the first 24 hours
 Small amounts of lanugo and vernix caseosa
 ANATOMY
 Fontanels
 Anterior: diamond in shape
 Posterior: triangular
 Should be flat and open

 Ears
 Should be even with the canthi of eyes
Cartilage is present and firm

 Eyes
 May be irritated by medication administration

 Nodules of tissues present in breast

 ANATOMY
 Female Genitalia
 Vernix seen between labia
 Pseudo menstruation is common

 Male Genitalia
 Testes descended or in inguinal canal
 Rugae cover scrotum
 Meatus at tip of penis

 Legs
 No click or displacement of head of femur observe when
hips are flexed and abducted
 ANATOMY
 Feet
 Flat
 Soles covered with creases

 Muscle Tone
 Predominantly flexed
 Occasional transient tremors of mouth and chin
 Newborn can turn head from side to side in prone position
 Needs head supported when held erected or lifted

 Cry
 Loud and vigorous
 Heard when infant is hungry
 ANATOMY
 Reflexes
 Moro (startle) – sudden movement
 Rooting – strokes on baby’s cheek
 Sucking – touching of roof of baby’s mouth
 Tonic neck – lying on his back with neck flexed on side
 Babinski – stroke on the sole of the foot
 Grasp (palmar) – pressing the finger or object in the palm
 Walking or stepping – holding baby upright with feet flat on sur
face
 PHYSIOLOGY
 Circulatory
 Umbilical veins & ductus venosus constrict after cord is clamped
 Foramen Ovalle closes functionally as respirations are establishe
d
 Ductus arteriosus constricts with establishment of respiratory fu
nction
 Peripheral circulation established slowly
 RBC count high immediately after birth
 PHYSIOLOGY
 Respiratory
 Thoracic squeeze in vaginal delivery helps drain fluids from respiratory tr
act.
 Adequate levels of surfactants ensure maturity of lungs
 Newborns are obligate nose breathers
 Chest and abdomen rise simultaneously

 Renal
 Urine present in bladder at birth, newborn may not void in the first 12 – 2
4 hours
 Urine is pale and straw colored
 Infant unable to concentrate urine in the first three months of life
 PHYSIOLOGY
 Respiratory
 Thoracic squeeze in vaginal delivery helps drain fluids from respiratory tr
act.
 Adequate levels of surfactants ensure maturity of lungs
 Newborns are obligate nose breathers
 Chest and abdomen rise simultaneously

 Renal
 Urine present in bladder at birth, newborn may not void in the first 12 – 2
4 hours
 Urine is pale and straw colored
 Infant unable to concentrate urine in the first three months of life
 PHYSIOLOGY
 Digestive
 Has full cheeks due to well – developed sucking pads
 Little saliva is produced
 Hard palate should be intact; presence of Epstein pearls is norm
al
 Newborns can’t move food from lips to pharynx
 Circumoral pallor may appear while sucking
 Newborn is capable of digesting simple CHO and protein but h
as difficulty with fats
 PHYSIOLOGY
 Digestive
 Immature cardiac sphincter may allow reflux of food whe
n burped
 Stomach capacity caries usually 50 – 60 ml
 First stool is meconium
 Transitional stools are thin and brownish green in color, a
fter 3 days
 Feeding patterns may vary
 PHYSIOLOGY
 Hepatic
 Liver responsible for changing hemoglobin into unconjugated bi
lirubin for excretion
 Excess unconjugated bilirubin can permeate the sclera and the s
kin
 The liver of a mature infant can maintain the level of unconjugat
ed bilirubin at less than 12mg/dL
 Physiologic jaundice is normal in early newborn if it appears afte
r 24 hours, usually 48 – 72 hours.
 Pathologic jaundice occurs within the first 24 hours after birth
 ABO Blood Incompatibility
 Hepatitis B
 Rh Incompatibility
 PHYSIOLOGY
 Temperature
 Heat production is accomplished by
 Metabolism of brown fat
 Increased metabolic rate and activity
 Newborns cannot shiver to release heat unlike adults
 Newborns temperature drops quickly after birth
 Body stabilizes 8 – 10 hours if baby is unstressed
 Cold stress increases oxygen consumption that may lead to metabolic aci
dosis and respiratory distress.
 PHYSIOLOGY
 Immunologic
 Newborns have passive acquired immunity from IgG from moth
er during pregnancy
 Additional antibodies are passed through breastfeeding
 Develops own antibodies during the first 3 months
 PHYSIOLOGY
 Neurologic/ Sensory
 Six states of consciousness
 Deep Sleep
 Light Sleep
 Drowsy
 Quite Alert
 Active Alert
 Crying
 PHYSIOLOGY
 Periods of Activity
 Newborn alert with good sucking reflex, irregular RR and
HR
 May regurgitate mucus, pass meconium and suck well
 Equilibrium usually achieved by 8 hours of age

 Sleep Cycle
 Newborn usually sleeps 17 hours a day
 PHYSIOLOGY
 Hunger Cycle
 Varies depending on mode of feeding
 Breast – fed infants may fed 2 – 3 hours
 Bottled – fed infants may be fed every 3 – 4 hours
 PHYSIOLOGY
 Special Senses
 Sight: very sensitive to light; eye movement uncoordinated
 Hearing: can hear before birth (24 weeks)
 Taste: sense of taste established; prefers sweet tasting fluids
 Smell: sense is developed at birth
 Touch: newborn is well prepared to receive tactile massages
 PHYSIOLOGY
 Special Senses
 Sight: very sensitive to light; eye movement uncoordinated
 Hearing: can hear before birth (24 weeks)
 Taste: sense of taste established; prefers sweet tasting fluids
 Smell: sense is developed at birth
 Touch: newborn is well prepared to receive tactile massages
PATHOPHYSIOLOGY
NURSING CARE PLAN
DRUG STUDY
DISCHARGE PLANNING
 METHODS
 Medication
 Advise the mother to give prescribed medications for the
baby
 Exercise
 Teach mother to exercise the baby’s sucking reflex.
 Treatment
 Take medications on time
 METHODS
 Health Teachings
 Educate mother about disease condition, its causes, avai
lable treatment, prognosis.
 Explain in detail about importance of breast feeding.
 Explain the importance of immunization
 Educated mother about importance of hygienic practices
in preventing infection to child
 METHODS
 Out – Patient
 Advise the mother to make a follow-up appointment as s
cheduled.
 Diet
 Breastfeed is the only diet that will be taken by the baby
 Spirituality
 Seek for spiritual guidance