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High risk related toDysmaturity?PretermInfants?Post term infants1Preterm Infants:? Infantsborn before completion of 37weeks of gestation are considered pretermor premature regardless of birth weight.? These newborns are the largest number tobe admitted to the NICU.(neonatalintensive care unit)? They have high incidence forcomplications and to have congenitaldefects2Incidence??a.b.c.d.Majority of cases the cause is unknownIt is common in:In low socioeconomic classesMultiple pregnanciesInterrupted pregnancy due to placentalaccidentsHypertension relater to pregnancy3The premature has to adjust to extra uterinelife with his immature systems that leads toproblems since his systems are notphysiologically ready.4Diagnostic evaluation:? Oninspection: Very small with littlesubcutaneous fat? Large head in proportion to body? Inactive and relaxed attitude5Clinical manifestations of prematurity:1.2.3.4.5.Very small, scrawny appearanceSkin: Red-Pink with visible veinsFine, feathery hair, Lanugo on back and faceLittle or no evidence of subcutaneous fatHead is relatively large to body66.7.8.9.10.11.12.13.Lies in a relaxed attitudeLimbs extendedEar cartilage poorly developedFew fine wrinkles on palms and solesClitoris prominent in femalesScrotum undeveloped and nonpendulous with minimal rugae andundescended testesLax, easily manipulated jointsAbsent, weak or ineffectual reflexes714.15.16.17.18.19.Other neurological signs are absent ordiminishedUnable to maintain body temperatureDiluted urinePliable thoraxPeriodic breathing hypoventilationFrequent episodes of apnea8Therapeutic Management:? Whena preterm delivery is expected theNICU is alerted and the team of neonatalspecialists are present at the time ofdelivery? Resuscitation?????? is done if needed in thelobar room the n infant is transferred toNICU in an incubator? Measurements taken and vitamin K isgiven9Cont. Management? Respiratorysupport: Apnea mattress –Incubator – O2 monitoring? Temperature regulation: Incubator, andmonitoring of temperature, Humidity asrecommended10Cont. Management?Complications such as hypoglycemia andhypocalcaemia are frequent in the prematureinfant and are managed according to specificconditions and monitored frequently? Respiratory distress syndrome is very commonand required respiratory support11Post term infants????Infant born after 42 weeks of gestationIncidence:12% of birthsCause: UnknownPost mature (posterm)delivery is much lesscommon than premature(preterm) delivery. The reasonfor a pregnancy to continuebeyond term is usually unknown12?????The placenta becomes less able to provideadequate nutrients to the fetus.To compensate?????, the fetus begins to use itsown fat and carbohydrates to provide energy.As a result, its growth rate slowsIts weight may decrease.If the placenta shrinks sufficiently, it may notprovide adequate oxygen to the fetus,particularly during labor. A lack of adequateoxygen may result in fetal distress13? Mayresult in injury to the fetal brain andother organs.? Fetal distress may cause the fetus to passstools (meconium) into the amniotic fluid.The fetus inhale the meconium-containingamniotic fluid into the lungs during birth.? As a result, the newborn may havedifficulty breathing after delivery(meconium aspiration syndrome).14Symptoms?????A post mature newborn has dry, peeling, looseskinMay appear emaciated, especially if the functionof the placenta was severely reduced.The newborn often appears alert.The skin and nail beds may be stained green ifmeconium was present in the amniotic fluid.A post mature newborn is prone to developinglow blood sugar levels (hypoglycemia) afterdelivery, especially if oxygen levels were lowduring labor.15Treatment?The post mature newborn who experienced lowoxygen levels and fetal distress may needresuscitation ??????at birth.? If meconium has been breathed into the lungs,a ventilator may be needed.? Intravenous glucose solutions or frequent breastmilk or formula feedings are given to preventhypoglycemia.? If these problems do not occur, the major goal isto provide good nutrition so that the newborncan catch up to the weight that is appropriate forhim.16 ................
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