Premature Birth: A Guide for Nursing Students
Definition
A premature birth, or preterm birth, occurs when an infant is born before completing 37 weeks of gestation. Premature infants face a range of health challenges due to underdeveloped organs, particularly the lungs, brain, and digestive system, which may not yet be mature enough to function effectively outside the womb.
Classification of Prematurity
• Late Preterm: 34-36 weeks
• Moderate Preterm: 32-34 weeks
• Very Preterm: 28-32 weeks
• Extremely Preterm: Less than 28 weeks
Risk Factors for Prematurity
Premature birth can result from maternal factors like multiple pregnancies, infections, preeclampsia, or lifestyle factors like smoking. Other times, it can occur spontaneously without a clear cause.
Common Health Complications
1. Respiratory Distress Syndrome (RDS): Due to a lack of surfactant in the lungs, which aids in lung expansion.
2. Intraventricular Hemorrhage (IVH): Bleeding in the brain, more common in very preterm infants.
3. Necrotizing Enterocolitis (NEC): A serious intestinal disease that can be life-threatening.
4. Temperature Instability: Premature infants often lack sufficient body fat to maintain body temperature.
5. Immature Immune System: Increases susceptibility to infections.
Nursing Care and Interventions
1. Respiratory Support:
• Administer oxygen therapy or support through CPAP or mechanical ventilation as needed.
• Monitor oxygen saturation closely to avoid complications of high oxygen levels, such as retinopathy of prematurity (ROP).
2. Thermoregulation:
• Use incubators and warmers to maintain stable body temperature.
• Monitor for signs of hypothermia or hyperthermia, as premature infants are highly sensitive to environmental temperature changes.
3. Nutritional Support:
• Early parenteral nutrition may be necessary, especially for very preterm infants.
• Enteral feeding, often through a nasogastric tube, is introduced gradually to prevent gastrointestinal complications.
4. Infection Prevention:
• Use strict hand hygiene and infection control protocols.
• Monitor for any signs of sepsis or localized infections, as premature infants have a compromised immune system.
5. Family Education and Support:
• Educate parents about their infant’s needs and involve them in care (e.g., kangaroo care) to promote bonding.
• Provide emotional support and resources, as having a premature infant in the NICU can be overwhelming for families.
Conclusion
Nursing care for premature infants is comprehensive, focusing on respiratory and nutritional support, thermoregulation, infection prevention, and family-centered care. Nurses play a critical role in helping premature infants achieve growth and developmental milestones while supporting their families through the NICU journey.
Sample Citation
Williams, A., & Garcia, M. (2022). Caring for Premature Infants: Essential Nursing Interventions and Family Support. Journal of Neonatal Nursing, 28(3), 150-157.
Common Nursing Diagnoses
Nursing Diagnoses for Prematurity
Premature infants (born before 37 weeks gestation) face numerous health challenges due to their underdeveloped organs and systems. Nurses must identify and address these risks to promote optimal growth and development. Below are common nursing diagnoses for prematurity:
1. Ineffective Thermoregulation
Related to: Immature thermoregulatory mechanisms and low subcutaneous fat reserves.
Evidenced by:
• Unstable body temperature (hypothermia or hyperthermia).
• Cool skin or signs of overheating.
Interventions:
• Use of radiant warmers or incubators to maintain a neutral thermal environment.
• Skin-to-skin (kangaroo) care with parents.
2. Impaired Gas Exchange
Related to: Immature lungs, insufficient surfactant production, or respiratory distress syndrome.
Evidenced by:
• Cyanosis, nasal flaring, or grunting.
• Altered blood gas levels (e.g., hypoxemia, hypercapnia).
Interventions:
• Administer oxygen therapy or mechanical ventilation as prescribed.
• Monitor oxygen saturation and respiratory rate.
• Promote surfactant replacement therapy if needed.
3. Risk for Infection
Related to: Immature immune system and invasive procedures (e.g., IV lines, intubation).
Evidenced by: (Potential rather than actual, as it’s a risk diagnosis.)
• Premature birth and exposure to invasive devices.
Interventions:
• Practice strict hand hygiene and aseptic techniques.
• Monitor for signs of infection (e.g., temperature instability, lethargy).
• Encourage maternal breast milk feeding to boost immunity.
4. Imbalanced Nutrition: Less than Body Requirements
Related to: Underdeveloped gastrointestinal system and inability to coordinate sucking and swallowing.
Evidenced by:
• Low birth weight and inadequate growth.
• Feeding intolerance or regurgitation.
Interventions:
• Administer enteral or parenteral nutrition as prescribed.
• Use gavage feeding if oral feeding is not possible.
• Monitor weight gain and nutritional intake closely.
5. Risk for Impaired Skin Integrity
Related to: Fragile skin and increased risk of pressure injuries due to medical devices.
Evidenced by: (Potential rather than actual, as it’s a risk diagnosis.)
• Premature birth and medical equipment usage (e.g., electrodes, IVs).
Interventions:
• Reposition infant frequently.
• Use protective barriers or silicone adhesives to reduce skin injury.
• Assess skin regularly for breakdown or irritation.
6. Risk for Delayed Development
Related to: Neurological immaturity and extended hospital stay.
Evidenced by: (Potential diagnosis; evident later in infancy if not addressed.)
• Premature birth and limited interaction opportunities.
Interventions:
• Promote bonding through kangaroo care.
• Provide age-appropriate sensory stimulation.
• Refer parents to early intervention programs.
7. Ineffective Coping (Parental)
Related to: Stress of preterm birth and prolonged NICU stay.
Evidenced by:
• Parental anxiety, fear, or difficulty bonding with the infant.
Interventions:
• Offer emotional support and counseling.
• Educate parents about their baby’s condition and care.
• Involve parents in caregiving tasks to foster bonding and confidence.
These diagnoses should be tailored to each infant’s specific needs and continuously reevaluated as their condition evolves. Nurses play a critical role in addressing these challenges and promoting positive outcomes for both the infant and their family.