Premature Baby Nursing Care Plans Diagnosis and Interventions
Premature Baby NCLEX Review and Nursing Care Plans
Premature birth or preterm birth occurs more than three weeks before the baby’s expected due date. Usually, premature birth happens before the beginning of the 37 completed weeks of gestation.
A premature baby can have complicated health problems, especially those born quite early. However, prematurity complications typically vary – the earlier the baby is born, the greater the likelihood of having congenital abnormalities.
The cases of premature babies are classified depending on how early they are delivered:
- Late Premature. The premature babies were born between weeks 34 and 36 of gestation.
- Moderately Premature. The premature babies were born between weeks 32 and 34 of gestation.
- Very Premature. The premature babies were born before 32 weeks of gestation
- Extremely Premature. The premature babies were delivered before or during the 25th week of gestation.
A developing baby grows rapidly during pregnancy, especially in the final months and weeks. The brain, lungs, and liver, for example, require the final weeks of pregnancy to develop ultimately.
A premature baby, especially one who is delivered before 32 weeks, has a higher risk of mortality and impairment. Premature birth and low birth weight accounted for around 17% of infant fatalities before one year of age. Babies who survive may develop the complications listed below:
- Hearing impairments
- Breathing difficulties
- Delay in physical and mental development
- Cerebral palsy
- Problems with vision
- Feeding difficulties
Premature birth was once the leading cause of infant mortality in the United States. Today, both the quality of neonatal care and the survival rates of premature babies have increased.
According to the Centers for Disease Control and Prevention, premature birth remains the leading cause of infant death globally. It is also a significant cause of long-term nervous system abnormalities in children.
Signs and Symptoms of Being a Premature Baby Preterm Birth
The baby may have very subtle premature birth symptoms or more noticeable complications. Premature birth symptoms include the following:
- Short physique, abnormally large head of the baby
- Due to a lack of fat storage, the features are sharper and less rounded than those of a full-term baby.
- The premature baby’s body is covered in fine hair (lanugo).
- The premature baby has low body temperature, particularly in the delivery room, due to a lack of stored body fat.
- The premature baby has breathing difficulties or respiratory discomfort.
- The premature baby has feeding difficulties caused by a lack of gripping and swallowing reflexes.
Causes of Premature Birth
The cause of preterm delivery is frequently unknown. Certain circumstances, however, are known to trigger a woman’s chance of premature birth.
Premature birth is more common in pregnant women who have any of the following health conditions:
- Diabetes mellitus
- Cardiovascular disease
- Kidney disorder
- Hypertension
Pregnancy-related risks that contribute to preterm delivery include:
- Inadequate nutrition prior to and throughout pregnancy
- Smoking, using illegal drugs or consuming excessive amounts of alcohol during pregnancy.
- Various infections, such as those of the urinary tract and the amniotic membrane
- A previous history of premature birth
- A dysfunctional uterus
- An incompetent cervix
Risk Factors to Having a Premature Baby Preterm Birth
Often, the precise cause of premature delivery is obscure. However, there are established risk factors for premature birth, such as:
- Pregnant women younger than 17 or older than 35 have a higher risk of delivering premature babies.
- The mother has a previous premature delivery.
- The mother has given birth to twins, triplets, or other multiple pregnancies.
- The mother has an interval of pregnancy between less than six months.
- The mother had a child through in vitro fertilization.
- The mother has developed complications in the uterus, cervix, or placenta.
- The mother is smoking or taking illegal drugs prior to pregnancy.
- The mother suffers from some illnesses, notably amniotic fluid and lower genital tract infections.
- The mother has chronic health conditions, such as hypertension and diabetes.
- The mother is overweight or underweight prior to pregnancy.
- The mother or the entire family suffers from stressful life situations, such as the death of a loved one or domestic violence.
- The mother has experienced several abortions or miscarriages.
- The mother has trauma or experiences physical injury before and during pregnancy.
