Preterm infant complications: Nursing

A preterm, infant is born before 37 completed weeks of gestation, which refers to the period between conception and birth that typically lasts for 40 weeks.

Now, the cause of preterm birth can be medically indicated when there are maternal fetal and placental complications such as preeclampsia, fetal anomalies or placenta praevia, preterm birth can also be spontaneous.

In which case, the cause is often unknown, but there are certain factors that can lead to premature birth. These include maternal factors such as extremes of age like teenage pregnancy or age over 40 years.

History of prior preterm birth being underweight or having a poor nutritional status. Use of assisted reproductive technology like with in vitro fertilization, cervical insufficiency, substance use including tobacco, alcohol or illicit drugs, infections like bacterial vaginosis or an intrauterine infection as well as factors like late or no prenatal care, high levels of stress, long working hours, especially when there's long periods of standing, lack of social support and intimate partner violence.

Regardless of the cause. Preterm, infants are more likely to develop severe or life threatening complications.

Respiratory complications are common and are mostly related to insufficient surfactant production. This prevents the alveoli from expanding completely, resulting in hypoxia and respiratory distress syndrome.

Other respiratory complications include transient tachypnea of the newborn because of decreased absorption of fetal lung fluid and subsequent decreased gas exchange pulmonary hemorrhage apnea with accompanying bradycardia, as well as persistent pulmonary hypertension of the newborn where pulmonary pressure remains high, resulting in continued shunting of blood away from the lungs through a patent ductus arteriosus.

Given these complications, preterm infants may remain on prolonged mechanical ventilation. Unfortunately, mechanical ventilation can damage the lungs over time leading to problems like bronchopulmonary dysplasia, a lung condition that can cause chronic respiratory and developmental problems even after the baby is discharged.

Moreover, premature infants usually require prolonged oxygen therapy. Increasing the risk of retinopathy of prematurity, which can result in vision loss.

Neurologic complications can occur due to the presence of fragile blood vessels called the germinal matrix that surround the ventricles in the brain.

These vessels can easily bleed, causing an intraventricular hemorrhage which can result in long term complications such as cerebral palsy and sensory or cognitive deficits.

Other problems experienced by preterm. Infants include impaired thermoregulation due to their lack of subcutaneous fat, their relatively large body surface to weight ratio and a decreased ability to generate heat due to absent or low levels of brown fat hypoglycemia due to insufficient glycogen stores and increased glucose needs infection due to an immature immune system and lack of IgG antibodies which are normally transferred through the placenta around 34 weeks of gestation, as well as fluid and electrolyte imbalance, anemia and hyperbilirubinemia.

Finally, because premature infants have an underdeveloped gi system, they are at risk for necrotizing enterocolitis or nec for short, which involves inflammation, ischemia and necrosis of the bowel.

Clinical manifestations of prematurity will vary depending on the gestational age. However, some common ones include a disproportionately large head compared to the rest of the body.

Thin extremities, low muscle tone and lack of subcutaneous fat. Skin can appear gelatinous or transparent with visible blood vessels.

As far as behavior goes, preterm, infants are often lethargic but can also be jittery, easily stressed by external stimuli and difficult to soothe.

Other findings include temperature instability, a weak sucking reflex and poor feeding treatment typically involves supportive care in the neonatal intensive care unit and includes close monitoring of respiratory status and providing respiratory support, body temperature, fluid and glucose levels are kept within a normal range.

Additionally, it's important to prevent complications and treat them if they do occur. In general, the preterm infant is ready for discharge when they are physiologically stable when they can coordinate their suck, swallowing and breathing and are feeding without difficulty when their weight stabilizes.

And there are no medical conditions that require treatment in the hospital. As the nurse caring for a preterm infant, you'll provide supportive care and monitor for complications while providing care, be sure to maintain a neutral thermal environment.

This will decrease the energy and oxygen the infant needs to maintain their body temperature. You can also keep their head covered with a cap and prewarm linens and any equipment that will be used to care for the infant.

Keep a close eye on their vital signs too, especially their respiratory status. Institute, cardio respiratory monitoring and administer warmed, humidified supplemental oxygen to keep their sp two at 94% or more.

Watch for signs of respiratory difficulties such as tachypnea, decreased po two retractions, nasal flaring or grunting on exhalation, cyanosis or apnea with bradycardia.

Assist with additional measures such as surfactant administration, continuous positive airway pressure or endotracheal intubation and mechanical ventilation as indicated.

Also monitor for non specific assessment findings that could indicate infection. If you note fluctuations in temperature, increased lethargy or diminished tone, obtain cultures and administer antibiotics as ordered.

Be sure to watch their fluid and electrolyte balance closely and check their blood glucose per protocol. Assess for clinical manifestations of hypoglycemia like jitteriness or tremors, weak cry or blood glucose, less than 40 mg per deciliter.

And if present, initiate early and frequent feedings or administer dextrose as ordered, monitor their weight and watch closely for feeding intolerance or signs of nec including weight loss, vomiting, abdominal distention, visible bowel loops, gastric residuals or blood in the stool or vomit.

Finally, be sure to provide a therapeutic care environment. Provide skin care according to the infant's individual needs and reposition them every 3 to 4 hours or more frequently to prevent skin breakdown position them in a flexed tucked position and use boundaries to provide containment.

Ensure there is minimal stimulation from light and noise cluster. Your care to provide adequate periods of rest and promote comfort by offering opportunities for non nutritive sucking as tolerated.

All right. As a quick recap.

A preterm infant is born before 37 completed weeks of gestation. Preterm birth can be medically indicated or spontaneous.

In which case the cause is often unknown. Preterm.

Infants are more likely to have problems with thermoregulation and experience respiratory complications, hypoglycemia, infection, hyperbilirubinemia and necrotizing enterocolitis.

Clinical manifestations vary depending on gestational age. However, common ones include thin extremities, low muscle tone, transparent skin and lack of subcutaneous fat treatment and nursing considerations are focused on providing supportive care and addressing complications.