Neonatal Care and Preterm Infants

This assignment delves into the complexities of neonatal care, focusing specifically on preterm infants. It explores various aspects of their care, such as pain management techniques, respiratory support strategies, and the impact of prematurity on developmental outcomes. The analysis also considers ethical dilemmas associated with neonatal intensive care and highlights best practices for providing optimal care to these vulnerable newborns.

Running head: POSTNATAL CARE AND MANAGEMENT BASED ON CASE STUDY
Post natal care and management based on case study
Name of the student:
Name of the University:
Author Note:

1POSTNATAL CARE AND MANAGEMENT BASED ON CASE STUDY
Table of Contents
Introduction: 2
Risk factors associated: 2
Care plan for Sam 4
Postnatal care and management for Yvette: 7
Conclusion: 10
References: 11

2POSTNATAL CARE AND MANAGEMENT BASED ON CASE STUDY
Introduction:
The prenatal and postnatal care or the lack thereof for the women who have had Caesarean
section and are pregnant again for the second time or have experiences complications during the
surgery is a major public health priority, especially for the single woman. One of the major
complications that the pregnant women face in the current times is the preterm labour or
premature delivery. Preterm labour can be defined as the phenomenon when the baby is born
before the 37 weeks of gestation is completed, there can be various contributing factors leading
to preterm labour like recurrent preterm birth, extreme anxiety or stress, excessive smoking,
cervical exhaustion, infections, etc. The rate of preterm birth has been increasing rapidly, and
just in the past decade the rate has jumped close to 30% (MacIntyre et al., 2012).
This case study selected for this assignment explains in detail about the medical history of
the Yvette, who have had two previous preterm births and is in preterm labour again with various
other complications. The woman under consideration in the case scenario had been a heavy
smoker and had been caring for two children singlehandedly. Along with that, she had been
suffering with whooping cough, UTI and several other infections while in 32 weeks of gestation
and had to be admitted to the hospital where she underwent LSCS (Khan et al., 2010). This
assignment will attempt to explore the risk factors associated with such scenarios, design a care
plan for the newborn and formulate a midwifery care plan for the woman as well.
Risk factors associated:
According to the case study, the mother, was 32 weeks in gestation and was admitted to the
hospital facility, with symptoms like abdominal pain, dysuria, and mild contractions occurring
for two days. The medical history includes Group B streptococcus positive urinary tract infection

3POSTNATAL CARE AND MANAGEMENT BASED ON CASE STUDY
at 26 weeks of pregnancy as well. Along with that her previous two children were both born
prematurely close to two years apart; Yvette is extremely stressed and is a heavy smoker with 20
cigarettes a day, and her premature labour is tensing her further. Based on the finding of this case
study the two major risk factors that could have positively contributed to her premature labour
are smoking and her past history of recurrent preterm births (MacIntyre et al., 2012).
There are a variety of adverse effects of smoking on the health and wellbeing of a normal
individual, in case of pregnancy however; the risk factors increase multiple folds. According to a
large number of exploratory study, smokers were found to be on an elevated risk of pre term
delivery, along with that, the risk for preterm birth increased with the increase in number. For
instance, heavy smoker mothers had the greater risk of 24% for very preterm labour, 28% for
spontaneous birth, and 28% of medically indicated preterm labour. However, the exact pathway
through which smoking escalates the risk for preterm birth is not completely known yet (Khan et
al., 2010). Although extensive research has discovered that excessive concentration of nicotine
and carbon monoxide in the system, compromising the placental blood flow, which in turn
disrupts the vasoconstriction of the placental vessels. Along with that the carbon monoxide
present in the tobacco smoke is also known to produce carboxy- hemoglobin interfering with the
fetal oxygenation (Tsiartas et al., 2012). The nicotine accumulated in the body system of a
smoker is also known to increase the maternal blood pressure and pulse rate, which in turn
restricts the blood flow to the fetus. The culmination of all these factors ultimately results in
altering the amniotic environment for the fetus and restricts the growth and development of the
fetus, leading to the preterm labour; idiopathic preterm labour is also associated with the
excessive smoking in pregnant woman and is rightfully considered one of the biggest risk factors
to preterm delivery in woman (Olsson, Ahlsén & Eriksson, 2016).

