13.4 Preterm Infants

Question 1

Risks

Answer 1

• Immature organ systems
• ## Lack adequate nutrition reserves

Question 2

LBW

Answer 2

• Less than 2500g (5.5 lbs)

Question 3

VLBW (Very Low Birth Weight)

Answer 3

• Less than 1500g (3.3 lb)

Question 4

Extremely LBW

Answer 4

Less than 1000g (2.2 lb)

Question 5

AGA

Answer 5

• Between 10-90 percentile

Question 6

TERMS

Answer 6

Preterm - Before 37 weeks
Late Preterm - 34-37
Early Term - 37-38
Full term - 39-40
Late-Term - 41-42
Post-Term - Greater than 42

Question 7

Preterm Infants

Answer 7

• Trouble with respiratory function

- Due to immature organ such as decreased alveolar function, decreased surfactant levels, smaller lumen airways.

Question 8

Thermoregulation

Answer 8

• Minimal subQ fat
• limited brown fat
• fragile capillaries
• poor muscle tone
• immature temperature regulation in brain

Question 9

CNS

Answer 9

• impaired coagulation
• recurrent hypoxic episodes
• predisposition to hypoglycemia
• birth trauma with damage to immature structures

COMPLICATIONS

• seizures
• hyperirritability
• CNS depression
• ICP (Intracrainal pressure)

Question 10

Immunity

Answer 10

• Shortage of immunoglobins

-

Question 11

Corrected Age

Answer 11

• Age of preterm newborn is corrected by adding gestational age and the postnatal age

MEASURABLE FACTORS

• Ability to cry when hungry
• Appropriate weight gain
• Neurological Responses appropriate for age

Question 12

Maintaining Body Temperature

Answer 12

• Cannot increase metabolic rate because of impaired gas exchange, caloric intake restrictions, or poor thermoregulation
• Trans epidermal water loss greater because skin immaturity in very preterm infants
• You should begin rewarming the baby right away by providing an external heat source
• RAPID CHANGES IN BODY TEMPERATURE CAN CAUSE APNEA AND ACIDOSIS

Question 13

Neonatal Resuscitation

Answer 13

• Rapid assessment (evidence of meconium, breathing or crying, good muscle tone)

IF CHARACTERISTICS ARE ABSENT

• Provide warmth via radiant warmer
• Clear airway with bulb syringe and make sure head is positioned to open airway
• Chest compressions
• Administration of epinephrine or volume expansion

Question 14

Barotrauma

Answer 14

• Pneumothorax (accumulation of air in the pleural space)
• Pulmonary interstitial Emphysema (free air accumulated in the interstitial fluid)
• High frequency ventilation - High frequency flow interrupters

Question 15

Nitric Oxide Therapy

Answer 15

• Delivered via gas to sustain pulmonary vasodilation

Question 16

FEEDINGS

Answer 16

• Oral feeding preferred for babies with adequate strength and GI function
• Gavage feeding preferred for babies with respiratory distress, immature reflexes, easily fatigued by sucking. (GIVEN THROUGH NG TUBE)
• Gastrostomy Feeding - for those with neuro problems that require long term feeding
• Parental Feeding - Supplemental for those who cant obtain sufficient fluids or calories by enteral feedings.

Question 17

Non-Nutritive Sucking

Answer 17

• Encouraged for TPN or Gavage Babies
• Improves oxygenation
• Leads to decreased energy expenditures with less restlessness
• Promotes positive weight gain and better sucking skills.

Question 18

Vernix Caseosa

Answer 18

• Epidermal Barrier
• Decreased bacterial contamination of skin
• Decrease trans-epidermal water loss

Question 19

Insensible Water Loss

Answer 19

Evaporative loss through the skin (70%) and through respiratory tract

Question 20

Position

Answer 20

• Proper body mechanics are necessary to prevent developmental problems.

Question 21

Retionpathy

Answer 21

• OXYGEN LEVELS OF BABY MUST BE MONITORED