PRETERM BABY CARE

PRETERM BABY CARE

Preterm Baby:

          A baby born before 37 completed week of gestation calculating from the first day of last menstrual period is arbiturarily defined as preterm baby.

Incidence:

          Preterm baby constitutes two thirds of low birth weight babies.

Etiology:

          In about 50% the cause of preterm labour is not known. The following are however, related with increased incidence of preterm labour.

High Risk Factor:

1. History:

There is an increased incidence of preterm labour in cases such as

1. Previous history of induced or spontaneous abortion or preterm delivery.
2. A symptomatic bacteria or recurrent urinary tract infection.
3. Smoking habits
4. Low socio economic and nutritional status


1. Iotrogenic:

Elective induction with wrong estimation of gestational period.

3. Idiopathic:

Premature effacement of the cervix with hyper irritable uterus and early engagement of the head are often associated.

Manifestation of Pre-maturity:

Anatomical:

1. The weight is 2500 gm or less
2. The length is usually less than 44cm
3. The head and abdomen relatively large
4. Pinnae of ears are soft and flat
5. The eyes are kept closed.

Care of the Preterm Baby:

Immediate Management following Birth

Ø      The cord is to be clamped quickly

Ø      The cord length is kept long

Ø      The air passage should be cleared of mucous

Ø      Adequate oxygenation

Ø      The baby should be wrapped including head in a sterile warm towel

Ø      Aqueous solution of Vit. K

Intensive Care:

Preterm babies are functionally immature and special care is needed for there survival. Those are:

1. Inability to suck the breast and to swallow
2. Incapacity to regulate the temperature within limited range from 96⁰-99⁰F (35-6⁰-37.2⁰C)
3. Inability to control the cardi- respiratory function without cyanotic attack

The Principle to be taken for Care:

Ø      To maintain a relative stable thermoneutral condition

Ø      Adequate humidification to counter balance increased insensible water loss

Ø      Oxygen therapy and adequate ventilation

Ø      To prevent infection

Ø      To maintain nutrition and adequate nursing care

To maintain body Temperature:

          They can easily develop hyperpyrexia or hypothermia. So the rectal temperature should be between 90⁰-99⁰F (35-6⁰ to 37⁰.2C)

Ø      The smaller babies are best placed incubator. The babies are could be placed naked

Ø      The skin temperature should be maintained at 36 – 37⁰C with surrounding humidity at least 50%

Ø      If it is not possible the baby’s should be kept warm and rubber hot water may be useful. Those should be carefully stoppered and well covered with clothing.

Respiratory Support

Ø      To tide over the initial cyanotic phase measures are to be taken to clear the air passage and to administer oxygen.

Ø      The baby is placed in the incubatory with oxygen running alternatively baby’s head is kept in an oxygen level box for prolonged oxygen therapy

Ø       Endotracheal intubation and mechanical ventilation should be given

Infection

Ø       The main site of infection are respiratory tack gastrointestinal tract, skin and the umblicus 

Ø      Every precaution should be taken to prevent or minimize infection

Ø      Prophylactic antibiotic therapy is to be given when the babies are born following premature mixture of the membranes

Nutrition

Ø      Preterm infants are often unable to suck and swallow

Ø      Babies may required gavase feeding or parentral nutrition.

Ø      Human milk is the first choice of nutrition.

Commencement

Ø      Early feeding between 1-2 hours of birth is recommended

Ø      It eliminates

·         Hypoglycemia

·         lowers serum bilirubin

·         Neurological sequelae

Food Volume

Ø      To meet the calorie requirement the amount of milk to be given is slowly but progressively increased until the baby receiving 200ml per kg/day

Additional supplements

Ø      All premature babies should receive additional supplement of vitamins and minerals which should be started after 2 weeks.

Adequate Nursing Care:

          The most important single factor is high standard of nursing and one trained nurse can adequately take care of two or three infants.

1. The temperature should be taken twice daily and the baby should be weighed daily to know what over or under hydrated.
2. Constant supervision specially during the crucial first 48 hours in imperative
3. Mother should allowed to her baby in the nursing
4. Mother is taught for the manual expression of breast milk by pressing over the areola and the nipple

          Intelligent observation prompt recognition of the abnormality and adequate measure to rectify the defect can be life saving in may on occasion.

CONCLUSION

          By knowing all this it is an responsibility of the nurse to take prompt care should be taken of the new born to prevent future complications to the bay and prevent from environmental hazards.

BIBLIOGRAPHY

1. Text Book of Obstetrics

D.C. Dutta, Sixth Edition, 2004 Page No. 458 – 460 & 314

2. Myles Text Book for Midwives

Diane M. Fraser & Margaret A Cooper

14^th Edition Page No. 785-786