10-12 Neonatal Flashcards
1
Q
Very low birth weight
A
- Equal or less than 3 lb 5 oz (1500 g)
- 23-24 wks gestation
- Increases incidence in birth defects
2
Q
Gestational Age (GA)
A
- Length of time in utero
3
Q
Chronological Age (CA)
A
- Age based on birthday
4
Q
Corrected/Adjusted Age (AA)
A
- Considers age baby is from due date
5
Q
Post-Conceptual Age
A
- AA prior to achieving term age
- GA + CA
6
Q
Term Adjusted Age
A
- CA - #weeks missed in utero
7
Q
NICU Levels
A
- Level 1: Minimal observation or care; small community hospital; “Well-baby nursery”
- Level 2: Step down from Level III; continued care from Level III, IV meds or alimentation, tube feedings, O2; regional or community hospitals
- Level 3: Highly specialized services for sickest and most fragile infants - complex, medical interventions, advanced diagnostic testing, surgery, resp. support; Teaching hospitals and affiliated with medical schools
- Level 4: Level III plus ECMO (extracorporeal membrane oxygenation)
8
Q
Family-Centered Care
A
- Parents, children, significant others
- The “constant” in an infant’s life
9
Q
Coping and Grief
A
- Stages of grieving: Shock, Denial, Anger, Guilt, Adjustment, Acceptance
- May interfere with bonding
- Staff facilitates bonding, provides empathy
10
Q
Basic requirements for survival
A
- Physiological: breathing, feeding, growing
- Sensorimotor: rooting, sucking, grasping, clearing the airway in prone, horizontal and vertical tracking
- Affective/Communications: crying, self-consoling, eye contact, facial animation, eye aversion
- Complex: auditory preferences, taste preferences, visual preferences, imitative capacities
- Primary “work”: feeding (sucking + swallowing + breathing requires skill as well as energy
11
Q
Failure in Feeding in Pre-Term or Sick Full-Term Babies
A
- Learned oral aversion resulting from NICU care
- Lack of flex/ext balance and chin tuck to assist with sucking, swallowing, breathing
- Residual lung disease may cause tachynea; interferes with sucking and swallowing
- Lack of self-regulation; unable to calm self with environmental stressors
- Apnea
- Bradycardia
- Unable to coordinate sucking, swallowing, breathing, and becomes physiologically unstable
- Immature GI Tract
12
Q
PM: Respiratory Distress Syndrome
A
- Pulmonary immaturity, inadequate pulmonary surfactant
- Surfactant lowers the surface tension and allows the alveoli to maintain its shape
13
Q
PM: Patent Ductus Arteriosus
A
- Structure bypasses circulation to lungs pre-birth
- Normal fetal circulation: Hole in R ventricle and L pulmonary artery allows blood to circulate in utero
- Closes within 10-15 hours after delivery
- If does not close, prevents oxygenation of blood, results in hypotension, poor perfusion, CHF
14
Q
PM: Hyperbilirubinemia
A
- Accumulation of bilirubin (liver enzyme) in the blood
- Caused by immature hepatic function
- Bilirubin can accumulate in the brain and cause neuronal damage - must be addresed right away
15
Q
PM: Gastroesophageal Reflux (GER)
A
- Some degree is normal, asymptomatic
- Frequent episodes can damage esophageal lining - inflammation, dysmotility, pain
- Leads to poor oral feeding patterns, oral aversion and excessive crying due to pain
16
Q
PM: Necrotizing Enterocolitis (NEC)
A
- Acute inflammation of the immature intestine causes acute intestinal necrosis
- Cause: Injury to intestinal mucosal lining
- Doubled in those exposed to cocaine (vasoconstrictive effects in intestine)
17
Q
PM: Germinal Matrix-Intraventricular Hemorrhage (GM-IVH)
A
- Occurs in those less than 32 weeks gestation
- Most common brain lesion in premature infants
- Hemorrhage in brain extends to the area between lateral ventricles
18
Q
PM: Periventricular Leukomalacia (PVL)
A
- Areas of white matter adjacent to the lateral ventricles become necrotic
19
Q
PM: Retinopathy of Prematurity
A
- Retinopathy: Vasoproliferative disease of immature retina
- Cause: Alteration in normal development of blood vessels in eye
- Higher risk in those born less than 30 weeks gestation
20
Q
PM: Prenatal Cocaine Exposure
A
- Defects: Dependency, malnutrition, retarded intrauterine growth
