Nursing Care for the Preterm Infant

Infants born prematurely, or before 37 completed weeks of gestation, miss beneficial time of intrauterine development, which places them at risk for complications.

As the nurse, you’ll collaborate with the registered nurse, or RN, to manage complications that can arise, including respiratory and thermoregulation issues, hypoglycemia, and hyperbilirubinemia.

Most respiratory complications that occur in preterm infants are due to insufficient production of surfactant, which is a lipoprotein produced by cells in the alveoli that helps keep the lungs expanded.

Insufficient surfactant can impair gas exchange, leading to respiratory distress syndrome and hypoxia. Other characteristics of preterm infants that impair effective respirations include underdeveloped chest wall muscles; an immature respiratory center in the brain; and weak gag and cough reflexes.

When caring for a preterm infant, you’ll monitor their respiratory status by checking their oxygen saturation, respiratory rate and effort, skin color, and arterial blood gas as indicated.

You’ll also support oxygenation by administering warmed, humidified supplemental oxygen, and promote lung expansion by elevating the head of their mattress, or positioning them on their side.

You can also help them conserve energy and oxygen consumption by keeping them warm, clustering care to allow time for uninterrupted rest, and handling them minimally and gently.

If apnea occurs, rub their feet, ankles, or back to stimulate breathing. If the apnea continues, or if you notice signs of respiratory distress, like decreased oxygen saturation, dyspnea, grunting, nasal flaring, intercostal retractions, or cyanosis, immediately notify the RN.

Now, preterm birth also affects an infant’s thermoregulation. They lack subcutaneous fat, which provides insulation, as well as brown fat, which is used to produce heat.

Their large surface area-to-weight ratio creates a large area from which heat can be lost through radiation, and their lack of muscle tone and extended posture further increases the surface area for heat loss.

Other characteristics that make them prone to heat loss include an immature heat-regulating center in their brain, and low muscle activity, which means they don’t generate extra heat through movement.

When caring for a preterm infant, be sure to place them under a radiant warmer or in an incubator to provide warmth and help maintain their temperature within a normal range.

Assist them into a flexed position, keep their head covered with a cap, and prewarm linens and equipment used in their care.

Also, encourage skin-to-skin contact with caregivers to promote warmth, comfort, and bonding. Monitor their temperature closely, and immediately notify the RN if you notice signs of cold stress, including decreased temperature, tachypnea, apnea, bradycardia, mottling, pallor, or lethargy.

Next, preterm infants are prone to hypoglycemia due to their inadequate stores of glycogen and fat. Other complications like respiratory issues and unstable body temperature further increase their glucose needs which can quickly deplete glycogen stores, resulting in hypoglycemia.

When caring for a preterm infant, initiate frequent oral feedings, as tolerated. If their suck and swallow is too weak or uncoordinated, administer gavage feedings or assist with administering IV glucose as prescribed.

Frequently monitor their glucose levels and notify the RN if their glucose is below the expected range, or if they have signs of hypoglycemia like tremors, jitteriness, or lethargy, as well as an unstable temperature or respiratory distress.

Premature birth can also increase the risk of hyperbilirubinemia, which can present as jaundice, or yellowing of the skin, sclera, and mucous membranes.

Now, bilirubin is produced when red blood cells are broken down. The bilirubin is metabolized by the liver, excreted into the bile, and eventually cleared from the body in the infant’s stool.

Since the preterm infant's liver is still relatively immature, jaundice occurs as bilirubin builds up in the bloodstream.

If bilirubin levels rise too high, it can cause brain damage. As you care for preterm infants, monitor for signs of jaundice, and check their transcutaneous and total serum bilirubin levels.

Notify the RN if levels are elevated above the expected range. Encourage frequent feedings to promote bilirubin excretion and facilitate phototherapy, to help break down excess bilirubin, as prescribed.

Alright, as a quick recap...Infants born prematurely, or before 37 completed weeks of gestation, miss beneficial time of intrauterine development, which places them at risk for complications.

As the nurse, you’ll collaborate with the registered nurse, or RN, to manage complications that can arise, including respiratory and