What is considered Preterm?
<37 weeks gestation
WHO Categories
What is considered extremely preterm?
< 28 weeks
WHO Categories
What is considered very preterm?
28-32 weeks
WHO Categories
What is considered moderate to late preterm?
32-37 weeks
What is the leading cause of death < 5 years old worldwide?
Prematurity
True or false: African American women have a lower preterm birthrate than white women
False, they have a 50% higher preterm birthrate
Overview
What are complications of prematurity?
4
- Apnea and respiratory distress
- Intraventricular hemorrhage
- Infection
- Feeding prblems
What does low surfactant in premature newborns cause?
Alveoli collapse (atelectasis)
What does a patent ductus arteriosus (PDA) cause in premature newborns?
- Pulmonary congestion
- Increased CO2
- Bounding pulses
What are reasons thermoregulation is a challenge in premature babies?
3
- Limited brown adipose
- Limited glycogen
- Cannot shiver
What are risk factors for thermoregulation challenges/hypothermia?
5
- Large surface area to weight ratio
- Little subcutaneous fat
- Thin, permeable skin
- Hypotonic posture (more surface exposed)
- Poor vasoconstriction
What is the nursing focus for thermoregulation challenges in premature babies?
Maintaining a neutral thermal environment (NTE)
What does a poor suck/swallow reflex put a premature baby at risk for?
Aspiration
What are GI challenges for premature babies?
4
- Small stomach capacity (limited intake)
- Difficulty digesting nutrients
- Risk for feeding intolerance
- Necrotizing entercolitis
What nutrients may premature babies have difficulty digesting?
3
- Amino acids
- Fats
- Lactose
What are renal system challenges a premature baby may face?
5
- Poor fluid/electrolyte control
- Glycosuria
- Osmotic diuresis
- Metabolic acidosis
- Risk of drug toxicity due to slow excretion
What are reasons premature babies are at risk of infection?
2
- Few maternal IgG antibodies
- Skin easily damaged
What are neurologic complications are premature babies at risk for?
4
- Intraventricular hemorrhage
- Hydrocephalus
- Weak reflexes
- Disturbed sleep/wake cycle
How many calories do premature babies need per day?
95-130 cal/kg/day
What are feeding options in order of preference?
4
- Breastfeeding
- Bottle with soft nipple
- Gavage feeding
- TPN
What supplements might a premature baby need?
6
- Vitamin A
- Vitamin D
- Vitamin E
- Iron
- Calcium
- Phosphorus
What are long-term risks for premature babies?
5
- Retinopathy of prematurity (ROP)
- Bronchopulmonary dysplasia
- Speech and neurologic delays
- Hearing loss
- SIDS
What is apnea of prematurity?
A pause in breathing defined by a pause greater than or equal to 20 seconds OR a pause in breathing less than 20 seconds with cyanosis, pallor, and bradycardia
What are causes of apnea of prematurity?
3
- Immature CNS
- Obstruction of airway
- GERD
