Preterm babies are those born before 37 weeks of gestation. They often have low birth weight and exhibit signs of clinical immaturity. Common problems include respiratory (HMD, BPD), gastrointestinal (NEC), cardiovascular (PDA), neurological (IVH, ROP) and thermal instability issues. Management involves providing supportive care in the NICU, including warmth, minimal stimulation, feeding and monitoring for complications. Nursing care focuses on thorough assessment, monitoring for problems, providing developmental care and teaching parents for home management of preterm infants.

1. Presented by :
Rinki Das
Third year Bsc Nursing
Rajarajeswari College Of
Nursing, Bangalore

2. CONTENTS
 Definition
 Incidence
 Causes
 Clinical features
 Physiological handicaps
 Management
 Care of Preterm Babies
 Nursing management

3. DEFINITION
Preterm babies/infants (also called
premature infants) are those born
before the beginning of 37th week of
gestation.

4. INCIDENCE
An estimated 15 million babies are born too early
every year.
That is more than 1 in 10 babies.
Approximately 1 million children die each year
due to complication of pre term birth.
Pre term birth occurs in 5-12% of all pregnancies.

5. CAUSES
Fetal
factors
Placental
factors
Uterine
factors
Maternal
factors
Other
factors

6. FETAL FACTORS
Fetal
distress
Multiple
gestation
Erythro-
blastosis
fetalis
Nonimmune
hydropes

7. PLACENTAL FACTORS
Placental dysfunction
Placenta previa
Abruptio placenta

8. Placental dysfunction

9. Placental
Previa
Placental
Abruption

10. UTERINE FACTORS
Bicornuate uterus
Incompetent cervix

11. Bicornuate Uterus

13. MATERNAL FACTORS
 Pre – eclampsia
 Chronic medical illness (renal or heart
disease)
 Infections(Listeria monocytogenes,
Group B streptococcus, UTI,
bacterial vaginosis etc)
 Drug abuse(Cocaine)

14. Premature rupture of
membranes
Polyhydramnios
Iatrogenic
Trauma
OTHER
FACTORS

15. PROM

17. CLINICAL FEATURES

18. MEASUREMENTS
 Size is small with
relatively large head
 Crown- heel length is
less than 47 cm
 Head circumference is
less than 33cm
But exceeds the chest
circumference by more
than 3cm
 Weight – Less than
2.5 kg

19. ACTIVITY AND POSTURE
General activity is poor.
Autonomic reflex
response such as Moro
response , sucking and
swallowing are sluggish
or incomplete.
Baby assumes an
extended posture due to
poor tone.

20. FACE AND HEAD
Face appears
small
Large head size
Sutures are
widely separated
and fontanels are
large.

21. SKIN AND SUBCUTANEOUS
TISSUE

22. Thin skin, gluteneous
,skiny Skin is excessively pink
Abundant lanugo Ear cartilage poorly developed

23. very little vernix caseosa.
Edema may be present.
Subcutaneous fat is deficient.
Breast nodule is small or absent.
Hairs are fine , fuzzy and wooly.
Sole of foot appears more turgid and
may have only fine wrinkles.

24. GENITALS
MALE
Testes undescended
Scrotum poorly developed
FEMALE
Labia majora widely separated
exposing labia minora
Hypertrophied clitoris

25. SCARF SIGN
It is a new born
assessment finding in
which the infant ‘s
elbow crosses the body
midline without
resistance as the
examiner draws the arm
Across the chest to the
opposite shoulder.

26. HEEL TO EAR MANEUVER
The preterm
Infant’s heel
is easily
brought to
the ear
with no
resistance.

27. PROBLEMS ASSOCIATED WITH
PRETERM BABIES (PHYSIOLOGICAL
HANDICAPS)
RESPIRATORY
PROBLEMS
 Hyaline membrane
disease
 Bronchopulmonary
dysplasia
 Pneumothorax
 Apnea

29. Cardiovascular
problems
Patent
ductus
arteriosus
bradycardia
hypotension

30. GASTROINTESTINAL
PROBLEMS
 Poor gastrointestinal function
 Necrotizing enterocolitis
 Hyperbilirubinemia
 Incompetent cardioesophageal
sphincter leading to regurgitation

31. PROBLEMS ASSOCIATED
WITH RENAL SYSTEM
 Hyponatremia/Hypernatremia
 Hyperkalemia
 Renal tubular acidosis
 Renal glycosuria
 Edema

32. CENTRAL NERVOUS SYSTEM
 Intraventricular hemorrhage
 Seizures
 Retinopathy Of prematurity
 Deafness
 hypotonic

33. OTHERS PROBLEMS
 Hypothermia
 Nutritional deficiencies
 Increased susceptibility to infections

34. MANAGEMENT
Arrest of premature labor
Induction of premature
labor
Antenatal corticosteroids

35. Arrest of premature Labor
Bed rest and sedation
Tocolytic agents
- Sympathomimetic agents
- Isoxsuprine (Duvadilan)
- Ritodrine
- Salbutamol and Terbutaline
 Magnesium Sulphate
 Indomethacin

36. Induction of premature labor
Maturity of fetus by examination of
amniotic fluid or phosphatidyl glycerol
or L/S ratio
Corticosteroids should be administered

37. Antenatal Corticosteroids
• Inj Betamethasone 12mg IM every 24
hours- 2 doses
• Dexamethasone 6mg IM

38. CARE OF PRETERM BABIES
Optimal management at birth
-Delayed clamping of cord
-Elective intubation of
extremly LBW babies.
- Dried promptly and covered
- Vitamin k – 0.5 mg in babies
<1500g
- Transferred to the NICU

39. Monitoring
- Vital signs
- Activity and behaviour
- colour
- Tissue perfusion
- Weight Gain velocity
- Fluid , electrolytes and ABGs
- Watch for development of
RDS , apneic attacks , sepsis
PDA , NEC , IVH etc.

40. Provide in - utero milieu
-Comfortable and cushioned
bed.
- Avoid excessive Stimuli
- Provide Warmth
- Ensure asepsis
- Effective and safe oxygenation
- Partial parental nutrition and
give trophic feeds with
expressed breast milk
Position of the baby
- Thermoneutral environment
- Application of oil or liquid paraffin on the
skin
- Covered with a cellophane or thin transparent
plastic sheet
- Provide partial Kangaroo Mother Care

41. Oxygen therapy
Phototherapy
Prevention of nosocomial infections
Feeding and nutrition
- IV Dextrous solution
10 % to babies > 1000g
5% to babies < 1000g
- Trophic feeds through NG tube
- Enteral feeds if condition is
stabilized.

42. Nutritional
supplements
Gentle
rhythmic
stimulation
Kangaroo
mother care

43. HOME CARE OF PRETERM
BABIES
 Mother must be explained about the
importance of sepsis
 Keeping the baby warm and ensuring
satisfactory feeding routine
 Environmental control
 Feeding

44. NURSING MANAGEMENT
 Obtain detailed antenatal, intranatal
history
 Assess the gestational age and birth weight
of the baby
 Assess the features of clinical immaturity
 Assess the behavior of preterm neonate
 Assessment of common problems