Parturition and Routine Care
Overview
Definition
Preterm: defined as babies born alive before 37 weeks of pregnancy are completed.Term: defined as babies born alive after 37 weeks and before 42 weeksPostterm (induced for labour): defined as babies born alive after 42 weeks.
- Low birth weight: <2500g regardless of age
- Very low birth weight: <1500g regardless of age
- Extremely low birth weight: <1000g regardless of age
Complications of prematurity are the underlying reasons for the higher rate of infant mortality and morbidity in preterm infants compared with full-term infants. The risk of complications increases with increasing immaturity.
Routine Care
The first few minutes
- Cooling of face and physical stimulation is a major stimuli to start breathing. Drying with a towel is very effective.
- The umbilical cord is clamped and cut cleanly close to the skin. Cord stump drops off.
- The plastic stump can be removed after 2 days.
- Failure of the cord to detach after 7 days indicates leukocyte adhesion deficiency.
The first hours
The first day
Infants sleep for most of the time and feed sometimes, but they must:
- Suck and swallow easily. If not consider congenital abnormality, hypoglycaemia or infection.
- Pass Urine. Boys not passing urine within the first 24 hours consider posterior urethral valves.
- Pass meconium within the first 48 hours. If not consider bowel obstruction or Hirschsprungs Disease
First examination (not discussed here)
The first week
- Feeding, stool and urine production normal
- Jaundice occurs in more than 50% of babies after the first 24 hours of age.
- Metabolic screening is performed for cystic fibrosis, hypothyroidusm, phenylketouria and other metabolic conditions from a heel prick.
- Screening for hearing problems – Swish Test
The first month
- Baby should gain 150-250g a week (~30g a day)
Preterm Infants
Preterm is defined as a neonate whose calculated gestational age from last menstrual period is <37 completed weeks.
Most preterm have low birth weights, but not all low birth weights are preterms. Birth weight terminology.
Infant Feeding
Overview
Breastfeeding is recommended as sole source of nutrition until 6 months of age. Solid food commencement advised age 6 months (can be earlier). Weight gain should be 150-200g/week in first 6 months (20-30g/day). Weight loss immediately post birth – should be regained by 2 weeks.
Breast feeding Benefits
Maternal bonding, Passive immunity, Clean, cheap, nutritious, Decreased risk of allergy.
When is breast milk not enough?
Prematurity
- <35weeks and <2.5 kg – need Iron and Pentavite
- <33week and Low Birth weight – need fortifier with breast milk
Poor supply
- Top up formula feeds
- Motilium – enhances milk supply
Failure to Thrive is defined by crossing 2 or more centiles. Most common cause is non-organic problems (ie inadequate intake). Organic problems – (every medical problem you can imagine).
Discussion