Case 5: NICU Flashcards
While doing PT with preemie infants, what 3 major complications interfere w/ PT?
- pain and stress
- decline in physiologic stability (apnea, bradycardia)
- fractures
What are precautions during PT with premature infants?
3 things we should do…
- monitor vitals and behavioral cues
- monitor medical lines and tubes
- determine whether physiologic cost of exam outweighs benefits
In premature population, ___ and ___ are strong predictors of outcome.
Which is more significant?
gestational age and birth weight
*gestational age is more significant outcome predictor
others: male sex, multiple births, lack of antenatal steroids
What is apnea of prematurity (AOP)
absence of respiration for 20 seconds or more, usually accompanied by bradycardia and/or oxygen desaturation
*related to respiratory control immaturity
What is neonatal respiratory distress syndrome (RDS)?
A breathing disorder in newborns caused by immature lungs (insufficient surfactant).
Symptoms include rapid, shallow breathing and a sharp pulling in of the chest below and between the ribs with each breath
*need mechanical ventilation and surfactant
What is bronchopulmonary dysplasia (BPD)?
a condition defined as: requiring supplemental O2 for at least 28 days of life.
cause: due to oversimplified alveoli (large, less of them) and abnormal pulmonary vasculature
**most common cause of chronic lung disease (CLD) in infants (increases risk of rehospitalization in first year)
What is intrauterine growth restriction (IUGR)?
baby born small (infant weight is below 10th percentile for its gestational age)
*2 classifications: symmetric or asymmetric (head sparing)
What is patent ductus arteriosus (PDA)?
failure of ductus arteriosus to close, causing heart failure, redistribution of systemic blood flow, reduced renal, mesenteric, cerebral blood flow
*larger PDA –> higher risk for IVH, BPD, death
What is the Apgar test? Name the 5 sections
test performed by delivering med team at 1, 5, 10 minutes after birth
1. respiratory effort
2. heart rate
3. mm tone
4. reflexes
5. skin color
(scored 0-2 for each section, total score 1-10)
What is a bacterial infection present in the woman’s vagina, rectum, urinary bladder that can be passed to infant during delivery?
If infant’s are infected, they are at risk for pneumonia, sepsis, and meningitis.
Group B Streptococcal infection
What is an oxygen delivery device that delivers heated and humidified air at higher fractions of inspired O2 than room air?
high flow nasal cannula
Name the apparatus used to control environmental factors for infants who are ill or born preterm; primary purpose is to provide thermal environment that helps infant maintain appropriate body temperature
incubator
Name the neonatal unit that provides highest level of comprehensive care for critically ill infants, including advanced respiratory support, 24 hour on-site neonatology team, advanced imaging, and urgent on-site access to pediatric medical and surgical subspecialists
level IV neonatal intensive care unit
gestational age plus chronological age (weeks since birth)
post-conceptual age
Example: an infant is delivered at 24 weeks gestation and is now 4 weeks old. Infant’s PCA is 28.
Name one of the most common complications of pregnancy, marked by hypertension and proteinuria
preeclampsia
*places mother at increased risk for brain injury, blood clotting issues, kidney and liver injury, decreases blood flow to placenta, leading to IUGR or prematurely born infants
T or F: premature birth alone predisposes infant to neurodevelopmental deficits
TRUE
*premature infants have white matter abnormalities that can persist into school age
medical management in extremely premature and very low birth weight infant (less than 1500 g) includes…
4 MAIN THINGS
- surfactant administration
- respiratory support
- parental and enteral nutrition
- early caffeine initiation
*prior to infants birth, mother may be given antenatal steroids
tummy time should be ___ minutes per day
30 minutes
T or F: infants born preterm are at risk for AOP, RDS, BPD, visual impairments, brain injury like intraventricular hemorrhage, PDA, feeding intolerance, osteopenia, gastroesophageal reflux, enterocolitis
true
T or F: students, PTAs and PTs without specialized training are able to be care providers in the NICU
false:
PTs need mentoring and competency process
*role is to promote typical development, prevent secondary sequelae, support and educate caregivers
Preemie infants have an immature nervous system, causing greater pain sensitivity. How can you monitor pain in preterm infants?
vital signs
facial expressions (eyebrow bulging, nasolabial furrowing, eye squeezing)
___ are a valid and reliable way to predict incidence of CP when compared to other neonatal assessments
GMs (general movements)
*asymmetry in active movements = abnormal
T or F: preemies have higher flexor tone
false: lower flexor tone compared to counterparts
T or F: premature babies have a greater incidence of head posture preference
true: can lead to positional plagiocephaly and also torticollis
common poor positioning includes neck hyperextension, trunk extension, scapular retraction, and anterior pelvic tilt. How should incubator babies be positioned to help with sleep, self regulation, and development of flexor tone?
positioned in a “nest” with boundaries assisting, not eliminating movement.
(help with flexed posture, midline orientation)
*in prone, a postural support nappy and support roll help with flexed posture
In infants requiring supplemental O2, ___ and ___ positions improve lung function and breathing strategies, resulting in fewer events of apnea and hypoxia compared to supine (grade C evidence)
left lateral and prone positions
Which of the following increases risk of positional plagiocephaly in pre term infants?
A. 30 min/day of tummy time
B. chronic lung disease diagnosis
C. female sex
D. reduced time in swings/ infant seats
B. male sex and chronic lung disease INCREASE risk of positional plagiocephaly
Which of the following strategies promotes behavioral organization in pre-term infant during PT sessions?
A. providing multimodal sensory input when infant is stressed
B. positioning infant in sidelying without 3 dimensional boundaries or nest
C. grading tactile input and allowing rest between positional changes
D. timing session between feeding times, when infant is in deep sleep
C. grading tactile input and allowing rest between positional changes
*do NOT schedule therapy when infant is in deep sleep
*don’t stress baby out too much
The therapist is performing initial evaluation. List order promoting optimal neurobehavioral organization during PT session.
- observe infant’s state, position, movement patterns
- open incubator softly
- provide contained touch
- take note of vitals at rest and all lines/tubes
- take note of vitals at rest and all lines/tubes
- observe infant’s state, position, movement patterns
- open incubator softly
- provide contained touch
