Actually, all the babies that develop under normal is called premature then it is known that both gestational age and growth as measured by body weight is an important indicator of the degree of risk that is appropriate. Corresponding public speaking, low birth weight have a high mortality rate compared with infants born full term with appropriate weight. Infants who have problems usually associated with the growth of respiratory disorders, neurology and terminals.
Infants of low birth weight (LBW) is a newborn birth weight at birth of less than 2,500 grams to 2,499 grams. Newborns weigh less or equal to 2,500 grams called premature infants
Premature babies are babies born at gestational age less than or equal to 37 weeks, regardless of birth weight (Donna L Wong 2004)
Premature infant is a baby born before 37 weeks, calculated from the first day of the last menstrual period, is regarded as shortened gestation period (Nelson, 1998 and sacharin, 1996)
The causes of preterm birth are usually not known. 15% of preterm births are found in multiple pregnancy (in utero there is more than one fetus). In the developed countries the incidence of preterm birth is approximately 6% - 7%, whereas in developing countries the death rate is approximately 3X as much.
Given the incomplete parts of the body work, the need for growth and development and adaptation to the environment outside the uterus then to consider the environmental temperature regulation, feeding and if necessary administration of oxygen, prevent infection and prevent vitamin deficiency and iron.
Nursing Care Plan for Premature Babies
Setting the Temperature
Premature babies easily and quickly suffer hypothermia, when in a cold environment. Heat loss caused by the baby's body surface relatively larger when compared to weight, lack of fatty tissue under the skin and brown fat deficiency. To prevent hypothermia needs to be cultivated environment that is warm enough for the baby and the consumption of oxygenated resting state at least, so that the baby's body temperature remains normal.
If the baby is cared for in an incubator at the temperature for a baby weighing less than 2 kg is 35 ˚ C and to a baby weighing 2 to 2.5 kg is 34 ˚ C in order to maintain the baby's body temperature is around 37 ˚ C. Incubator humidity ranged between 50% - 60%. Higher humidity is needed in infants with respiratory distress syndrome. Incubator temperature can be lowered 1 ˚ C per week to a baby weighing 2 kg and gradually, the baby can be put in the crib with the ambient temperature 27 ˚ C - 29 ˚ C. If the incubator is not available, the heating can be done by wrapping the baby and put the bottles warm surroundings or by installing lights near the crib. Another way to maintain the baby's body temperature around 36 ˚ C - 37 ˚ C is by using the tool "perspexheat shield" on the baby in the incubator. This tool is used to remove heat due to radiation.
Baby in incubator only applied diapers. It is possible to control the general condition, changes in behavior, skin color, breathing, seizures and so on so that the illness could be known as early-as well as an early and treatment measures can be implemented as soon as possible.
Breast feeding in premature infants
Breast milk is the best food that can be given by the mother to the baby, also for premature babies. The composition of breast milk produced by mothers who give birth prematurely is different from the composition of breast milk produced by mothers who gave birth at term and this difference lasted for about 4 weeks.
Often there is a failure of breastfeeding in mothers who gave birth prematurely. This is caused by maternal stress, no guilt, lack of confidence, not knowing expressing milk in premature babies sucking and swallowing reflex does not exist or less, to suck less energy, less gastric volume, frequent reflux, slow peristalsis.
In order for the mother who gave birth prematurely can successfully breast feed need the support of family.
Baby food
In premature infants, reflexes suck, swallow and cough is not perfect, the capacity of the stomach is still small, the power of digestive enzymes, especially lipase still lacking besides protein needs 3-5 grams / day and high-calorie (110 cal / kg / day), so that the weight bodies as well as possible increases. This amount is higher than the required term infants. Provision of drinking starts when the baby was 3 hours so the baby does not suffer from hypoglycemia and hyperbilirubinemia.
Before administering the first drink to be done imbibing gastric fluid. It is necessary to determine the presence or absence of esophageal atresia and prevents vomiting. Inhalation of gastric fluid was also performed prior to each subsequent drink. In general, infants with a birth weight of 2000 grams or more can breastfeed. Infants with birth weight less than 1500 grams less able to suck milk or milk bottles, especially in the first days, the infants were given water by stomach sonde (orogastric intubation).
The amount of fluid administered for the first time is 1-5 ml / h and the amount can be added bit by bit every 12 hours. The amount of fluid given was 60 mg / kg / day, and every day was increased to 200mg / kg / day at the end of the second week.
Preventing infection
Premature infants infection easily. This is caused by the body's resistance to infection is less, relative not yet able to form antibodies and phagocytosis and the inflammatory reaction is not good therefore necessary precautions were initiated during the perinatal improve the state of socio-economic, educational programs (nutrition, hygiene and health , family planning, antenatal and post natal care), screening (TORCH, hepatitis, AIDS), as well as the birthplace of tetanus vaccination and treatment are assured of cleanliness. Aseptic antiseptic action should always be encouraged, either join or dibangsal treated neonates.
To prevent infection it is necessary to:
- Held separation between infants infected with infants not exposed to infection.
- Wash hands before and after holding the baby.
- Cleaning the crib as soon as no longer in use (maximum of a baby wearing a bed for 1 week and then cleaned with an antiseptic solution).
- Cleaning the room at certain times.
- Each baby has his own equipment.
- Every officer in the baby ward must wear clothing that has been provided.
- Officers who have a communicable disease is prohibited caring for the baby.
- Baby's skin and the umbilical cord should be cleaned as well as possible.
- The visitors can only see the baby from behind the glass.