Dysmaturity (Intrauterine Growth Retardation )

Subject: Midwifery III (Theory)

Overview

Babies whose births fall below the 10th percentile of the gestational age average are considered to have intrauterine growth retardation. Babies who are preterm, term, or postterm may experience growth restriction. About one-third of low birth weight babies are dysmature. Its overall incidence in developed countries is 2.8%. About 5% of term newborns and 15% of post-term babies experience the occurrence. anomalies of the placenta and cord, such as velamentous insertion of the cord, chronic placental abruption, infraction, tiny placenta, circumvallate placenta, etc. Can lead to dysmaturity as well. In around 40% of cases, the cause is still a mystery. The baby should be wrapped in a sterile towel and given an intramuscular injection of vitamin K 1 mg to prevent hemorrhagic manifestations as part of the nursing management of prematurity and dysmaturity. The cord should be clamped quickly to prevent hypervolemia and adequate oxygenation through a mask or nasal catheter.

Dysmaturity (Intrauterine growth retardation )

Definition

Incidence

About one-third of low birth weight babies are dysmature. Its overall incidence in developed countries is 2.8%. About 5% of term newborns and 15% of post-term babies experience the occurrence.

Causes

Unknown
- In around 40% of cases, the reason is still unknown.
Maternal
- Genetics from the mother, maternal petite size, and race.
- Inadequate nutrition for the mother before and throughout pregnancy.
- Reduced uterine blood flow as a result of hypertension and pre-eclampsia toxicemia.
- A poor pregnancy weight growth for the mother.
- Heart disease-related low blood oxygen levels.
- Malnutrition/malabsorption syndrome.
- Alcohol, tobacco, chronic renal failure, chronic urinary tract infection, etc. are all examples of toxins.
Fetal cause
- Congenital abnormalities/genetic flaws.
- Turner syndrome, trisomy 21, trisomy 18, and other chromosomal abnormalities
- Increased fetal metabolism brought on by the TORCH agent.
- A number of pregnancies.
Placental cause
- Anomalies of the placenta and cord, such as velamentous insertion of the cord, chronic placental abruption, infraction, tiny placenta, circumvallate placenta, etc.

Signs of dysmaturity

Posture
- Tonic or flexed as term baby
Appearance
- Resemble an elderly person
Skin
- Wrinkled, dry, and pink skin
Lanugo
- Thin lanugo
Vernix
- Numerous vernix
Fontanelle and suture
- Suture width, fontanelle width, and skull bone width are all normal for babies.
Ear
- Standard ear pinna
Planter creases
- Dark with several planter wrinkles
Nails
- Delicate, pink-colored nails.
Activity
- Like an active term
Male
- Dropped testis

Complication

Asphyxia.
Low glycogen reserves cause hypoglycemia.
Aspiration of feces.
DIC-causing microbes during the first day of life.
Pulmonary bleeding.
Polycythaemia.
Syndrome of hyperviscosity.
Decreased intestinal blood flow resulting in necrotizing enter colitis.

Nursing management of prematurity and dysmaturity

Immediate management following birth
- To avoid hypervolemia and the later development of hyperbilirubinaemia, the chord needs to be clamped as soon as possible.
- If an exchange transfusion is necessary because of hyperbilirubinemia, the cord length should be kept long (10–12 cm).
- Using a mucus sucker, the airway should be rapidly and gently cleaned of mucus.
- Only when necessary, enough oxygenation by a mask or nasal catheter at a concentration no more than 35% should be given, along with interrupted therapy.
- The infant is placed in the cot with its head slightly lowered, wrapped in a sterile towel.
- To avoid hemorrhagic symptoms, intramuscular injection of vitamin K 1 mg is required.
- Extreme gentleness should be used when handling the infant. Both premature and dysmature infants are functionally underdeveloped, necessitating "Special care" to ensure their life.
The principles to care preterm and dysmature babies are as follows
- Maintain a body temperature that is largely constant.
- A sufficient humidification system to compensate off the increased insensible water loss.
- To stop or cure atelectasis
- To avoid becoming sick
- To keep one's nourishment

Things to remember

Babies whose births fall below the 10th percentile of the gestational age average are considered to have intrauterine growth retardation.
Babies who are preterm, term, or postterm may experience growth restriction.
About one-third of low birth weight babies are dysmature.
Its overall incidence in developed countries is 2.8%.
About 5% of term newborns and 15% of post-term babies experience the occurrence.
Dysmaturity can also result from anomalies of the placenta and cord, such as chronic placental abruption, infraction, tiny placentas, circumvallate placentas, velamentous cord insertion, etc.
In around 40% of cases, the cause is still a mystery.
The baby should be wrapped in a sterile towel and given an intramuscular injection of vitamin K 1 mg to prevent hemorrhagic manifestations as part of the nursing management of prematurity and dysmaturity. The cord should be clamped quickly to prevent hypervolemia and adequate oxygenation through a mask or nasal catheter.

Questions and Answers

Define Intrauterine growth retardation.

Babies whose births fall below the 10th percentile of the gestational age average are said to have intrauterine growth retardation. Babies who are preterm, term, or postterm may experience growth restriction.

What are the causes of dysmaturity ?

Unknown: About 40% of cases still have no clear cause.
Maternal: Small stature, ethnic and genetic influences on mothers.
Inadequate nutrition for the mother before and throughout pregnancy.
Reduced uterine blood flow as a result of hypertension and pre-eclampsia toxicemia.
A poor pregnancy weight growth for the mother.
Heart disease-related low blood oxygen levels.
Malnutrition/malabsorption syndrome.
Alcohol, tobacco, chronic renal failure, chronic urinary tract infection, etc. are all examples of toxins.
Genetic flaws or congenital anomalies are the fetal cause.
Turner syndrome, trisomy 21, trisomy 18, and other chromosomal abnormalities
Increased fetal metabolism brought on by the TORCH agent.
A number of pregnancies.
Placental cause: Abnormalities in the placenta and cord, such as chronic placental abruption, infraction, a small placenta, a placenta with a circumvallate shape, velamentous cord insertion, etc.

What are the Nursing management of prematurity and dysmaturity and also write the principle to care preterm baby ?

Nursing management of prematurity and dysmaturity

Immediate management following birth
- To avoid hypervolemia and the later development of hyperbilirubinaemia, the chord needs to be clamped as soon as possible.
- If an exchange transfusion is necessary because of hyperbilirubinemia, the cord length should be kept long (10–12 cm).
- Using a mucus sucker, the airway should be rapidly and gently cleaned of mucus.
- Only when necessary, enough oxygenation by a mask or nasal catheter at a concentration no more than 35% should be given, along with interrupted therapy.
- The infant is placed in the cot with its head slightly lowered, wrapped in a sterile towel.
- To avoid hemorrhagic symptoms, intramuscular injection of vitamin K 1 mg is required.
- Extreme gentleness should be used when handling the infant. Both premature and dysmature infants are functionally immature, necessitating "Special care" to ensure their survival.

The principles to care preterm and dysmature babies are as follows:

Maintain a body temperature that is largely constant.
A sufficient humidification system to compensate off the increased insensible water loss.
To stop or cure atelectasis
To avoid becoming sick
To keep one's nourishment
Sufficient nursing care