Preterm Birth

"Mommy I'm not yet ready"

A case study about Maternal and Child Health with emphasis on Preterm Birth

Description

• Refers to the birth of a neonate before the end of 37th week of gestation;
• Associated with numerous problems
• All body systems are immature;
• The extent of immaturity depends on gestational age and level of development at delivery;
• Preterm neonates between 28 and 37 weeks of gestation have the best chance of survival.

What happened?

• Preterm birth may occur because of maternal disease that necessitates delivery of the neonate for the health of the mother - example, preeclampsia (gestational hypertension);
• Preterm birth may also be a direct result of preterm labor.

Assessment findings

• Inspection findings
• Low birth weight
• Minimal subcutaneous fat deposits;
• Proportionally large head in relation to body;
• Wrinkled features;
• Thin, smooth, shiny skin that is almost translucent;
• Veins clearly visible under the thin, transparent epidermis;
• Lanugo hair over the body;
• Sparse, fine, fuzzy hair on the head;
• Soft, pliable ear cartilage; the ear may fold easily;
• Minimal creases in the soles and palms;
• Prominent eyes, possibly closed;
• Few scrotal rugae (males);
• Undescended testes (males);
• Prominent labia and clitoris (females)
• Neurologic examination findings
• Inactivity (although may be unsually active immediately after birth);
• Extension of extremeties
• Absence of sucking reflex;
• Weak swallow, gag, and cough reflex;
• Weak grasp reflex;
• Ability to bring neonate's elbow across the chest when eliciting the scarf sign;
• Ability to easily bring the neonate's heel to his ear
• Additional findings
• Inability to maintain body temperature;
• Limited ability to excrete solutes in the urine;
• Increased susceptibility to infection, hyperbilirubinemia, and hypoglycemia;
• Periodic breathing, hypoventilation, and periods of apnea.

Treatments

• Cardiac and respiratory assessment and assistance;
• Resuscitation if necessary;
• Maintenance of fluid and electrolyte balance;
• Nutritional support;
• Prevention of infection;
• Assessment of neurologic status;
• Maintenance of body temperature and neutral thermal environment;
• Monitoring of renal fuction;
• Emotional support to parents;
• Assessment of glucose and bilirubin levels

Interventions

• Closely assess all body systems;
• Anticipate the need for endotracheal intubation and mechanical ventilation;
• Administer oxygen as needed, avoiding concentrations that are too high;
• Monitor transcutaneous oxygen levels or pulse oximetry reading;
• Have emergency resuscitation equipment readily available.
• Administer medications to support cardiac and respiratory function;
• Institute measures to maintain a neutral thermal environment; anticipate the need for incubator or radiant warmer;
• Avoid vigorous stroking or rubbing; use firm but gentle touch when handling a neonate;
• Support the head and maintain extremeties close to the body during position changes;
• Monitor fluid and electrolyte balance, assess intake and output and administer intravenouos fluids as ordered;
• Provide emotional support, education and guidance to the mother and family;
• Explain the procedures and treatments to the parents, allow parents to verbalize their concerns, correct any misconceptions or  erroneous information;
• Assist with referrals for supportive services.