Preterm Newborn
Key Points
- A preterm newborn is born before 37 weeks and has risk severity strongly linked to gestational age.
- Major morbidity domains are respiratory immaturity, thermoregulation failure, infection risk, neurologic injury, and feeding instability.
- Early surveillance and protocolized NICU care reduce mortality and long-term disability.
- Family education and ongoing developmental follow-up are essential components of preterm care.
Pathophysiology
Prematurity interrupts organ maturation across pulmonary, neurologic, gastrointestinal, and immune systems. Immature lungs, fragile vasculature, poor thermal reserve, and limited metabolic buffering drive many high-risk complications.
Complications often cluster: respiratory instability increases infection and neurologic injury risk, while feeding intolerance and illness worsen growth and developmental trajectory.
Classification
- Late preterm: 34 to 36 weeks.
- Moderately preterm: 32 to 34 weeks.
- Very preterm: Less than 32 weeks.
- Extremely preterm: 28 weeks or earlier.
Nursing Assessment
NCLEX Focus
Priority questions emphasize trend-based assessment: a subtle change in breathing, temperature, perfusion, or feeding can indicate severe deterioration.
- Assess respiratory pattern and support needs for respiratory-distress-syndrome, apnea of prematurity, MAS overlap, PPHN, and chronic lung risk.
- Assess thermal stability, glucose risk, and feeding tolerance progression.
- Assess for neurologic complications (IVH, seizures, hypoxic-ischemic injury) using exam and ordered imaging trends.
- Assess infection risk and sepsis indicators with culture/lab pathway awareness.
- Assess GI tolerance and early warning signs of necrotizing-enterocolitis.
Nursing Interventions
- Provide respiratory support escalation/de-escalation with continuous monitoring and frequent reassessment.
- Maintain strict thermoregulation and glucose-support strategies.
- Implement infection-prevention bundles and timely antibiotic administration when sepsis is suspected.
- Optimize nutrition pathways (enteral/parenteral) and monitor growth trajectory closely.
- Prepare family for prolonged care course, high-acuity warning signs, and developmental follow-up needs.
Rapid Deterioration Potential
Preterm infants can decompensate quickly from subtle respiratory, infectious, or neurologic changes; delayed escalation increases severe outcome risk.
Pharmacology
| Drug Class | Examples | Key Nursing Considerations |
|---|---|---|
| surfactants | Beractant context | Supports immature lungs and can reduce severity of respiratory distress. |
| antibiotics | Ampicillin plus aminoglycoside context | Early empiric therapy for suspected neonatal sepsis while cultures are pending. |
| antiepileptics | Levetiracetam context | Used for neonatal seizure control with close neurologic monitoring. |
Clinical Judgment Application
Clinical Scenario
A very preterm infant develops increasing tachypnea, recurrent desaturation, temperature instability, feeding intolerance, and intermittent apnea.
Recognize Cues: Multi-system instability in a high-risk gestational-age infant. Analyze Cues: Possible overlap of respiratory immaturity, infection, and metabolic stress. Prioritize Hypotheses: Immediate priorities are oxygenation, perfusion, and sepsis exclusion. Generate Solutions: Escalate respiratory support, initiate sepsis workup/treatment pathway, optimize thermal and nutrition support. Take Action: Implement NICU protocol bundle with close serial reassessment. Evaluate Outcomes: Stabilized oxygenation, improved perfusion/temperature, and clearer diagnostic direction.
Related Concepts
- newborn-resuscitation - Many preterm infants require advanced transition support at birth.
- physiological-adaptation-and-transition - Prematurity magnifies normal transition challenges.
- neutral-thermal-environment - Thermal instability is a major contributor to preterm morbidity.
- care-of-common-problems-in-the-newborn - Jaundice, hypoglycemia, and infection overlap with prematurity risk.
- discharge-planning-for-high-risk-newborns - Preterm discharge requires structured readiness and follow-up.
Self-Check
- Which complications are most strongly associated with decreasing gestational age?
- Why are respiratory, thermal, and nutritional interventions tightly linked in preterm care?
- Which subtle bedside findings should trigger immediate escalation in a preterm infant?