- Infant may go through withdrawal
- Can cause placental vasoconstriction and decreased uterine blood flow
21
Q
PM: Chorioamnionitis
A
- Cervicovaginal bacteria invades amniotic cavity, causing inflammatory response in membranes of the developing fetus
- Most common cause of preterm labor
- Infant more susceptible to brain damage and intestinal abnormalities
22
Q
PM: Osteopenia
A
- Decrease in bone density
- Occurs because of immature bone development
- 80% of bone formed between 24 and 40 weeks; 3rd semester essential for bone formation
23
Q
PM: Bronchopulmonary Dysplasia (BPD)
A
- Most common chronic lung disease associated with prematurity
- Causes: Effects of O2 toxicity, barotrauma, volutrauma from mechanical ventilation on immature infant lungs
- Alternatives: Continuous positive airway pressure (CPAP), inhaled nitric oxide (iNO), high frequency ventilation (HFV)
24
Q
Meconium Aspiration Syndrome
A
- During delivery, fetus may pass BM into amniotic fluid; as infant gasps for first breath, may aspirate meconium-tainted fluid
- Meconium particles obstruct airway, interfere with gas exchange; leads to respiratory distress
25
Q
Toxoplasmosis
A
- Hydocephalus
- Seizures
- Intracranial calcifications
- Ophthalamic disease
- Located in cat feces, undercooked meat
26
Q
Rubella
A
- Hearing loss
- Mental retardation (MR)
- Cardiac malformations
- Ophthalamic defects
- Will affect younger than 20 wks if mother contracts
27
Q
Cytomegalovirus (CMV)
A
- Microcephaly
- Periventricular calcification
- Congenital cataracts
- Hepato-splenomegaly
- Jaundice
- Profound mental retardation
- Deafness
- Blindness
- Cerebral Palsy
- Transferred in utero via placenta, breast milk, birth canal
28
Q
Herpes Simplex Virus (HSV)
A
- Local skin infection
- Encephalitis
- Multiple organ involvement
- Seizures
- Temperature instability
- Hypotonia
- Microencephaly
- Hydroencephalus
- Porencephalic cysts
- CP
- blindness
- cog deficits
- 80% Type 1, 20% Type 2
29
Q
HIV
A
- Meds have decreased passing this
30
Q
Streptococci Group B
A
- Respiratory distress
- Vomiting
- Diarrhea
- Abdominal Distention
- Ileus
- Poor feeding
- Temperature instability
- Hypotension
- Hyperglycemia
- Seizures
- Petecchia
31
Q
Fetal Alcohol Syndrome (FAS)
A
- Physical, behavorial, cog abnormalities
- Dysmorphic facial characteristics
- Pre- and post-natal growth deficits
- Mental retardation
32
Q
Brachial Plexus Injury
A
- Caused by difficult delivery
- Brachial plexus nerves stretched or avulsed
- “Waiter’s Tip” position
- Recovery: Spontaneous within 2 months (average); Long term impairments if not recovered after 6 months
- Treatment: Gentle PROM 7-10 days (decrease hemorrhage and edema, splinting, activities to promote movement, motor learning, strengthening, developmental appropriate skills, early surgical intervention if indicated
33
Q
Torticollis
A
- Neck muscles contract voluntarily on one side causing the neck and head to rotate on one side
- Unilateral shortening of the SCM with limited cervical ROM
- Treatment: stretching, don’t only breast feed to one side, rotate head to opposite side, tummy time
34
Q
Metatarsus Adductus (MTA)
A
- Most common foot deformity
- Tranverse deformit of talometatarsal joints with medial deviation of the MT, slight hindfoot valgus, full DF
- Can be flexible or fixed
- INterventions: Prolonged passive stretching, therapeutic taping, serial casting, corrective shoes, bracing, surgery
35
Q
Talipes Equinovarus
A
- Clubfoot
- 3-4 components
- Equinus (upward bending limited
- Cavus (high arch)
- Varus (of hind foot)
- forefoot adduction
36
Q
Arthrogryposis
A
- “Curved, hooked joint”
- Multiple congenital joint contractures
- Occurs in 2 or more joints in different body areas
- Caused by loss of movement in utero
- Amyoplasia: classic form - no joint crease, everything cylindrical, featureless; symmretic involvement; all 4 extremities
37
Q
Ortho INterventions
A
- ROM
- Serial Casting
- Taping
- Splinting
- Surgery
- Family Education
38
Q
CRIES
A
- Crying, Oxygen requirement, INcreased vital signs, Facial Expressions, Sleep
- 0-2 for each parameter based on changes from baseline
