the preterm infant Flashcards
- AKA premature infant, preemie
- Born prior to 38 week gestation
- May be SGA, AGA, LGA (most AGA)
- Infant mortality increases as gestational age decreases
- Incidence of blindness, hearing loss, developmental retardation, CP increases as gestational age decreases
preterm infants
- Multi-fetal gestation
- Low socioeconomic status
- PIH/Preeclampsia
- Diabetes
- Maternal infections
- Incompetent cervix, uterine anomalies
- Prevention thru early prenatal care is key!!
risk factors of preterm
•Characteristics vary with gestational age •Frail looking, little fat, “stick” extremities, large head with prominent eyes—unfinished development! •Easily over stimulated
preterm infants (2)
• Less mature lungs, inadequate surfactant predispose to RDS • Assess respiratory status - Periodic breathing vs apnea - Distress –Silverman index (Ricci 817) • O2 therapy via hood, cannula, vent • Position in side lying or prone position to improve ventilation, secretion drainage • Suctioning - increase O2 need so increase O2 flow - Mouth then nose - Gentle • Monitor for dehydration—viscosity of secretion
respiratory problems of preterm infant
• Inadequate fat store, thin skin with subcutaneous vessels • Increased surface area relative to mass • Immature thermoregulatory center • Cold stress more dangerous in preemie -Hypoglycemia -Metabolic acidosis -Respiratory distress want temp of 36.6 • Monitor for -Poor feeding -Lethargy -Irritability -Cool skin with mottling • Hypoglycemia and respiratory distress • Radiant warmer or incubator until able to maintain temp • Warmed oxygen • Warm blankets and hat if held • Monitor temperature of equipment carefully—overheating • Weaned slowly to open crib
thermoregulation problems of preterm
• Insensible fluid loss thru thin, permeable skin
-Radiant warmer, incubator
-Respiration, GI
• Large surface area to mass ratio
• Immature kidneys unable to concentrate/dilute urine—greater Na+
needs
• Avoid overhydration
-Increasing output with decreasing SG
-Edema, wt gain
• Always administer IV fluids with infusion controller
• Medications diluted with as little fluid as possible
fluid and electrolyte imbalance of preterm
•Vigilant I and O monitoring
-Between 1-3 ml/kg/hour normal
-Measure all fluids
-Weigh diapers (1 gm=1ml), drainage from tubes, monitor blood draws
•Monitor weight
-Weigh before and after breastfeeding
•Decreased output and increasing specific gravity
first signs
• Poor turgor, dry mucus membranes, sunken
fontanel are LATE signs
fluid and electrolyte imbalance of preterm (2)
• Extremely fragile -Susceptible to tearing, irritation • Avoid tape when at all possible -Gauze wrap -Hydrocolloid dressing/adhesives • Avoid alcohol, betadine (iodine --> thyroid problems) • Emollient application • Positioning
skin problems of preterm
- Once believed neonates did not feel pain
- Pain increases O2 need, caloric needs
- Assess for increased HR, respirations, decreased O2 saturation
- Facial grimacing, harsh high pitched crying or “cry face”
- Promote comfort thru containment—swaddling, position
- Nonnutritive sucking
- Pain medications
pain of preterm
• Preemies easily over stimulated by light, sound, movement
• Increase O2 and caloric needs—not available for G & D
• Changes in O2 oxygenation, increased HR, resp distress
• Exhibits avoidance behaviors
•Stiffening, avoiding eye contact, regurg,
yawning
environmental stress of preterm
• Promote sleep/rest
• Schedule procedure and assessment free periods
• Calm, soothing environment
• Low lights
• Decrease volume of voices, equipment
• Promote motor development thru positioning—side
lying, prone
•Act as pt advocate and coordinate cares to provide
individualized care to infant
environmental stress of preterm (2)
• Preemies need more calories and nutrients per kg
• Absence of calcium, iron and nutrient stores
• Minimal or absent fat stores
• Minimal glucose reserves
• Nutrients poorly absorbed from immature gut—especially fat, lactose
• When demonstrating readiness provide oral feedings, may
supplement with gavage feedings
• Monitor for signs of distress during feeding
nutrition of preterm
• Poor suck and swallow, gag reflex
-Coordination around 34 weeks
• Decreased muscle tone in jaws
• If nippling/sucking too exerting need IV or gavage feedings
• Always check residual prior to gavage feeding
-Amount
-Appearance of residual
nutrition of preterm (2)
- Don’t forget the parents!!!
- Reachable, teachable moments
- Parents are part of the health care team
- Allay fears, encourage, support
- Don’t be judgmental!!
- Kangaroo care—best idea anyone ever had!
parenting of preterm