4POSTNATAL CARE AND MANAGEMENT BASED ON CASE STUDY
Another highly impactful risk factors in this case scenario that could have contributed to
Yvette having to undergo third preterm birth by the means of lower segment caesarean section is
her past history of recurrent preterm labour. Recurrent labour can be defined as the occurrence of
two or more births before the 37 weeks of gestation can be completed. Various studies have
suggested that the occurrence of previous spontaneous preterm labour increases the risk of the
next pregnancy to be preterm as well, however in case of preterm labour associated with
preeclampsia, the statistics may vary (Pryhuber et al., 2015). Hence it can be suggested that her
previous history of premature birth following preeclampsia followed by second premature
delivery due to preterm labour increased the risk factor for her indicated preterm pre labour
rupture of membranes or PROM. Authors have discussed the cervical insufficiency resulting
from the occurrence of more than one preterm delivery to be the contributing factor behind the
indicated recurrent preterm labour (Henderson et al., 2012). Cervical insufficiency is the result of
early cervical ripening caused by the loss of connective tissue or intrauterine infection which has
been present in case of the woman under consideration. Therefore it can be concluded that the
post operative cervical ripening due to more than one preterm surgical delivery has been one of
the greatest risk factors for Yvette, and coupled with excessive anxiety, smoking, and infections
propelled her towards her third PROM (Russell et al., 2014).
Care plan for Sam
Currently, the newborn baby Sam is undergoing investigation in nursery, as he is a premature
baby. He is also undergoing treatment for acute infection. Sam is at increased risk of infection
owing to the immunological immaturity and the UTI infection from mother. In addition to
infection the preterm babies are at risk of respiratory distress, hypothermia and hyperthermia due
to ambient temperature changes. According to Drysdale et al. (2014), respiratory distress is

5POSTNATAL CARE AND MANAGEMENT BASED ON CASE STUDY
related to lung immaturity and low surfactant produced. The premature babies are also at risk of
impaired sensory, auditory functions.
Thus, the care plan for Sam include the following –
To ensure thermal homeostasis the infant will be placed in the warmer and isolette incubator
and ensure that the baby has appropriate clothing. The carer may dry Sam thoroughly and
discard the wet blanket soon. This process may prevent heat loss from evaporation. The baby
must not be positioned on close surface. Sam may have cold stress due to hypothermia and
hyperthermia may cause respiratory distress, thus regular monitoring of the temperature is
needed. The care provider must provide medication as prescribed to prevent seizures
associated with hypethermia (Drysdale et al., 2014).
The breast milk can be instilled that is the expressed breast milk (EBM) to maintain body
nutrients. It is because Sam may be at risk of imbalanced nutrition as a consequent of low
glucose, iron and calcium reserve in the premature baby. As the premature babies have high
rate of metabolism and inadequate calorie intake, they have low glycogen stores. Thus, it is
mandatory to assess the input and output as well as blood sugar level (risk of hypoglycemia),
weight and serum sodium (Green et al., 2015). The baby will be nil by mouth and on IV
therapy to restore fluids. As the baby preterm, the careers must insert the nasogastric tube.
The rationale for this is the premature babies, who are also prone to fluid and electrolyte
imbalances caused by environmental factors and loss through lungs, skin,urine and skin. In
case of edema, the fluid volume should be adjusted accordingly. Usually the preterm babies
can concentrate urine to ~ 600 mOsm/L (Green et al., 2015).
The baby must be regularly assessed for the BP, TPR and ascultate breath sounds to track the
spread of infection. Therefore, the baby must be monitored for fever, vomiting, jaundice,

