h. Congenital malformations of the fetus.
i. Chronic infection or disease of the mother (i.e., syphilis, tuberculosis, cardiac
disease, and diabetes).
Acute infection of the mother (that is, pneumonia and rheumatic fever).
10-4. INITIATION AND MAINTENANCE OF RESPIRATION IN THE PREMATURE
Initiation and maintenance of respiration in the premature infant is of primary
concern. The lung maturity varies in accordance with the degree of prematurity, drugs
given before hand, and/or prolonged stress before delivery. The alveoli began to form
at twenty six to twenty eight weeks gestation. The longer the delivery of the baby can
be delayed, the greater will be the ability of the lungs to sustain extrauterine life.
a. At the moment of delivery, the newborn must switch from passive reception of
oxygen to establishing and maintaining ventilation by untried lungs. Not infrequently,
the premature infant is incapable of this task, making resuscitation necessary. The
respiratory muscles are poorly developed, the chest wall lacks stability, and production
of surfactant is reduced. Effective resuscitation must be established to prevent the
development of irreversible respiratory acidosis.
b. The infant should be positioned to allow for easy drainage of mucus from his
mouth. Very small infants are placed on their side, whereas, large infants are placed on
their abdomen. The infant's head may be tilted down except when danger of increased
intracranial pressure or increased respiratory distress, which is due to his liver pressing
on the diaphragm.
c. The best way to evaluate the baby's oxygen status is through arterial blood
gases. Caution must be applied during the administration of 100% oxygen during
resuscitation or to maintain respirations because it places the immature infant in danger
of developing pulmonary edema or retrolental fibroplasia.
d. The infant needs continuous monitoring/assessment for:
Respiratory rate, depth, and regularity.
Periods of apnea greater than 20 seconds.
Respiratory rate after apneic episode (same, increased, or decreased).