NCLEX Review Guide: Preterm Newborn Care

Physical Characteristics of Preterm Infants

• Gestational age less than 37 weeks with weight typically under 2500g, though some may be appropriate for gestational age
• Skin appears translucent and thin with visible blood vessels, minimal subcutaneous fat, and abundant lanugo hair
• Head appears disproportionately large compared to body with soft, pliable ear cartilage that folds easily
• Genitalia development varies: males may have undescended testes, females may have prominent labia minora

Respiratory Distress Syndrome (RDS)

• Surfactant deficiency leads to alveolar collapse, requiring immediate respiratory support and possible surfactant replacement therapy
• Signs include nasal flaring, grunting, retractions, and cyanosis with oxygen saturation below 90%
• Continuous positive airway pressure (CPAP) or mechanical ventilation may be necessary to maintain adequate oxygenation

Respiratory Assessment Steps

1. Observe respiratory rate, rhythm, and effort
2. Assess for signs of distress (retractions, grunting, flaring)
3. Monitor oxygen saturation continuously
4. Auscultate lung sounds for equality and adventitious sounds
5. Document findings and report abnormalities immediately

Temperature Control Interventions

• Neutral thermal environment is critical as preterm infants have limited ability to generate and conserve heat due to minimal brown fat
• Incubators or radiant warmers maintain optimal temperature while allowing access for care and monitoring
• Avoid overheating which increases oxygen consumption and metabolic demands beyond the infant's capacity

Feeding Considerations

• Coordination of suck-swallow-breathe reflex typically develops around 34-36 weeks gestation, requiring alternative feeding methods before this time
• Gavage feeding through nasogastric or orogastric tubes provides nutrition while conserving energy and preventing aspiration
• Breast milk is preferred due to immunological benefits and easier digestibility compared to formula
• Total parenteral nutrition (TPN) may be necessary for extremely preterm infants unable to tolerate enteral feeds

Major Complications to Monitor

• Intraventricular hemorrhage (IVH) occurs due to fragile blood vessels in the germinal matrix, requiring neurological monitoring and head ultrasounds
• Necrotizing enterocolitis (NEC) presents with feeding intolerance, abdominal distension, and bloody stools requiring immediate intervention
• Patent ductus arteriosus (PDA) may require pharmacological closure with indomethacin or surgical intervention if conservative management fails
• Retinopathy of prematurity (ROP) develops from oxygen toxicity and requires ophthalmologic screening and potential laser therapy

Supporting Parents and Bonding

• Kangaroo care (skin-to-skin contact) promotes bonding, stabilizes vital signs, and supports breastfeeding initiation when infant is stable
• Encourage parental involvement in care activities like diaper changes and feeding to promote attachment and confidence
• Provide education about preterm infant behaviors, developmental care, and signs of illness to prepare parents for discharge

• ☐ Respiratory status: rate, effort, oxygen saturation
• ☐ Temperature regulation and thermal environment
• ☐ Feeding tolerance and nutritional status
• ☐ Neurological status and IVH monitoring
• ☐ Growth and development progression
• ☐ Parent education and involvement