- Race. African American women are more likely than other races to have premature babies for undetermined reasons. Premature birth, on the other hand, can happen to anyone. Indeed, many women who give birth prematurely have no identified risk factors.
Complications of Being a Premature Baby Preterm Birth
The earlier a baby is delivered, the more probable he or she may have medical complications. A premature baby may exhibit the following symptoms soon after birth:
- Breathing difficulties
- Low body weight
- Low body fat percentage
- Failure to keep a consistent body temperature
- Fewer activities than usual
- Difficulties with movement and coordination
- Feeding difficulties
- Skin that is unusually pale or yellow
A premature baby may also be born with potentially fatal disorders. These complications may include:
- Cerebral hemorrhage. The brain of a premature baby contains several tiny, vulnerable blood vessels. The premature baby’s brain is vulnerable to fluctuations in blood circulation and oxygen saturation after birth. Premature birth can cause blood vessels to rupture and have hemorrhage.
- Pulmonary hemorrhage. Bleeding of the lungs, also known as pulmonary hemorrhage, is most common in infants born before 37 completed weeks of gestation as a result of severe lung disease, specifically respiratory distress syndrome, a disorder caused by inadequate standard lung lining chemicals (surfactants) and the need for a breathing device such as respiratory support.
- Hypoglycemia. Premature babies are distinctively preconditioned to developing hypoglycemia and its related complications. This is because of the following reasons:
- premature babies’ limited glycogen and fat stores
- incapability to generate new glucose via gluconeogenesis pathways
- increased metabolic demands due to significantly bigger brain size
- failure to mount a counter-regulatory response to hypoglycemia
- Neonatal sepsis. Premature babies are more susceptible to infections that can lead to sepsis. They have a compromised immune system, and their skin and intestines are more delicate than the babies who complete the 37 weeks of gestation.
- Pneumonia. Premature babies (those born before 37 weeks of pregnancy) may not have produced adequate surfactant. The tiny alveoli collapse with each breath when there is an insufficient surfactant. Damaged cells accumulate in the airways when the alveoli rupture. They also impair respiration and sometimes cause pneumonia.
- Patent Ductus Arteriosus (PDA). PDA is a cardiac abnormality discovered in the days or weeks following birth. It happens when a standard fetal link between the aorta and the pulmonary artery fails to close properly after birth. PDA is ubiquitous in premature babies.
- Anemia. Anemia can occur in premature babies due to slower red blood cell synthesis compared to full-term babies.
- Gastrointestinal concerns. Premature babies are more prone to undeveloped gastrointestinal systems, leading to issues like necrotizing enterocolitis (NEC). When premature babies begin feeding, they may develop this potentially fatal condition in which the intestinal wall cells are damaged. Premature babies that exclusively receive breast milk have a significantly reduced risk of developing NEC.
Diagnosis of a Premature Baby Premature Birth
The following tests and techniques are used to diagnose premature birth:
- Pelvic examination. The doctor may examine the rigidity and tenderness of the mother’s uterus and the location and size of the baby. If the water has not yet ruptured, and there is no risk that the placenta is blocking the cervix (placenta previa), he or she may also perform a pelvic exam to see if the cervix has started to open. The doctor may also examine the mother for uterine hemorrhage.
- Ultrasound. Transvaginal ultrasound measures the exact length of the cervix. An ultrasound may also be conducted to determine any congenital abnormalities in the baby, verify the baby’s location, determine the volume of amniotic fluid, and determine the baby’s weight.
- Uterine monitoring. The doctor will use a uterine monitoring procedure to measure the length and spacing of the mother’s contractions.
- Laboratory tests. A swab of the mother’s vaginal secretions may be obtained to assess the presence of certain infections and fetal fibronectin — a protein that acts as a glue between the fetal sac and the uterine lining and is released during labor. These findings will be weighed against other risk factors. The mother must also submit a urine sample so the doctor can determine if there’s a presence of particular microorganisms.
