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High risk related to Dysmaturity

الكلية كلية التمريض     القسم قسم التخصصات التمريضية     المرحلة 3
أستاذ المادة عبد المهدي عبد الرضا حسن الشحماني       28/10/2016 16:02:49

High risk related to Dysmaturity
Dr.Abdmahdi.A.Hasan
Preterm Infants
Post term infants
Preterm Infants:
Infants born before completion of 37 weeks of gestation are considered preterm or premature regardless of birth weight.
These newborns are the largest number to be admitted to the NICU.(neonatal intensive care unit)
They have high incidence for complications and to have congenital defects
Incidence
Majority of cases the cause is unknown
It is common in:
In low socioeconomic classes
Multiple pregnancies
Interrupted pregnancy due to placental accidents
Hypertension relater to pregnancy

The premature has to adjust to extra uterine life with his immature systems that leads to problems since his systems are not physiologically ready.
Diagnostic evaluation:
On inspection: Very small with little subcutaneous fat
Large head in proportion to body
Inactive and relaxed attitude
Clinical manifestations of prematurity:
Very small, scrawny appearance
Skin: Red-Pink with visible veins
Fine, feathery hair, Lanugo on back and face
Little or no evidence of subcutaneous fat
Head is relatively large to body
Lies in a relaxed attitude
Limbs extended
Ear cartilage poorly developed
Few fine wrinkles on palms and soles
Clitoris prominent in females
Scrotum undeveloped and non pendulous with minimal rugae and undescended testes
Lax, easily manipulated joints
Absent, weak or ineffectual reflexes
Other neurological signs are absent or diminished
Unable to maintain body temperature
Diluted urine
Pliable thorax
Periodic breathing hypoventilation
Frequent episodes of apnea
Therapeutic Management:
When a preterm delivery is expected the NICU is alerted and the team of neonatal specialists are present at the time of delivery
Resuscitation is done if needed in the lobar room the n infant is transferred to NICU in an incubator
Measurements taken and vitamin K is given
Cont. Management
Respiratory support: Apnea mattress – Incubator – O2 monitoring
Temperature regulation: Incubator, and monitoring of temperature, Humidity as recommended

Cont. Management
Complications such as hypoglycemia and hypocalcaemia are frequent in the premature infant and are managed according to specific conditions and monitored frequently
Respiratory distress syndrome is very common and required respiratory support

Post term infants
Infant born after 42 weeks of gestation
Incidence:12% of births
Cause: Unknown
Post mature (posterm)
delivery is much less
common than premature
(preterm) delivery. The reason
for a pregnancy to continue
beyond term is usually unknown

The placenta becomes less able to provide adequate nutrients to the fetus.
To compensate, the fetus begins to use its own fat and carbohydrates to provide energy.
As a result, its growth rate slows
Its weight may decrease.
If the placenta shrinks sufficiently, it may not provide adequate oxygen to the fetus, particularly during labor. A lack of adequate oxygen may result in fetal distress

May result in injury to the fetal brain and other organs.
Fetal distress may cause the fetus to pass stools (meconium) into the amniotic fluid. The fetus inhale the meconium-containing amniotic fluid into the lungs during birth.
As a result, the newborn may have difficulty breathing after delivery (meconium aspiration syndrome).
Symptoms
A post mature newborn has dry, peeling, loose skin
May appear emaciated, especially if the function of the placenta was severely reduced.
The newborn often appears alert.
The skin and nail beds may be stained green if meconium was present in the amniotic fluid.
A post mature newborn is prone to developing low blood sugar levels (hypoglycemia) after delivery, especially if oxygen levels were low during labor.
Treatment
The post mature newborn who experienced low oxygen levels and fetal distress may need resuscitation at birth.
If meconium has been breathed into the lungs, a ventilator may be needed.
Intravenous glucose solutions or frequent breast milk or formula feedings are given to prevent hypoglycemia.
If these problems do not occur, the major goal is to provide good nutrition so that the newborn can catch up to the weight that is appropriate for him.


المادة المعروضة اعلاه هي مدخل الى المحاضرة المرفوعة بواسطة استاذ(ة) المادة . وقد تبدو لك غير متكاملة . حيث يضع استاذ المادة في بعض الاحيان فقط الجزء الاول من المحاضرة من اجل الاطلاع على ما ستقوم بتحميله لاحقا . في نظام التعليم الالكتروني نوفر هذه الخدمة لكي نبقيك على اطلاع حول محتوى الملف الذي ستقوم بتحميله .