preterm infant


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infant

 [in´fant]
a human child from birth (see newborn infant) to the end of the first year of life. Emotional and physical needs at this time include love and security, a sense of trust, warmth and comfort, feeding, and sucking pleasure.
Growth and Development. Development is a continuous process, and each child progresses at his own rate. There is a developmental sequence, which means that the changes leading to maturity are specific and orderly. The various types of growth and development and the accompanying changes in appearance and behavior are interrelated; that is, physical, emotional, social, and spiritual developments affect one another in the progress toward maturity.

Development of muscular control proceeds from the head downward (cephalocaudal development). The infant controls the head first and gradually acquires the ability to control the neck, then the arms, and finally the legs and feet. Movements are general and random at first, beginning with use of the larger muscles and progressing to specific smaller muscles, such as those needed to handle small objects. Factors that influence growth and development are hereditary traits, sex, environment, nationality and race, and physical makeup. See also growth.
large-for-gestational-age infant a preterm, term, or postterm infant who is above the 90th percentile for gestational age in head circumference, body weight, or length.
low-birth-weight infant one that weighs less than 2500 grams at birth. This standard is routinely used for infants in developed countries, but infants born in other countries typically weigh less at birth. In India the criterion for normal birth weight is 2150 grams and in Malaysia it is 2000 grams.
newborn infant a human infant from the time of birth through the 28th day of life. At birth, the gestational age as well as birth weight is assessed and the newborn classified accordingly; for example, large for gestational age, preterm (premature), or low birth weight. Called also neonate and newborn.
premature infant (preterm infant) one born before a gestational age of 37 completed weeks (259 days). The duration of gestation is measured from the first day of the last menstrual period and is expressed in completed days or weeks.
postmature infant (postterm infant) one born any time after the beginning of the forty-second week (288 days) of gestation.
small-for-gestational-age infant a preterm, term, or postterm infant who is below the 10th percentile for gestational age in head circumference, body weight, or length.
term infant one born at a gestational age of 37 to 42 completed weeks (259 to 293 completed days).
very-low-birth-weight infant one that weighs less than 1000 grams at birth.
Patient Care. Low-birth-weight and very-low-birth-weight infants require special care and support, preferably in a neonatal intensive care unit (NICU), until sufficient weight is gained and the infants have matured and are able to thrive without elaborate support systems.

At the time of delivery, whether cesarean or vaginal, a skilled neonatal team should be present to provide immediate care. After resuscitation measures under a radiant warmer are completed and the newborn is stabilized, transfer to the NICU is done without interruption of warming and oxygen therapies.

Among the problems associated with low birth weight are hypothermia, respiratory distress, hyperbilirubinemia, fluid and electrolyte imbalance, susceptibility to infection, and feeding problems.

Very-low-birth-weight newborns and infants are at significant risk for hypothermia because of their small body mass, large surface area, thin skin, minimal subcutaneous tissues, and posture. Thermoregulation is provided through the use of a standard incubator or a radiant warmer. Radiant warmers have the advantage of accessibility for caregivers and improved visibility of the infant. Their chief disadvantage is increased insensible water loss.

Neonatal respiratory distress syndrome is the major cause of death in newborns. Atelectasis can lead to hypoxemia and elevated serum carbon dioxide levels and all the problems related to inadequate gas exchange. Oxygen therapy must be administered with caution because of the danger of retinopathy.

The treatment of hyperbilirubinemia remains a challenge because of lack of consensus on the level of serum bilirubin concentration at which therapy should begin, the uncertain diagnosis of kernicterus, and the currently limited knowledge of the blood--brain barrier. It is believed that these infants are at critical risk for bilirubin-related brain damage at serum concentrations as low as 6 to 9 mg/dl. Phototherapy is the treatment of choice and may be given prophylactically in some institutions to all infants weighing less than 1000 grams.