6POSTNATAL CARE AND MANAGEMENT BASED ON CASE STUDY
urine with blood, cloudy urine or unpleasant-smelling urine. Since the baby already have an
acute infection, there is a need of antibiotic therapy (IV antibioticss) as it inhibits the growth
of bacteria. The UTI infection is usually treated within two to three days. Until the infection
is cured breast, milk should be stopped to void further infections. Further, there is a need of
identification and treatment of the voiding dysfunction. Evaluating the condition and based
on the child’s clinical judgment, the imaging evacuation of the urinary tract can be
individualised. The UTI infection from mother can impose the risk of kidney in Sam. Thus,
the baby must be assessed for the Kidney function (Vachharajani et al., 2015).
It must be ensured in the nursery that all the people coming in contact with the baby maintain
hand washing protocol to prevent infection. Sterilised equipments should be used to make
necessary assessments (Olsson et al., 2016). Further, the neonate must be monitored for the
signs of poor skin turgor, dehydration, ad sunken eyeballs for medical intervention. The
baby’s eyes must be covered with patches while under the phototherapy lights to prevent
retinal damage. Regular inspection of eyes is necessary to facilitate treatment for purulent
conjunctivitis. The care provider in the intensive care unit must position Sam on side with
rolled blanket at his back as this position facilitates breathing. As per Pryhuber et al. (2015),
immaturity also leads to fragile skin. To prevent the superficial burns on skin avoid oily
applications and repositioning is needed every two hours to avoid pressure areas (Russell et
al., 2014).
Lastly, the mother should be trained on the implications of the infection and the precautions
to be taken to avoid further infections. Proper guideline must be given regarding care,
handling of the baby and nutrition and the symptoms that need immediate medical
intervention.

7POSTNATAL CARE AND MANAGEMENT BASED ON CASE STUDY
Postnatal care and management for Yvette:
Preterm birth is considered to be one of the most common pregnancy related complication ad
a vast majority of the young mothers suffer from this particular complication. Although a
preterm delivery is generally highly complicated and there are a number of risk factors
associated with the preterm labour (Mercer, 2012). Hence even after the delivery, the preterm
birth mothers face dire need of ongoing care and support both medical and psychological from
the post natal care providers. Although the nursing acre professions will assist the woman with
the pharmacological care needs and requirements the midwives can help the mother deal with
other related complications after the preterm birth that will help her recover faster and care for
herself and her child much better.
One of the greatest challenges that a mother post preterm delivery include the infection, pain,
confusion, anxiety, and most of helplessness in controlling her grievances. The midwives can
provide immense psychological support along with guiding the mother with the care needs of
herself and her baby. He care and management that Yvette will receive from the post natal
obstetric staff or midwives in particular, include kangaroo care, postpartum pain management,
psychological and social support including anxiety management, successful lactation, family
centred care and guidance for planning future pregnancy (Lamont et al., 2011).
Kangaroo care can be defined as the skin to skin contact of the mother with her newborn
dressed only in a cap and diaper, and for the preterm babies in the neonatal intensive care unit,
this technique is highly beneficial facilitating improved breastfeeding rates, stable body
temperature for the new born, decreased hospital stays, and improved neurological development
of the newborn (Di Renzo et al., 2011). And as the preterm babies lack in body weight and slow
growth rates, this technique is even more beneficial for the preterm babies. In this technique the

8POSTNATAL CARE AND MANAGEMENT BASED ON CASE STUDY
midwife will train Yvette to hold her neonate on her chest providing skin to skin contact which
will regulate the baby’s body temperature decreasing the risk for preterm hypothermia and will
train the other in readily accessible breastfeeding when need be.
The second support that the woman under consideration for the assignment will receive from
the midwives is regarding post partum pain management which is a very common occurrence
following a LSCS (Flenady et al., 2013). The immediate relief intervention that the woman can
achieve include lateral recumbent position, relaxation techniques like breathing exercises, back
rubs, therapeutic touch exercise and administration of mild analgesics as directed by the
registered midwife.
Successful lactation is one of the most vital parts of the post natal care management and for
good health of both the mother and the newborn. According to the American academy of
paediatrics, the human milk is absolutely necessary for adequate growth and development of the
baby. Although the mothers that give preterm deliveries face the challenge of successful lactation
and maintaining adequate milk supply. The midwife can train Yvette the hand pumping
technique to increase the milk supply, along with monitoring the breast health and milk
production of the mother regularly to avoid mastitis or candidiasis as consequences of excessive
pumping. Periodic breast massage is also a caring tactic that midwives take in order to help the
preterm mothers increase their milk production rate (Flenady et al., 2013).
Post partum depression and anxiety has emerged as one of the major maternal health and
wellbeing priorities and Yvette, the woman under consideration for this assignment has already
been dealing with excessive stress, anxiety and depression while being a single mother with two
infants and a neonatal newborn, psychological support is one of the mandates in this situation. In
case of NICE screening for postnatal anxiety and depression is one of the mandatory protocols;

