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Prematurity
Lifespan III
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Ineffective Thermo Regulation
The state in which the individuals
temperature fluctuates between
hypothermia and hyperthermia
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Prematurity Defined
Born before end of 37th week
Typically a lower birth weight
Now consists of about 13-15% of alldeliveries
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Causes of Prematurity
The biggest is unknown reasons
Medical conditions with mom such as PIH,
Infection, DM, Heart Disease, incompetentcervix, defect in uterus, STDs, drugs,
alcohol, cigarette smoking, etc.
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Prenatal Tests for Maturity
Amniocentisis
L/S Ratio: estimates pulmonary maturity
a ratio used to determine fetal pulmonarymaturity, found by testing the amniotic fluid;
when the lungs are mature, lecithin exceeds
sphingomyelin by 2 to 1.
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Physical Signs of Prematurity
Basis for Gestational Age
Body hair (lanugo)
Abnormal breathing patterns (shallow,
irregular pauses in breathing called apnea)
Enlarged clitoris (female infant)
Problems breathing due to immature lungs(neonatal respiratory distress syndrome) orpneumonia
Lower muscle tone and less activity thanfull-term infants
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Ballard Score
6 neuromuscular signs
6 external physical signs
Age assessable from 20-44 weeks
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Review of A&P-Thermoregulation
Thermoregulation
Evaporation:
Convection:
Conduction:
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Body Surface Factors
Cold Stress-
Posture-
Brown Fat Stores-
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Consequences of Cold Stress
o metabolic consumption of calories
o oxygen consumption p hypoxia
o glucose consumption p hypoglycemia Fatty acid release p hyperbilirubinemia
andq bilirubin levels
Interference with clotting factorso risk of bleeding
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Heat Production
Constriction of blood vessels in the skin
Increase metabolic rate
Restlessness and hyperactivity
Non-shivering thermogenesis-
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How can we prevent heat loss?
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More Nursing Management for
Premies!
Remember they are only as old as their
due date!
Remember this is scary-so lots of TLC
Skin-to-skin (AMAZING)
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Respiratory Distress Syndrome
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Pathophysiology Of RDS
Deficiency in surfactant activity = high
pulmonary resistance
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S&S of RDS
Occurs within 2 hours after birth (usuallynoticed during initial assessment)
Expiratory grunt or sigh
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Treatment
Supportive
Provide oxygen-warm and moistened
CPAP
ECMO
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Risk Factors for RDS
A brother or sister who had RDS
Diabetes in the mother
Cesarean delivery
Delivery complications that lead to
acidosis in the newborn at birth
Multiple pregnancy (twins or more) Rapid labor
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Complications
Air or gas may build up in:
The space surrounding the lungs (pneumothorax)
The space in the chest between two lungs
(pneumomediastinum) The area between the heart and the thin sac that
surrounds the heart (pneumopericardium)
ROP
BPD
And more
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Retinopathy of Prematurity
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Risk Factors For ROP
In addition to prematurity, other risks
factors may include:
Brief stop in breathing (apnea)
Heart disease
High carbon dioxide (CO2) in the blood
Infection
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Stages of ROP
There are 5 stages of ROP.
Stage I: There is mildly abnormal blood vessel
growth.
Stage II: Blood vessel growth is moderately
abnormal.
Stage III: Blood vessel growth is severely
abnormal.
Stage IV: Blood vessel growth is severely
abnormal and there is a partially detached
retina.
Stage V: There is a total retinal detachment.
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S&S of ROP
Symptoms of severe ROP include:
Abnormal eye movements
Crossed eyes
Severe nearsightedness
White-looking pupils (leukocoria)
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Treatment of ROP
Early intervention has the best outcomes
Cryotherapy
Laser Therapy
Surgery if detachment
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