The management of fluid and electrolyte administration to maintain proper balance is highly complex. Factors taken into consideration are proportion of body, composition of water, renal function, and insensible water loss. Fluid and electrolyte status must be closely monitored. Overhydration is a hazard because it has been implicated in the development of such serious complications as pulmonary edema, patent ductus arteriosus, and necrotizing enterocolitis in these infants.

Low-birth-weight and very-low-birth-weight infants are particularly susceptible to infection because their immunologic system is deficient. Additionally, equipment and care related to long-term respiratory and nutritional support, together with frequent laboratory testing, increase exposure to infectious agents. Infection control measures must be adhered to faithfully. In some NICUs reverse isolation is required for all infants weighing less than 1000 grams.

Since the skin of these infants is highly permeable and easily traumatized, every effort must be made to preserve its integrity. Routine care to preserve the integrity of the skin, caution in the use of topical ointments and antiseptic preparations, and minimal handling also are essential.

At the beginning, nutritional support in the form of total parenteral nutrition may be necessary until enteral feedings are feasible. Oral feedings usually are initiated by the end of the first week of life. Continuous gastric feedings via infusion pump have the advantage of preventing vomiting and aspiration and abdominal distention associated with intermittent feedings of larger amounts. The enteral feedings given in this manner include breast milk (donor or mother) and special formulas.

Discharge planning and follow-up care are begun upon admission to the NICU. Individual family needs should be assessed and available community resources identified. Parental education and support are provided throughout the time the infant is in the NICU. At the time of discharge parents should be confident of their ability to care for the infant, knowledgeable about sources available to them, and able to utilize those resources to the fullest.

pre·term in·'fant

an infant with gestational age of more than 20 weeks and less than 37 completed weeks (259 completed days).

preterm infant

Premature infant, see there.

pre·term in·fant

(prē'term in'fănt)
An infant with gestational age of fewer than 37 completed weeks (259 completed days).
Synonym(s): preemie, premature infant, premature newborn, preterm newborn.
References in periodicals archive ?
Human milk fortifier with high versus standard protein content for promoting growth of preterm infants: A meta-analysis.
A recent study reported that the incidence of premature births in China has increased from 5.0% to 8.1%, with a survival rate of 79.2-87.3%; extremely premature infants account for 18.5% of all cases of preterm births.[1] Compared with full-term infants, preterm infants are in a state of continuous and immature brain development, are more vulnerable to injury and long-term disability, and are at high risk of death.
(22) Thus, preterm infants, particularly those born before thirty weeks gestation, experience this time of rapid and critical brain development outside of the womb rendering them particularly vulnerable to postnatal psychosocial stressors.
In our service, all preterm infants start to be fed milk expressed from their own mother unprocessed or pasteurized breast milk from the milk bank.
POFRAS was applied by the same researcher in all preterm infants, about fifteen minutes before receiving the diet by orogastric tube, in the evening period according to the routine of the hospital, with the premature baby being accommodated inside the incubator, it is emphasized that all the premature infants were feeding via catheter.
All the aforementioned problems led us to develop the new Handy preterm infant incubator.
Efficacy of semielevated side-lying positioning during bottle-feeding of very preterm infants. J Perinat Neonatal Nurs 2014; 28: 69-79.
Heart rate variability responses of a preterm infant to Kangaroo care.
A randomised, double-blind, placebo-controlled study was conducted involving 94 preterm infants who were recruited between days 1 and 3 of life between June 2008 and May 2011.
It is well known that iron-deficiency anemia is most likely to occur in preterm infants. With nearly 500,000 preterm deliveries each year in the United States, a significant number of infants stand to benefit from delayed cord clamping.
What is fascinating in this material is the continuum of fetal behaviour, that is then seen in preterm infants, term babies and young infants, as documented in Prechtl's Method on the Qualitative Assessment of General Movements in Preterm, Term and Young Infants ((Einspieler, Prechtl, & Bos, 2005).
Assessment and care of the late preterm infant. Evidence-based clinical practice guideline.