Nursing Management 1. Provide adequate fluid and electrolytes and nutrition.

o Provide a high calorie formula for feeding (more than 20 calories per ounce) to promote steady weight gain (15 to 30 grams per day growth plotted on curves shows a normal growth rate). o If the infant is breast feeding, add human milk fortifier to expressed breast milk. Decrease metabolic demands when possible. o Provide small frequent feedings. o Provide gavage feedings if the infant does not have a steady weight gain. o Provide a neutral thermal environment. o Decrease iatrogenic stimuli. Prevent hypoglycemia o Monitor glucose screening. o Provide early feedings. o Provide frequent feedings (every 2 to 3 hours) o Administer IV glucose if blood sugar does not normalize with oral feedings. Maintain a neutral thermal environment. Monitor serum hematocrit (normal is 45% to 65%). o If an initial high hematocrit was obtained by heel stick capillary sample, a follow-up sample should be done by venipuncture. o Observe for signs, symptoms, and complications of polycythemia Ruddy appearance Cyanosis Lethargy, jitteriness, and seizures Jaundice o Provide adequate hydration to prevent hyperviscosity Assess the prenatal history for possible toxoplasmosis, rubella, cytomegalovirus, and herpes simplex infections during pregnancy. Assess maternal and infant antibody titers. Use isolation precautions when congenital infections are suspected. Provide education and emotional support. o Explain the possible causes of intrauterine growth retardation. o Inform parents of the infants goal weight for discharge. o Provide instruction on managing the infant at home. Explain how to prepare a higher calorie formula or breast feeding. Explain the importance of follow-up with a developmental specialist who will screen for milestone achievements.

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Nursing Diagnosis: Impaired Gas Exchange rt immature pulmonary functioning 1. assess respiratory status, noting signs of respiratory distress (e.g., tachypnea, nasal flaring, grunting, retractions, rhonchi, or crackles) Tachypnea indicates respiratory distress esp when respi are>75cpm/min after the first 5 hours of life. Expiratory grunting represents attempt to maintain alveolar expansion; nasal flaring is a compensatory mechanism to increase diameter of nares &increase Oxygen intake. 2. Assess skin color for devt of cyanosis. Lack of Oxygen will result in cyanosis 3. Promote rest, minimize stimulation& energy expenditure to decrease the metabolic rate & Oxygen consumption.

4. Give oxygen properly as indicated To improve respiratory function Nursing diagnosis: Ineffective thermoregulation r/t lack of subcutaneous fat 1. Assess V/S (esp T) Hypothermia predisposes infant to cold stress. Hyperthermia causes further respiratory depression instead of increased RR, leading to apnea &reduced O2 uptake. 2. Place infant in a warmer, isolette, Incubator, or open bed with radiant warmer or open crib wherein infant also has appropriate clothing Maintain thermoneutral environment, helps prevent cold stress 3. Use heat lamps during certain procedures & warm objects coming in contact with the infants body such as clothing Decreases heat loss to the cooler environment of the room Nursing Diagnosis: imbalanced Nutrition: less than body requirements rt small stomach capacity 1. Assess presence of reflexes associated with feeding (i.e swallowing, sucking &root) Determines the appropriate feeding method for the infant 2. Instill breast milk or formula slowly over20min @ a rate of 20ml/min Too rapid entry of feeding into stomach may cause rapid rebound response with regurgitation, increased risk of aspiration & abdomen distension all of which compromises respiratory status. 3. Initiate intermittent or tube feedings as indicted Gavage feedings may be necessary to provide adequate nutrition in infant who has a poorly coordinated suck-and-swallow reflex or who becomes fatigued during oral feedings. 4. Position infant on right side or prone with HOB elevated @30 degrees. Facilitates gastric emptying & prevents reflux. Thermoregulation The SGA baby is at greater risk of hypothermia than the appropriate for gestational age (AGA) baby.The management goal is to maintain normothermia (36.5 37.5C). by: providing a warm birth room/theatre (25 - 28C) drying the baby after birth with pre-warmed towels applying bonnet and bootees placing the stable baby in skin to skin contact (covered with a warm blanket) with his/her mother.Frequent observation (every 5 to 10 minutes) and documentation of central colour, respiratory pattern, tone and/or activity is required in the immediate postnatal period during transition to extra-uterine life.Initiation of early skin to skin contact (condition permitting) has no apparent short or long-term negative effects, is an effective method for preventing heat loss in the newborn and may be of benefit to: o Estabilish babys temperature preventing hypothermia o promote innate behaviours that assistin the initiation of breastfeeding o increase the duration of breastfeeding

o maintain normal blood glucose levels o enhance early mother baby interaction and attachment o reduce baby crying time o increase cardiorespiratory stability use of an overhead radiant warmer use of a water bed (e.g. Kanmed Baby Warmer) may be suitable for low birth weight babies who do not require intensive care or need to be observed naked in an incubator use of an incubator. Babies nursed in incuba tors should be taken out for skin to skin contact with their mothers and for breastfeeding when stable or if condition permits Hyperthermia (greater than 37.5C) is as dangerous to the newborn as hypothermia and can be prevented by not over dressing the baby and monitoring th e incubator and the babys temperature Hypoglycaemia SGA babies are at increased risk of hypoglycaemia due to: decreased muscle glycogen decreased alternative energy stores decreased gluconeogenesis decreased counter regulatory hormones increased insulin sensitivity increased insulin levels (hyperinsulinaemia) hypoxia hypothermia polycythaemia grunting Etymology: ME, grunten abnormal, short, deep, hoarse sounds in exhalation that often accompany severe chest pain. The grunt occurs because the glottis briefly stops the flow of air, halting the movement of the lungs and their surrounding or supporting structures. Grunting is most often heard in a person who has pneumonia, pulmonary edema, or fractured or bruised ribs. Atelectasis in the newborn also causes grunting, which results from the effort required to fill the lungs. Retractions, the inward movement of the skin of the chest wall or the inward movement of the breastbone (sternum) during inspiration, is an abnormal breathing pattern. Retractions mean that the child is having to use chest muscles (not usually needed) and neck muscles to get air into the lungs. The child is having to work too hard to breath. Rhonchi is the coarse rattling sound somewhat like snoring, usually caused by secretion in bronchial airways. Normal ranges: RR: 30-60 PR: 100-160 T: 36-37 Birth asphyxia occurs when a baby doesn't receive enough oxygen before, during or just after birth. There are many reasons that birth asphyxia may occur. Some of the causes of decreased oxygen before or during the birth process may include: Inadequate oxygen levels in the mother's blood due to heart or respiratory problems or lowered respirations caused by anesthesia Low blood pressure in the mother

Inadequate relaxation of the uterus during labor that prevents oxygen circulation to the placenta Early separation of the placenta from the uterus, called placental abruption Compression of the umbilical cord that decreases blood flow Poor placenta function that may occur with high blood pressure or in post-term pregnancies, particularly those past 42 weeks

Regurgitation is the expulsion of material from the mouth, pharynx, or esophagus, usually characterized by the presence of undigested food or blood Gavage (guh-vahj) feeding is a way to provide breastmilk or formula directly to your babys stomach. A tube placed through your babys nose (called a Nasogastric or NG tube) carries breast milk/formula to the stomach.