Chapter 22: NICU Flashcards
Based on the Dynamic Systems Theory, what is interacting and how is it impacting the child’s performance?
Child and environment are all interacting to positively impact child’s performance
Neurodevelopmental Theory: In-turning
Easily stressed from movement, touch, or stimuli
- Go into visible stress response
Neurodevelopmental Theory: Coming out
Medical maturity and more stable
- Can be handled more without as much negative stress responses
What is anticipatory guidance?
Anticipatory needs of the infant, NICU has protocols for infants and provides guidance for parents and staff
Based on the Synactive Theory, what is the infant always interacting with?
The environment
- Can be too stimulating
- Make sure parents are involved as much as possible
- Monitor infant in environment to encourage development
How does the brain develop differently in the NICU vs. in the womb?
Exposed to stress, increased cortisol levels which affects development
IDC Model
Model of developmentally supportive care
IDC Model components
Healing environment- dim lights, minimal noise
Partnering with families- skin to skin contact to create a bond
Positioning and handling- swaddling during painful procedures
Safeguarding sleep
Minimizing stress and pain
Protecting skin- layers of skin are underdeveloped
Optimizing nutrition
Interdisciplinary care in the NICU
OT- sensory experiences, family and infant support
SLP- feeding and swallowing
PT- positioning
Level I
Support for healthy newborns who may require additional assessment and intervention
Level II
Staff are equipped to provide close observation with continuous monitoring of heart rate, respiration, oxygen saturation levels, and basic respiratory support (nasal cannula and IV)
Level III
More intensive services including higher levels of respiratory support
Level IV
Cares for infants undergoing highly complex, life-saving interventions
What levels of NICU care are provided at specialized hospitals?
Levels III and IV
What levels of NICU care are provided at local hospitals?
Levels I and II
Basics of NICU care practice
Evidence-based, cost-effective, and provide only necessary intervention
Insurance reimbursement is contingent upon…
- Cost containment
- Reduction of length of stay
- Avoid readmissions
Do many NICUs allow parents to visit around the clock?
Yes
Single family rooms
Instead of having baby in large nursery, they are in a room with their parents
Pros of single family rooms
Private and intimate setting, easier to control stimuli, less germs
Cons of single family rooms
Parents may be unable to be there, isolation, can be overwhelming for parents who are not prepared for their role
What is the average birth weight for a baby in the U.S?
7 lbs. 7 oz.
What weight is considered normal for a baby in the U.S?
5 lbs. 5 oz. - 11 lbs.
Low birth weight (LBW)
3.3-5.5 lbs
Very low birth weight (VLBW)
2.2-3.3 lbs
Extremely low birth weight
Less than 2.2 lbs
Incredibly low birth weight/micropreemie (ILBW)
1.6 lbs or less
Appropriate gestational age BW (AGA)
90%-10%
Small for gestational age BW (SGA)
10% or less
Large for gestational age BW (LGA)
90% or more
What types of health challenges can be a result of a NICU stay?
Cardiopulmonary issues
Underdeveloped lungs→ chronic lung disease
Stress
Low stamina
Suck/swallow/breathe issue→ NG tube does not help
Retinopathy of prematurity→ babies are given supplemental oxygen for extended period of time→ stops retinas from developing
Corrective surgery can help this
Necrotizing enterocolitis→ tissue and cell damage in the colon, enflamed or ripped colon
Hemorrhaging or bleeding in the brain
Long term issues→ developmental disabilities or delays, learning challenges (ex. ADD), behavior challenges etc.
Neonatal abstinence syndrome
Challenges a baby has due to their mother using drugs during pregnancy (usually opioids)
Persistent pulmonary hypotension
The blood vessels to the lungs don’t fully open, causing too much blood to bypass into the lung, brain and body don’t get enough oxygen, high BP in the lungs hurt the baby’s heart and lungs
Tracheo-esophageal fistula
Abnormal connection between esophagus and trachea, diagnosed by inability to insert NG tube
Hypoxic ischemic encephalopathy
Type of brain injury that occurs when the brain experiences a decrease in oxygen or blood flow
Neurological signs→ severe respiratory difficulty, atypical posturing, seizures, dysregulation states of arousal
Congenital diaphragmatic hernia
Hole in the diaphragm which forms during development, another organ moves into chest cavity interfering with lung development
Prader-Willi syndrome
Genetic disorder with low muscle tone
Deletion in a chromosome from father
Arthrogryposis
Associated with multiple joint contractures and stiffness, no muscle around the joint causes joint to build other tissues to hold in place
Outcomes of NICU survivors
Survival improves with each week of gestation
24 weeks: 35%-84% chance of survival
Any baby that spends time in the NICU is at an increased risk of…
Having a developmental delay
It is important to provide consistent ______ in the NICU
Support and occupation based care
What should the child be receiving after their NICU stay?
Early intervention
Sensory habitat of a typical fetus
Unrestricted access to mother
Flexible boundaries that offer containment and support
Opportunities for movement against fluid resistance without the pull of gravity
Limited exposure to external stimuli
Sensory based interventions in the NICU consider what?
Type of sensory stimuli and the amount of exposure
Conditions under which these interventions are being implemented
Timing of intervention with regard to the infant’s gestational age and ability to process the intervention
OT assessment in the NICU
Safety, collaboration, observation, checklists, and interview (nurse and parents)
Specific therapeutic interventions in the NICU
Address sensory needs
Promote therapeutic handling and positioning
Breast and bottle feeding
Being close with the family
Modifying the environment
Partnering with families in the NICU
Family has greatest influence over infant’s health and well-being
Parents should be included as partners in care planning
How do we support parental participation in the NICU?
Explaining procedures
Encouragement to participate and practice skin to skin contact
Giving ideas of what is to come