9POSTNATAL CARE AND MANAGEMENT BASED ON CASE STUDY
though there is not much for the midwives to do in clinical care, therapeutic management can be
given to Yvette effectively by midwifery professional. Counselling and relaxation therapies
engaging active communication and compassionate support can help the mother overcome her
depression and fears and concentrate on keeping herself and her child healthy (Neilson, West &
Dowswell, 2014).
Lastly overall guidance and training for preplanned future pregnancy and social support
given by the midwife to the preterm mother, Yvette for this case scenario, has been proven to
reduce the risk of post partum depression and anxiety along with the risk of recurrent preterm
birth. The midwife will engage Yvette in a proper woman education regarding the risk factors of
safe time gap between the next pregnancy and contraceptive techniques ensuring the best health
for the mother and her children at large (Wylie et al., 2011). Proper social support of counselling
and day care for her children, while she is in the hospital, will also be discussed with Yvette by
the midwife.
However, there are a few precautionary assessments that the midwife will engage the woman
because of the infections that she had been suffering with. As per the case study, there is need for
a few blood tests needed for testing the infection status of the whooping cough and the group B
streptococcus infection like the CBC or complete blood count test. The temperature of the
woman needs to be monitored periodically because of her infections. As Yvette has had
whooping cough before the delivery, the midwife will also need to restrict the woman from
visiting the newborn until all her infections are reduced. For her C-section, the incision site will
be monitored regularly by the midwife for any signs of infection and any irregular bleeding
should be monitored diligently as well, along with any impending fever.

10POSTNATAL CARE AND MANAGEMENT BASED ON CASE STUDY
Conclusion:
On a concluding note, it can be stated that the rate of preterm births have been increasing a at
a rapid rate over the years and there are a myriad of risk factors that facilitate the preterm labour
in women. For instance, in this case scenario where Yvette had suffered through two previous
preterm deliveries and different infections and had to suffer through another preterm birth
followed by a LSCS surgery. The anxiety and fear that Yvette had been experiencing had been
very natural given the circumstances she went through as a single mother without any support,
although continuing smoking had been one of the major contributing factors that propelled her
towards the complications for the most part.
However, it must not escape notice that optimal compassionate care and support has the
potential to help her overcome the crisis situation and attain speedy recovery for both herself and
her premature child. This assignment has discussed three of the key factors associated with the
premature birth in the current age, the risk factors contributing to preterm birth, the postnatal
care and management for the neonate and post natal care and management for the mother. It can
be hoped that the care techniques and management outlined in the assignment will be beneficial
in helping Yvette gain proper health in no time along with her newborn child.

11POSTNATAL CARE AND MANAGEMENT BASED ON CASE STUDY
References:
Di Kenyon, S., Boulvain, M., & Neilson, J. P. (2010). Antibiotics for preterm rupture of
membranes. Cochrane Database Syst Rev, 8(8).
Di Renzo, G. C., Roura, L. C., Facchinetti, F., Antsaklis, A., Breborowicz, G., Gratacos,
E., ... & Radunovic, N. (2011). Guidelines for the management of spontaneous preterm
labor: identification of spontaneous preterm labor, diagnosis of preterm premature
rupture of membranes, and preventive tools for preterm birth. The Journal of Maternal-
Fetal & Neonatal Medicine, 24(5), 659-667.
Drysdale, S. B., Alcazar, M., Wilson, T., Smith, M., Zuckerman, M., Lauinger, I. L., ... &
Greenough, A. (2014). Respiratory outcome of prematurely born infants following
human rhinovirus A and C infections. European journal of pediatrics, 173(7), 913-919.
Flenady, V., Hawley, G., Stock, O. M., Kenyon, S., & Badawi, N. (2013). Prophylactic
antibiotics for inhibiting preterm labour with intact membranes. The Cochrane Library.
Green, J., Darbyshire, P., Adams, A., & Jackson, D. (2015). Looking like a proper baby:
nurses' experiences of caring for extremely premature infants. Journal of clinical nursing,
24(1-2), 81-89.
Henderson, J. J., McWilliam, O. A., Newnham, J. P., & Pennell, C. E. (2012). Preterm birth
aetiology 2004–2008. Maternal factors associated with three phenotypes: spontaneous
preterm labour, preterm pre-labour rupture of membranes and medically indicated
preterm birth. The Journal of Maternal-Fetal & Neonatal Medicine, 25(6), 642-647.

