Lectur 7 Clinical aspects of Maternal and Child Nursing NUR 363

Premature Newborns Definition: The premature newborn is a baby born before completion of 37 weeks of gestation. The cause of prematurity is unknown.

Predisposing Factors of Premature Newborn: Mothers’ age less than 17 years or over 35 years. Toxaemia of pregnancy. Multiple births. Antepartum hemorrhage. Premature rupture of membrane. Chronic maternal malnutrition. Cardiac disease and hypertension of the mother. Maternal diabetes mellitus. Acute or chronic infection. Inadequate antenatal care. Abnormality of the pelvis. Exposure to radiation during pregnancy. Fetal abnormality.

Newborns who do require resuscitation are transferred immediately to the NICU in a heated incubator where they are weighed. Intravenous lines, O2 therapy, and other therapeutic interventions are initiated as needed. Subsequent care is determined by the status of newborn. Therapeutic Management:

Mechanism of Thermoregulation: Thermoregulation is a balance between heat loss and heat gain. The main goal is to control the neonate’s environment to maintain a neutral thermal environment and minimize energy expenditure. If heat production exceeds heat loss, the temperature rises and vice versa.

Hypothermia It occurs when body temperature is below 36.3ºC axillary.

 The incubator should always be pre warmed before placing a newborn.  The newborn is clothed and warmly wrapped in blanket when removed from the warm environment of the incubator for feeding or cuddling.  Inside or outside the incubator, head covering is effective in preventing heat loss.  Compare the newborn’s temperature with the temperature in the incubator (axillary temperature procedure Nursing Care for Hypothermia:

Body temperature is above 37.5ºC axillary, it occurs when conditions associated with hyperthermia are: 1. Infection. 2. Dehydration. 3. Intracranial hemorrhage. 4. Hot weather. 5. When incubators‘ temperature itself are closely for incorrect high as well as low temperature. Hyperthermia

Nursing Care for Hyperthermia:  Cool the newborn by removing external heat source by removing anything that block heat loss such as radiant warmer.  Check the heating control for proper function and proper position.  Consider sources of heat e.g. direct sunlight, heaters and lights as possible causes of hyperthermia. Excessive covering with blankets and a hat and elevated environmental temperature can cause a newborn’s body temperature to rise into febrile range.  Removing extra blankets.  Observe for manifestation of infection, or CNS disorders.  During the cooling process, skin, axillary, and environment temperature should be monitored and record every 30 minutes.

Hyperbilirubinemia Hyperbilirubinemia is a condition in which the bilirubin level in the blood is increased. It is characterized by a yellow discoloration of the skin, mucous membrane, sclera, and various organs

 Increase feeds in volume and calories. Early feeding lowers serum bilirubin level by stimulating the peristalsis.  Stop drugs interfering with bilirubin metabolism.  Correct hypoxia, infection, and acidosis.  Phototherapy. (It consists of the application of fluorescent light (blue or white) to the newborns naked skin. Light causes break down of Bilirubin by the process of photo oxidation. It alters the structure of Bilirubin to a soluble form for easier excretion.) Management of Hyperbilirubinaemia:

Hypoglycemia Definition of Hypoglycemia: Hypoglycemia is defined as a blood glucose level of less than 40 mg/dl in the term newborn or less than 30 mg/dl in the preterm newborn.

1- Assessment: History. Determine gestational age. Assess feeding and fluid. Assess glucose level. Assess for signs of hypoglycemia. 2- Nursing Diagnosis: Altered nutrition, less than body requirement, related to inadequate supply of glucose of increased glucose use in the neonate. Nursing Management:

3-Implementation: Blood glucose level should be obtained regularly with a screening strip. Provide feeding. Provide I.V. fluids.

Definition: It is a type of infection, which occurs when bacteria or their poisonous products known as endotoxins, gain access to the blood stream. Sepsis or septicemia refers to a generalized bacterial infection in the blood –stream. Neonatal Sepsis

Diagnosis Measurement: Blood culture. Urine culture. Tracheal culture. Cerebo-spinal fluid culture. CBC with different and platelet count

Prevention:  Demonstrate the effect of hand washing upon the prevention of the noscomial infections.  Standard precautions should be applied in the nursery for infection prevention  Instillation of antibiotics into newborn’s eye 1-2 hours after birth is done to prevent the infection.  Skin care should be done using worm water and may use mild soup for removal of blood or meconium and avoid the removal of vernix caseosa (covered with a whitish, cheesy, slippery substance )  Cord care should be cared out regularly using alcohol or an antimicrobial agent. Nursing Consideration:

Curative:  Encourage breastfeeding from the mother.  Adequate fluid and caloric intake should be administered by gavage feeding or intravenous fluids as ordered.  Extra- measure for hypothermia or hyperthermia that may take place to the newborn.  Administering medications as doctor order.  Follow the isolation precautions.  Monitoring the intravenous infusion rate and antibiotics are the nurse responsibility.  Administer the medication in the prescribed dose, route, and time within hour after it is prepared to avoid the loss of drug stability.

 Care must be taken in suctioning secretions from the newborn as it may be infected.  Isolation procedures are implemented according to the isolation protocols of the hospital.  Observe for the complication e.g. meningitis and septic shock.

Nursing Management:  Provide care individually according to each newborn’s needs.  Observe signs and symptoms of respiratory distress.  Take temperature.  Monitor serum glucose.  Observe signs and symptoms of hypoglycemia because of limited glycogen stores.  Monitor serum calcium.  If oral calcium is ordered, give the medication with enteral feeding because it may cause gastric irritation. Post-Term Newborn

 If calcium is ordered IV, monitor the heart rate during administration, administer slowly, and stop it if bradycardia or arrhythmia occurs.  Provide skin care, wash with non- alkaline soap or water only and allow skin to slough naturally.