Oxford Handbook of Midwifery (134 page)

Some evidence suggests that babies with abnormal metabolic adaption have had abnormal end diastolic flow velocities (EDVs) in the umbilical artery.
³

Not all small for gestational age babies are at risk of hypoglycaemia. Those at risk:

Frequent blood sampling is not necessary to identify those at risk. Laboratory measurements of cord blood glucose and blood glucose at 4–6h of age (before the second feed) are recommended.
⁶

Each maternity unit will have its own protocol for identifying and treating babies at risk of hypoglycaemia, based on the recommendations from WHO.
⁶

Prevention of hypoglycaemia

Early enteral feeding

Temperature control

CHAPTER 23
Care of the newborn

632

mother’s lactation, and promotes bonding between the baby and the parents as the father can also provide skin-to-skin care.

Prevention of infection

• The baby may have been exposed to congenital infection. Depending on the baby’s condition, a TORCH screening at birth will confirm or eliminate such infection.
  
• The baby’s skin may be in a poor condition. If it is dry and cracked and stained with meconium, the baby will be at increased risk of infection.
  
• Close observation of the baby’s condition will detect any changes that indicate a developing infection. If suspected, this will be treated following a full infection screening.
  
• Breast milk from the baby’s mother will help to give the baby some protection
  against
  infection. Breast milk confers some immunity due to its high IgA content (b see Neonatal infection, p. 598).
  

  Follow-up
  

• If the baby is well and able to maintain its temperature and blood glucose level then he or she will be discharged home as soon as possible.
  
• Those who are premature or who have other problems will stay in the NICU/SCBU until they have recovered.
  
• There may be a need for follow-up to assess the baby’s future development.
  

  Parental support
  

  • If the baby is ill at birth and needs care within the NICU/SCBU,
    then the parents will need the same level of support as discussed
    

  in b Management of the preterm baby, p. 634. Where congenital
  

  abnormality is confirmed, the parents will be referred for genetic counselling.
  

  1. World Health Organization (1992).
     International Statistical Classification of Diseases and Related Health Problems
     . 10th revision. Geneva: WHO.
     
  2. Yeo H (ed.) (2000).
     Nursing the Neonate
     , 2nd edn. Oxford: Blackwell, pp. 1–17.
     
  3. Rennie JM, Roberton NRC (eds) (1999).
     Textbook of Neonatology
     , 3rd edn. London: Churchill Livingstone, pp. 133–40.
     
  4. Department of Health (1990).
     Guidance for Clinical Health-care Workers: Protection Against Infection with HIV and Hepatitis Viruses: Recommendations of Expert Advisory Group on AIDS
     . London: HMSO.
     
  5. Hawdon JM, Ward-Platt MP (1993). Metabolic adaptation in small for gestational age infants.
     

     Archives of Diseases in Childhood
     68
     , 262–8.
     

  6. World Health Organization (1997).
     Hypoglycaemia of the Newborn: Review of the Literature
     . Geneva: WHO.
     
  7. Beresford D (2001). Fluid and electrolyte balance. In: Boxwell G (ed.)
     Neonatal Intensive Care Nursing
     , 2nd edn. London: Routledge, p. 220.
     

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  CHAPTER 23
  Care of the newborn
  

  634‌‌
  

  Management of the preterm baby
  

  Definitions
  

  • A preterm baby is any baby born before 37 completed weeks of gestation.
    ¹
    
  • The legal age of viability is 24 weeks.
    ²
    

    These definitions indicate a wide range of babies between 24 and 37 weeks of gestation who will potentially need specialist management in a NICU or a SCBU.
    

    Main aims of management
    

  • To provide an appropriate environment where normal homeostasis can be maintained and where emergencies can be responded to in an appropriate way.
    
  • To support the physical, developmental, psychological, and emotional welfare of the babies.
    
  • To provide support for the families of babies nursed within these contexts.
    

    As there is a vast difference in maturity between a baby of 24 weeks gestation and a baby of 37 weeks gestation, the care provided will be tailored to each individual baby’s needs.
    

  • As the baby approaches 34–37 weeks there is less need for intensive or invasive care, and these babies will be treated as normal term infants, provided they do not have any other problems.
    

    

  • Babies of 24–34 weeks will need specialist care, with the smaller, sickest babies needing intensive care from birth.
    

    Management and care
    

    Initially most preterm babies will be nursed in an incubator for:
    

  • Temperature control
    
  • Humidity control
    
  • Easier observation
    
  • Oxygenation
    
  • Barrier to infection
    
  • To cut down on handling.
    

    Ventilation and surfactant replacement
    

    A baby of 30 weeks or less will require ventilation and surfactant replace- ment from birth, due to surfactant deficiency and immaturity of the lungs (b see Respiratory distress syndrome in the newborn, p. 640). The need for ventilation will be assessed according to the baby’s gestation and con- dition at birth. The main aim is to prevent the baby’s condition becoming worse because of tiredness.
    

    Several different methods of ventilation are available, which have been developed especially for use with premature babies.
    

    Different techniques of ventilation
    

  • High-frequency oscillation ventilation (HFOV)
    has been developed to cut down on the use of high-pressure ventilation, which can lead to long-term damage to the immature lungs. HFOV provides breaths or cycles of 240–3000 per min. It facilitates the diffusion of gases and
    

  MANAGEMENT OF THE PRETERM BABY
  

  635
  

  improves ventilation and perfusion matching. It is used where there is poor gas exchange, as in RDS that has not responded to conventional ventilation.