If the NICU team suspects a specific complication, they may perform a series of tests on the premature baby. Here are the tests that the premature baby might need to undergo:
- Monitoring of breathing and heart rate. Constantly checking the baby’s respiration, heart rate, and blood pressure readings are some ways to diagnose any abnormalities in a premature baby.
- Monitoring of input and outflow of fluids. The NICU team closely monitors how much fluid the baby consumes via feedings and intravenous fluids and how much fluid the baby loses by measuring his or her wet and dirty diapers.
- Blood tests. The laboratory technician will collect blood samples through a heel stick, or a needle injected into a vein to monitor a variety of vital chemicals in the baby’s blood, including calcium, glucose, and bilirubin levels. Also, the doctor might recommend testing a blood sample to determine the red blood cell count and rule out anemia or infection.
- Echocardiogram. An ultrasound of the heart is used to look for abnormalities in the baby’s cardiac function. Like a prenatal ultrasound, an ECG uses sound waves to create moving images on a monitor screen.
- Ultrasound examination. Ultrasound scans can examine hemorrhage or fluid accumulation in the brain and abnormalities in the gastrointestinal tract, liver, or kidneys.
- Examination of the baby’s eyes. An ophthalmologist (eye doctor) may evaluate the baby’s eyes and vision to look for retinal abnormalities (retinopathy of prematurity).
Treatment of Premature Baby or Premature Birth
- Supportive Care. The premature baby may benefit from intensive supportive care, which may include:
- Incubator. The premature baby will most likely be kept warm in an enclosed plastic bassinet (incubator) to help the baby maintain a constant body temperature. Later, NICU staff may demonstrate a specific manner to hold the premature baby, known as “kangaroo” care, which involves direct skin-to-skin contact with the mother.
- Monitoring of the baby’s vital signs. Blood pressure, heart rate, respiration, and temperature sensors are attached to the baby’s body. A ventilator may be used to assist the infant with breathing.
- Tube for feeding. Initially, the baby will receive fluids and nutrition via an intravenous (IV) tube. Breast milk can later be delivered to the baby through a nasogastric tube inserted in his or her nose and then into his or her stomach.
- Fluid replenishment. Depending on the baby’s age and medical conditions, the baby requires a particular amount of fluids daily. The NICU team will regularly check fluids, sodium, and potassium levels to ensure that the baby’s fluid levels remain within normal ranges. If fluids are required, the nursing staff will administer an IV line.
- Bilirubin lights procedure. To treat premature babies with jaundice, the baby will undergo a procedure where he or she needs to stay under bilirubin lights. The lights assist the baby in breaking excessive bilirubin in the blood, which accumulates due to the liver’s inability to process it all.
- Blood transfusion. The premature baby may require a blood transfusion to increase blood volume, mainly if numerous blood samples have been obtained for various tests.
- Medications. Medications may be given to the baby to enhance maturation and stimulate normal lungs, heart, and circulation function. Medication may include the following, depending on the baby’s condition:
- Surfactant. This medication is a treatment for respiratory distress syndrome.
- IV or fine-mist (aerosolized) medicine. This medicine is used to improve respiration and heart rate.
- Antibiotics. This medication is used if there is an infection.
- Diuretic. This medication is used to treat excess fluid and promotes urine production.
- Ophthalmic drops. This medication aims to prevent the formation of new blood vessels, which could lead to retinopathy of prematurity.
- Medications for cardiac irregularities. This medication is given to premature babies with Patent Ductus Arteriosus (PDA).
- Surgery. Surgery is sometimes required to treat a variety of prematurity-related problems. Discuss with the baby’s medical team whether issues may necessitate surgery and the kind of surgery that may be required to treat them.
Nursing Diagnosis for Premature Baby Preterm Birth
Nursing Care Plan for Premature Baby 1
Ineffective Infant Feeding Pattern
Nursing Diagnosis: Ineffective Infant Feeding Pattern related to deficient knowledge about proper feeding strategies and feeding interruptions secondary to being a premature baby as evidenced by poor baby feeding process, infrequent suckling at the mother’s breast, and visible indicators of insufficient infant intake.
