The Preterm Infant
The appearance, clinical problems, chances of survival, and long term prognosis depend on the infants gestational age. Infants born at 24-26 weeks gestation encounter many problems and require special care. At birth, they have very thin, dark red, transparent skin, no palpable breast tissue and shapeless soft ears.
Males have no testes in their scrotum and females have widely separated labia majora and protruding labia minora. The infants lie with their arms and legs extended and have poor muscle tone. The external appearance and neurological findings can be scored to provide an estimate of an infants gestational age. the number and severity of problems associated with prematurity decline markedly with increasing gestation, with modern intensive care the prognosis is excellent after 32 weeks gestational age. The severity of an infants respiratory disease largely determines the neonatal course and outcome.
Medical Problems of Preterm Infants
- Need for resuscitation at birth
- Respiratory distress syndrome
- Apnoea and Bradycardia
- Patent Ductus Arteriosus
- Temperature Control
- Electrolyte Imbalance
- Osteopenia of Prematurity
- Intracranial Haemorrhage
- Retinopathy of Prematurity
- Anaemia of Prematurity
- Bronchopulmonary Dysplasia (Chronic lung disease of prematurity)
- Inguinal Hernia
Newborn infants have a large surface area relative to body weight. Their skin is thin and poorly keratinised. In the 1st week of life it is an important source of water and heat loss. Preterm infants are unable to shiver, cannot curl and are usually nursed naked. this ads to their difficulty in maintaining body temperature.
If the environment is too hot or too cold O2 consumption is increased. There is a neutral temperature range in which infants O2 consumption is lowest, and in the very immature baby it is highest in the 1st few days of life. the temperature of these small babies is maintained using incubators. Closed incubators provide a more constant environment and ambient humidity can be readily reduced evaporative heat loss.
Information reproduced from study notes kindly donated by Tracie Kendrew, Paediatric Emergency Nurse Practitioner