Preterm Newborn Nursing Care Plan & Management


  • A preterm newborn is one born before 37 weeks’ gestation.
  1. The etiology of preterm labor is poorly understood.
  2. Possible factors include the following:
    1. Multiple gestation
    2. Maternal history of preterm delivery
    3. Hydramnios
    4. Uterine anomalies
    5. More than one second trimester abortion
    6. Incompetent cervix
    7. Infection
    8. Uterine structural anomalies
    9. Premature rupture of membranes
    10. Maternal substance abuse (especially cocaine).
    11. Maternal age less than 18 years , poor nutrition, and lack of prenatal care
  • Preterm newborns exhibit anatomic and physiologic immaturity in all body systems; this immaturity hinders the adaptations to extrauterine life that the newborn must make.
Assessment Findings

1. Associated findings. Altered parenting as evidenced by:

  • Decreased or absent parental visits
  • Parental resistance or refusal to participate in newborn care
  • Denial of severity of newborn illness
  • Resistance or refusal to touch newborn
  • Persistent verbalization of guilt

2. Clinical manifestations. There is a higher risk for the following manifestations with a younger gestational         age.

  • Respiratory manifestations include tachypnea, grunting, nasal flaring, retractions, cyanosis, decreased oxygen saturation, decreased oxygen levels, and abnormal arterial blood gas (ABG) values.
  • Cardiovascular manifestations include poor tissue perfusion, hypotension, and patent ductus arteriosus.
  • Gastrointestinal manifestations include feeding intolerance, gastric reflux, vomiting, and gastric residuals.
  • Altered fluid status may be manifested by fluid excess or fluid deficit.
    • Fluid excess is manifested by edema and congestive heart failure.
    • Fluid deficit is manifested by tachycardia, poor skin turgor, decreased urine output, abnormal electrolyte levels, and decreased blood pressure.
  • Iatrogenic anemia secondary to blood sampling may be present. It is exhibited by tachycardia, pallor, decreased blood pressure, increasing oxygen requirements, and apnea.
  • Infection may occur.
  • Hypoglycemia or hyperglycemia may be present.
  • Ineffective temperature control may be observed, and is exhibited by an inability to maintain core body temperature.
  • Neuromuscular system manifestations include decreased suck and swallow reflex, hypotonia, and altered state transition.
  • Hyperbilirubinemia is characterized by rapid destruction of red blood cells, jaundice, and lethargy. Kernicterus is the deposition of unconjugated bilirubin in the brain cells and is associated with mental retardation.

Nursing Management

1. Provide respiratory support (see Drug Chart)

2. Perform the following assessments.

  • Assess heart sounds for presence of murmurs.
  • Assess pulse and perfusion.
  • Monitor blood pressure, heart rate, and pulse pressures.

3. Provide adequate fluids and electrolytes and nutrition.

4. Maintain a neutral thermal environment.

5. Prevent infection.

6. Assess for readiness for selected interventions.

  • Provide stimulation when appropriate to infant state and readiness.
  • Encourage flexion in the supine position by using blanket rolls.
  • Provide the newborn with body boundaries through swaddling or using blanket rolls against the newborn’s body and feet.

7. Promote parent-newborn attachment.

8. Initiate phototherapy as required.

DRUG CHART Medications Used for Postpartum Complications
 Classifications  Used for  Selected Interventions
Lung surfactant

  • Restores naturally occurring lung surfactant to improve lung compliance
  • Used to prevent or treat respiratory distress syndrome in premature infants
  • The usual dose is 4 mL/kg intratracheally in 4 doses at least 6 hours apart in the first 48 hours of life.
  • Suction the infant’s airway before administration and delay further suctioning as long as possible.
  • Assess the infant’s respiratory rate, arterial blood gases, and color before administration.
  • Change the infant’s position every 2 hours to promote flow to both lungs.
  • Assess the infant’s respiratory rate, color, and arterial blood gases after administration.
  • Monitor for side effects, which may include transient bradycardia or rales.


Maternal & Child Practice Exam 11 (Newborn Care) PM

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Nursing Care Plan