Desired Outcomes:
- The patient will develop a desirable feeding routine.
- The patient’s mother will be able to exhibit ways of dealing with ineffective feeding patterns.
- The patient will be able to acquire the necessary nutrients through a healthy feeding pattern.
| Nursing interventions for Premature Babies | Rationale |
| Regularly check the baby’s vital signs. | These vital signs will be used as a baseline. Any variations in these measures will reveal if the premature infant has any defects. |
| While feeding, provide a peaceful, quiet, and non-stimulating atmosphere for the infant. | This intervention intends to minimize any disturbances that may interfere with the baby’s feeding pattern. |
| Determine which alternate feeding approach is best for the baby. Breastfeeding, bottle feeding, or syringe feeding are all options. | This intervention aims to find a more accessible and comfortable feeding pattern for the baby. |
| Teach the parents how to feed their babies in the appropriate position. Remind them that the infant should be completely awake while being fed. | This intervention seeks to enhance proper feeding techniques while preventing regurgitation and aspiration. |
| Keep track of the baby’s feeding routines and record their progress. | This strategy intends to keep track of the baby’s spit-ups and the amount of food consumed throughout feedings. |
| Explain to parents the principles of proper infant nutrition by following the recommended feeding pattern. | This intervention attempts to improve parents’ knowledge of their babies’ nutritional requirements and promote strict adherence to proper feeding patterns. |
Nursing Care Plan for Premature Baby 2
Risk for Ineffective Breathing Pattern
Nursing Diagnosis: Risk for Ineffective Breathing Pattern related to apnea, the immature respiratory system, and limited development of the baby’s lungs during pregnancy secondary to being a premature baby.
As a risk nursing diagnosis, the Risk for Ineffective Breathing Pattern is entirely unrelated to any signs and symptoms since it has not yet developed in the patient, and safety precautions will be initiated instead.
Desired Outcomes:
- The patient will achieve a typical breathing pattern.
- The patient will no longer have apneic episodes.
| Nursing interventions for Premature Babies | Rationale |
| Examine the baby’s breathing rate and rhythm. | Effective respiratory rate monitoring allows for the reduction of life-threatening illnesses and the improvement of therapeutic outcomes for patients. |
| The primary care line for babies with respiratory difficulties is to clear the airway and ensure proper breathing and circulation. | An infant in evident respiratory distress should be monitored with a continuous pulse oximeter to determine when intubation and ventilation are required. |
| Examine the baby’s skin color, warmth, and capillary refill; compare central and peripheral cyanosis. | A lack of oxygen causes blue or cyanosis color of the lips, tongue, and fingers. Inside-of-the-mouth cyanosis is a life-threatening emergency. |
| If apnea occurs, provide immediate tactile stimulation, such as rubbing the infant’s back. | Tactile stimulation has been demonstrated to reduce apnea duration, particularly in babies. |
| Keep the baby’s body temperature at a suitable level. | Maintaining average body temperature is critical because even minor temperature changes can trigger apnea, a potentially fatal sleep disease in which breathing frequently stops and starts. |
Nursing Care Plan for Premature Baby3
Readiness for Enhanced Knowledge
Nursing Diagnosis: Readiness for Enhanced Knowledge related to the pregnant patient’s expression of her desire to learn more about appropriate neonatal care secondary to having a premature baby or preterm birth, as evidenced by providing the new infant the care they need and parenting with confidence.
Desired Outcomes:
- The mother will have a better understanding of premature baby care and will execute all the information that she learned.
