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High risk related to Dysmaturity ?Preterm

الكلية كلية التمريض     القسم قسم التخصصات التمريضية     المرحلة 3
أستاذ المادة عبد المهدي عبد الرضا حسن الشحماني       13/11/2017 02:48:48
High risk related to

Dysmaturity






?Preterm






Infants


?Post term infants











1





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


2





Incidence





?

?















a.


b.


c.






d.





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











































3



The premature has to adjust to extra uterine
life with his immature systems that leads to
problems since his systems are not
physiologically ready.

































4





Diagnostic evaluation:





? On





inspection: Very small with little

subcutaneous fat

? Large head in proportion to body

? Inactive and relaxed attitude





















5




Clinical manifestations of prematurity:



1.

2.

3.

4.

5.



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












































6




6.


7.


8.


9.


10.


11.









12.


13.





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




















































7









14.






15.


16.


17.


18.


19.









Other neurological signs are absent or
diminished

Unable to maintain body temperature

Diluted urine

Pliable thorax

Periodic breathing hypoventilation

Frequent episodes of apnea




















































8




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






9



Cont. Management


? Respiratory


support: Apnea mattress –

Incubator – O2 monitoring

? Temperature regulation: Incubator, and
monitoring of temperature, Humidity as
recommended

























10


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
























11

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














































12






?




?




?

?

?







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









13







? 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).








14



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.



15



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 .