12POSTNATAL CARE AND MANAGEMENT BASED ON CASE STUDY
Lamont, R. F., Nhan-Chang, C. L., Sobel, J. D., Workowski, K., Conde-Agudelo, A., &
Romero, R. (2011). Treatment of abnormal vaginal flora in early pregnancy with
clindamycin for the prevention of spontaneous preterm birth: a systematic review and
metaanalysis. American journal of obstetrics and gynecology, 205(3), 177-190.
MacIntyre, D. A., Sykes, L., Teoh, T. G., & Bennett, P. R. (2012). Prevention of preterm
labour via the modulation of inflammatory pathways. The Journal of Maternal-Fetal &
Neonatal Medicine, 25(sup1), 17-20.
Mercer, B. (2012). Antibiotics in the management of PROM and preterm labor. Obstetrics
and Gynecology Clinics, 39(1), 65-76.
Neilson, J. P., West, H. M., & Dowswell, T. (2014). Betamimetics for inhibiting preterm
labour. The Cochrane Library.
Olsson, E., Ahlsén, G., & Eriksson, M. (2016). Skin‐to‐skin contact reduces near‐infrared
spectroscopy pain responses in premature infants during blood sampling. Acta
Paediatrica, 105(4), 376-380.
Pryhuber, G. S., Maitre, N. L., Ballard, R. A., Cifelli, D., Davis, S. D., Ellenberg, J. H., ... &
Ren, C. (2015). Prematurity and respiratory outcomes program (PROP): study protocol of
a prospective multicenter study of respiratory outcomes of preterm infants in the United
States. BMC pediatrics, 15(1), 37.
Reiss, I., Schaible, T., van den Hout, L., Capolupo, I., Allegaert, K., van Heijst, A., ... &
Tibboel, D. (2010). Standardized postnatal management of infants with congenital
diaphragmatic hernia in Europe: the CDH EURO Consortium
consensus. Neonatology, 98(4), 354-364.

13POSTNATAL CARE AND MANAGEMENT BASED ON CASE STUDY
Reynolds, L. P., & Caton, J. S. (2012). Role of the pre-and post-natal environment in
developmental programming of health and productivity. Molecular and cellular
endocrinology, 354(1), 54-59.
Russell, G., Sawyer, A., Rabe, H., Abbott, J., Gyte, G., Duley, L., & Ayers, S. (2014).
Parents’ views on care of their very premature babies in neonatal intensive care units: a
qualitative study. BMC pediatrics, 14(1), 230.
Sweet, D. G., Carnielli, V., Greisen, G., Hallman, M., Ozek, E., Plavka, R., ... & Halliday, H.
L. (2013). European consensus guidelines on the management of neonatal respiratory
distress syndrome in preterm infants-2013 update. Neonatology, 103(4), 353-368.
Tsiartas, P., Holst, R. M., Wennerholm, U. B., Hagberg, H., Hougaard, D. M., Skogstrand,
K., ... & Jacobsson, B. (2012). Prediction of spontaneous preterm delivery in women with
threatened preterm labour: a prospective cohort study of multiple proteins in maternal
serum. BJOG: An International Journal of Obstetrics & Gynaecology, 119(7), 866-873.
Vachharajani, A., Vricella, G. J., Najaf, T., & Coplen, D. E. (2015). Prevalence of upper
urinary tract anomalies in hospitalized premature infants with urinary tract infection.
Journal of Perinatology, 35(5), 362.
Van Der Ham, D. P., Vijgen, S. M., Nijhuis, J. G., Van Beek, J. J., Opmeer, B. C., Mulder,
A. L., ... & Bloemenkamp, K. W. (2012). Induction of labor versus expectant
management in women with preterm prelabor rupture of membranes between 34 and 37
weeks: a randomized controlled trial. PLoS medicine, 9(4), e1001208.

14POSTNATAL CARE AND MANAGEMENT BASED ON CASE STUDY
Wylie, L., Hollins Martin, C. J., Marland, G., Martin, C. R., & Rankin, J. (2011). The enigma
of post‐natal depression: an update. Journal of psychiatric and mental health
nursing, 18(1), 48-58.