- The premature baby will obtain proper parenting from his parents.
| Nursing interventions for Premature Babies | Rationale |
| Educate the mother to cooperate with the NICU team and the baby’s pediatrician. | Premature infants are frequently admitted to the neonatal intensive care unit (NICU) to get the specific care they require to develop optimally after birth. This technique is beneficial for the mother to gain the knowledge she will need after the baby is discharged from the hospital. |
| Educate the mother about infant feeding preferences. | The mother will select whether the baby will be fed breast milk or formula in the NICU. Hence, educate the mother that breast milk is the best type of nutrition since it contains vital nutrients and antibodies for developing the baby’s immune system. Breast milk, no matter how nutritious it is, frequently needs to be supplemented with added protein, minerals, and vitamins to fulfill the essential nutritional requirements of premature babies. |
| Instruct the mother to pay attention to (frequent) feeding cues. | When the baby arrives home from the hospital, the mother should learn to modify the timing and quantity based on feeding cues. |
| Educate the mother on the importance of keeping things clean and sanitized for the infant. | Even when the newborn is discharged from the hospital, his immune system is unlikely to develop fully. That is why it is necessary to observe extra precautions to protect the baby. |
| Educate the mother that she may gently touch, hold, and cradle her newborn as soon as the doctor approves. | Skin-to-skin contact also aids in the self-regulation of the baby’s body, which helps stabilize the heartbeat and breathing rhythms. Skin-to-skin contact has been shown to reduce 75% of cardiac and breathing difficulties. |
Nursing Care Plan for Premature Baby 4
Interrupted Breastfeeding
Nursing Diagnosis: Interrupted Breastfeeding related to breastfeeding contraindications such as extended hospitalization, consuming specific medications, breast milk, jaundice, and the necessity to wean the infant immediately secondary to having a premature baby / preterm birth as evidenced by inefficient breastfeeding process, visible evidence of minimal infant intake, and actual or perceived insufficient milk supply.
Desired Outcomes:
- The baby will be able to successfully breastfeed.
- The mother will verbalize or exhibit ways of dealing with breastfeeding issues.
- The infant will show signs of appropriate intake of milk at the mother’s breast.
| Nursing interventions for Premature Babies | Rationale |
| Evaluate the mother’s perception and understanding of breastfeeding and the extent of instruction provided to them. | This intervention seeks to determine what the mother presently knows and what she needs to remember. |
| Provide emotional support to the mother and accept her decision to stop or continue breastfeeding. | This strategy seeks to assist mothers in continuing to breastfeed as desired. |
| Educate the mother on how to use a manual piston-type breast pump. | This approach allows the newborn to be fed with breast milk even when the mother is not around. |
| Examine the mother’s methods for storing and using expressed breast milk. | This intervention aims to provide appropriate nutrition and encourage breastfeeding continuation. |
| When a mother breastfeeds her baby, provide her a private and peaceful environment. | The goal of this intervention is to encourage successful newborn feeding. |
Nursing Care Plan for Premature Baby 5
Risk for Impaired Parent or Infant Attachment
Nursing Diagnosis: Risk for Impaired Parent – Infant Attachment related to incapacity of parents to fulfill personal needs, parental anxiety, unwell infant who is unable to begin parental contact efficiently owing to a disrupted behavioral pattern, physical barriers, and lack of privacy secondary to having a premature baby.
Desired Outcomes:
- The mother will discover and demonstrate strategies to improve the neonate’s behavioral structure.
- The parent/s will be able to have mutually satisfying relationships with their newborns after discharge.
| Nursing interventions for Premature Babies | Rationale |
| Discuss with parents their opinions about the baby’s health condition and individual concerns. | This intervention seeks to learn about the parent’s reactions to the circumstance. |
| Educate parents about their children’s growth and development, considering parental perceptions. | This method assists parents in clarifying reasonable expectations. |
| Motivate the parents to engage in activities with the newborn and ensure they can effectively complete them. | This intervention improves the relationship of the parents with their newborn. |
| Recognize and provide loving and protective parenting practices by giving excellent comments. | This intervention encourages parents to maintain desired parenting habits. |
| Examine the interactions between the parent and the newborn. | Because of the newborn’s current condition and hospitalization, the parents may be concerned about handling their infant because the baby is in a fragile state and requires special care. Thus, assessing how the mother interacts with her newborn is vital. |
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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