Care of preterm babies
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Transcript of Care of preterm babies
CARE OF PRETERM BABIES
PRESENTED BYAMRUTHA R1ST YR MSc nsg
LOW BIRTH WEIGHT BABIES
<2500GMS TYPES
VLBW ELBW
CLINICAL TYPES
PRETERMS IUGR
PRETERM BABIES
DEFINITION
A baby born before 37 completed weeks of gestation irrespective of birth weight.
Etiology
Maternal factors socio economic factors Pregnancy related factors Medical conditions Anatomic issues
Behavioral factors
Infections
CHARACTERISTICS OF PRETERMS
SMALL AND SCRAWNY
PROPORTIONALLY LARGE HEAD TO BODY
TRANSLUCENT SKIN
VISIBLE BLOOD VESSELS
CHARACTERISTICS OF PRETERMS
FINE LANUGO HAIR
SOFT PLIABLE EAR CARTILAGE
SOFT BONES
CLOSED EYES
FEW SCROTAL RUGAE AND UNDECENDED TESTIS
PROMINENT LABIA AND CLITTORIS
INACTIVE AND LISTLESS
EXTENDED EXTRIMITIES
PARTIALLY DEVELOPED REFLUX ACTIVITIES
ABSENT WEAK OR INEFECTIVE SUCKING
INABILITY TO MAINTAIN BODY TEMPERATURE
LIMITED ABILITY TO EXCRETE SOLUTES IN URINE
INCREASED SUSCEPTIBILITY TO INFECTION
PLIABLE THORAX IMMATURE LUNG TISSUE
CHARACTERISTICS OF PRETERMS
IMMATURE REGULATORY CENTRE
MORE SUSCEPT IBLE TO HYPOGLYCEMIA AND HYPER BILIRUBINEMIA
PHYSIOLOGIC HANDICAPPS
POOR CONTROL OF BODY TEMPERATURE
RESPIRATORY DIFFICULTY
SUSCEPTIBILITY TO INFECTION
PHYSIOLOGIC HANDICAPPS
DIFFICULTIES WITH NUTRITION
IMMATURITY IN RENAL FUNCTION
COMPARISON OF PRETERM AND TERM
POSTURE
EAR
LANUGO
SOLE
GENETALIA FEMALE
MALE
SCARF SIGN
GRASP REFLEX
HEEL TO EAR MANEUVER
PROBLEMS OF PRETERMS
HYPOTHERMIA
BREATHING DIFFICULTY
APNOEA
RDS
INTRA VENTRICULAR HAEMORRHAGE
FEEDING DIFFICULTIES
HYPOGLYCEMIA
METABOLIC ACIDOSIS
HYPERBILIRUBINEMIA
ROP
FLUID AND ELECTROLYTE IMBALANCES
NECROTISING ENTEROCOLITIS
ANEMIA
BPD
INFECTIONS
LONG TERM PROBLEMS
INTELLECTUAL DISABILITIES
CEREBRAL PALSY
VISION AND HEARING LOSS
PRINCIPLES OF MANAGEMENT
CARE AT BIRTH
APPROPRIATE PLACE OF CARE
THERMAL PROTECTION
FLUIDS AND FEEDS
MONITORING AND EARLY DETECTION OF COMPLICATIONS
APPROPRIATE MANAGEMENT
Care at birth
Elective intubation of extremely LBW babies (< 1000g) is practised in
some centers to support breathing and for prophy lactic administration of exogenous surfactant.
The baby should be promptly dried, kept effectively covered and Warm.
Vitamin K 0.5 mg should be given intramuscularly.
MAINTAINING BREATHING
ET TUBE
VENTILATOR
C PAP
02 SUPPLEMENTATION
PREVENTION OF HYPOTHERMIA
MUMMIFICATION
KMC
NESTING
DELAY BATH
WARMER
NUTRITION FLUID AND FEEDING
<30– IV FLUIDS, NG ,KATORI, BREAST FEEDS
30—34 NG ,KATORI, BREAST FEEDS
>34 KATORI, BREAST FEEDS
FEEDING SCHEDULE
FLUID REQUIREMENT
PROTEIN 10% of daily calories should be
derived from proteins. • Recommended allowance for LBW
neonates is 3-4 gms/kg/day
BREAST FEEDING
Carbohydrates • Should provide 40% energy. • Recommended allowance is 10-15
gms/kg/day. Fats • Should provide 50% of total
energy. • Recommended allowance is 5.4-
7.2 gms/kg/day
Sodium
• Recommendations are 2.5 to 3.5 meq/ kg/ day each.
• Mature Human milk contains 1.1 meq/100 kcal of sodium and premature milk contains 1.9 meq /100 kcal which is often insufficient for VLBW infants.
VITAMIN
Vitamin A- An intake of 1500 IU/kg/day is recommended for preterms.
It may promote epithelial repair and minimize fibrosis in preterm
babies with CLD. • Vitamin D- Vit. D at 400 IU/day
maintains adequate Vit D status and prevents Rickets.
• Vitamin E- Vit. E is recommended for preterm infants in 6 to 12
IU/kg/day. One ml of Evion (E-Merck) contains 50 IU.
• Vitamin K- Vit K is required for hepatic synthesis of coagulation
factors II, VII, IX, & X. Administration at birth of 0.5 to 1.0 mg i.m. Vit K can prevent HDN.
METHOD OF FEEDING
CHOICE OF MILK
EBM
DONOR HUMAN MILK
FORMULA FEEDS
NG/OGT
FREQUENCY
POSITIONING
SUPPLEMENTS
VITAMIN D
Ca and Ph
ZINC
IRON
HAEMORRHAGE
WATER AND FLUID LOSS
RDS
HYPOGLYCEMIA
INFECTION PREVENTION PROTOCOL
IMMUNISATION
5 CLEANS
CLEAN HAND CLEAN CORD CLEAN CORD CLAMP CLEAN SURFACE CLEAN PROCEDURESN
USE OF DRUGS
CORTICOSTEROIDS
SYNTHETIC SURFACTANT
VIT K
ANTIBIOTICS
Monitoring
Vital signs
Activity and behaviour.
Color; Pink, pale, grey, blue, yellow.
Tissue perfusion
Fluids, electrolytes and ABG's.
Tolerance of feeds; Vomiting, gastric residuals, abdominal girth.
Look for development of RDS, apneic attacks, sepsis, PDA, NEC, IVH
Weight gain
FAMILY EDUCATION
Immunisation
Danger signs