Question

Baby Jamila was born at 31 weeks gestation to 21-year-old Adiza, a petty trader at the community market. Adiza is married to a man who is 60 years old. This is her first child. Baby Jamila was delivered at home and was rushed to health centre with low respiration of 20 cpm and subnormal temperature, which kept dropping.
She now looks anemic and has not been fed for 2 hours.

A. What are some of the pregnancy-related problems that could have increased the risk of preterm labour? (5marks)

B. Perform a head to toe assessment of the neonate, stating clearly your assessment findings.

C. Outline the plan of care for the baby

Answer 1

• Women who have delivered preterm before, or who have experienced preterm labor before, are considered to be at high risk for preterm labor and birth.¹
• Being pregnant with twins, triplets, or more (called "multiple gestations") or the use of assisted reproductive technology is associated with a higher risk of preterm labor and birth. One study showed that more than 50% of twin births occurred preterm, compared with only 10% of births of single infants.²
• Women with certain abnormalities of the reproductive organs are at greater risk for preterm labor and birth than are women who do not have these abnormalities. For instance, women who have a short cervix (the lower part of the uterus) or whose cervix shortens in the second trimester (fourth through sixth months) of pregnancy instead of the third trimester are at high risk for preterm delivery.
• Urinary tract infections
• Sexually transmitted infections
• Certain vag inal infections, such as bacterial vagi nosis and trichomoniasis
• High blood pressure
• Bleeding from the va gina
• Certain developmental abnormalities in the fetus
• Pregnancy resulting from in vitro fertilization
• Being underweight or obese before pregnancy
• Short time period between pregnancies (less than 6 months between a birth and the beginning of the next pregnancy)
• Placenta previa, a condition in which the placenta grows in the lowest part of the uterus and covers all or part of the opening to the cervix
• Being at risk for rupture of the uterus (when the wall of the uterus rips open). Rupture of the uterus is more likely if you have had a prior cesarean delivery or have had a uterine fibroid removed.
• Diabetes (high blood sugar) and gestational diabetes (which occurs only during pregnancy)
• Blood clotting problems

• Other factors that may increase risk for preterm labor and premature birth include:

• Ethnicity. Preterm labor and birth occur more often among certain racial and ethnic groups. For example, infants of African American mothers are more likely to be born preterm than infants of white mothers. American Indian/Alaska Native mothers are also more likely to give birth preterm than are white mothers.⁴
• Age of the mother.
  • Women younger than age 18 are more likely to have a preterm delivery.
  • Women older than age 35 are also at risk of having preterm infants because they are more likely to have other conditions (such as high blood pressure and diabetes) that can cause complications requiring preterm delivery.⁴
• Certain lifestyle and environmental factors, including:³
• Late or no health care during pregnancy
• Smoking
• Drinking alcohol
• Using illegal drugs
• Domestic violence, including physical, sexual, or emotional abuse
• Lack of social support
• Stress
• Long working hours with long periods of standing
• Exposure to certain environmental pollutants

Head to toe assesment of neonate

• Vital signs:

  • Temperature. Able to maintain stable body temperature of 97.0°F to 98.6°F (36.1°C to 37°C) in normal room environment.

  • Heartbeat. Normally 120 to 160 beats per minute. It may be much slower when an infant sleeps.

  • Breathing rate. Normally 40 to 60 breaths per minute.

  • Blood pressure. Normally an upper number (systolic) between 60 and 80, and a lower number (diastolic) between 30 and 45.

  • Oxygen saturation. Normally 95% to 100% on room air.

• General appearance. Physical activity, muscle tone, posture, and level of consciousness or whether or not an infant is awake and alert.

• Skin. Color, texture, nails, presence of rashes.

• Head and neck:

  • Appearance, shape, and shaping of the head from passage through the birth canal (molding)

  • The open soft spots between the bones of the baby's skull (fontanels)

  • Bones across the upper chest (clavicles)

• Face. Eyes, ears, nose, cheeks. Presence of red reflex in the eyes.

• Mouth. Roof of the mouth (palate), tongue, throat.

• Lungs. Breath sounds, breathing pattern.

• Heart sounds and femoral (in the groin) pulses

• Abdomen. Presence of masses or hernias.

• Genitals and anus. Open passage for of urine and stool and normally formed male and female genitals.

Plan of care of baby

• Newborn care is immediately done after birth in a separate space near the birthing area.
• Equipment such as radiant heat table, warm blankets, resuscitation, eye care, suction, weighing scale and equipment for oxygen administration are already prepared and ready to use.
• Newborn identification and registration is an important step after the immediate newborn care to avoid switching of babies or kidnapping in the healthcare facility.
• An identification band is placed around the newborn’s arm or leg which contains the mother’s hospital number, the mother’s full name, sex, date, and time of infant’s birth.
• The newborn’s footprints are then taken and kept for permanent identification.
• The birth registration of the infant is taken care of by the physician or nurse-midwife who supervised in the delivery.
• The mother’s name, the father’s name, and the infant’s name and birthdate, as well as the place, are recorded.
• The newborn’s chart is also a mine of information when it comes to the newborn’s welfare.
• Essential information such as the time of the infant’s birth, the Apgar score, eye care given, immunizations, and the general condition of the infant must be reflected on the chart.

Care of the Newborn in the Postpartum Period

• Newborn care varies among cultures and in some areas in the world.
• During the initial feeding, a term newborn could be fed immediately after birth while a formula-fed one should be fed at 2 to 4 hours of age.
• Bathing is done an hour after birth to gently wash away the vernix caseosa, and this is done daily.
• Areas such as the newborn’s face, skin folds, and diaper area are the areas that need washing regularly.
• The nurse must supervise the bathing together with the parents.
• The bath water must be pleasantly warm as well as the room to prevent chilling.
• Bathing should be before feeding and not after it to prevent aspiration and vomiting.
• Equipment needed during bathing are a basin of water, washcloth, soap, towel, diaper, a clean shirt, and comb.
• Start bathing the infant from the cleanest area (the eyes) towards the dirtiest area (the diaper area), and soap is never used for the baby’s face, only for the body.
• Do not soak the cord when you wash the skin around it.
• Instruct the parents that the sleeping position of the infant must be flat on the back to prevent SIDS, but never place a pacifier on the infant during sleep.
• During diaper change, the area must be washed and dried well to prevent diaper rash.
• Petroleum jelly or a mild ointment is applied on the buttocks to avoid accumulation of ammonia and remove meconium.
• Vaccination for Hepatitis B and Vitamin K administration is also essential in the postpartal period.