High Risk Infants Flashcards
Level I nursery
normal newborn nursery
Level II nursery
Intermediate continuing care nurseries (“feeders and growers” – no ventilation)
Level III nursery
neonatal intensive care units (NICU); house the sickest and most fragile infants; provide highly specialized care
members of NICU care team
attending neonatologists, neonatology fellows, pediatric residents, medical students, nurse practitioners, neonatal nurses, respiratory therapists, discharge/care members, therapists
high risk infants
Any newborn who has a high probability of manifesting in childhood a sensory, motor, cognitive/language, or social delay later in life. Any infant at high risk should be followed for up to 1 year in a high-risk clinic. The following could place an infant in a high-risk category:
- Prematurity
- Birth weight
- Pathophysiology
birth weight (3 types)
Low Birth Weight (LBW): 3.3-5.5 lbs
Very Low Birth Weight (VLBW): 2.2-3.3 lbs
Extremely Low Birth Weight (ELBW): less than 2.2 lbs
infants with VLBW and ELBW have higher incidence of
neurological problems, developmental delay, and decreased intellectual and language abilities. Small for gestational age infants have birth weights below the 10th percentile of published norms.
Asphyxia
– an interruption in the exchange of oxygen and carbon dioxide that may occur at birth due to trauma, prolonged labor or compression of the umbilical cord
Asphyxia may result in
hypoxic-ischemic encephalopathy (HIE)
hypoxic-ischemic encephalopathy (HIE)
HIE is a lesion in the brain that may cause problems later in life, depending on the severity of the HIE. HIE is the leading cause of severe, non-prgressive neurological deficits resulting from pre-natal event.
Brain hypoxia and ischemia from systemic hypoxemia and reduced cerebral blood flow (CBF) are the primary triggering events for HIE and can occur from any mechanism which results in poor blood flow to the fetal brain in utero including
1) chorioamnionitis
2) placental abruption
3) chronic maternal hypertension
treatment option for HIE
hypothermia (as soon as possible)
clinical signs of HIE at birth
- Stupor, coma, or depressed awake state not attributed to medication
- Seizures
- Alternations in tone, posture, reflexes, respiration, and autonomic function
- Low APGAR scores (ie. 1/1, 1/5, 3/10, 5/15….)
intraventricular hemorrhage (IVH)
- bleeding in/around ventricles in the brain
- causes: unstable respiratory status, hypoxemia, difficult deliveries, or any stresses that increase blood pressure
- especially the germinal matrix
prognosis grades I and II IVH
generally GOOD prognosis, minimal risk for developing neurological deficits
prognosis grades III and IV IVH
higher risk of neurological deficits (cerebral palsy, intellectual disability)
Periventricular leukomalacia (PVL)
bilateral white matter lesion of premature infants
- may result from hypotension, ischemia, and coagulation necrosis at the border of deep penetrating arteries of the middle cerebral artery
- Decreased blood flow manifests as cystic lesions at the corners of the lateral ventricles. The site of injury affects the descending corticospinal tracts, visual radiations, and acoustic radiations.
risks/common occurrence/co morbidities with PVL
- Other risk factors include hypotension, infections, apnea, ischemic events
- PVL occurs most commonly in premature infants younger than 32 weeks’ gestation at birth.
- Children may present with spastic diplegic cerebral palsy have intellectual deficits or visual problems (blindness, strabismus, nystagmus).
Bronchopulmonary Dysplasia (BPD)
A chronic lung disease (CLD) in infants. Infants who have an abnormal chest x-ray and continue to require oxygen supplementation after 28 days of life (DOL) are considered to have BPD.
- commonly seen in ELBW infants.
- can be caused by trauma, intubation, or prolonged mechanical venitilation.
process of BPD
- Damage to ciliary lining of bronchi leads to necrosis
- Decreased oxygenation leads to chronic hypoxia
- Now at risk for brain anoxia
- May predispose infant to neurological disorders
impacts of BPD
- Potential long-term developmental problems may be seen such as mild intellectual deficits, motor coordination deficits, visual perceptual functioning
- Most likely will affect early feeding experiences and typically infants with BPD take longer to achieve full oral feeding (by breast or bottle)
treatment of chronic respiratory disorders
- artificial surfactant, supplemental oxygen, ventilator support, and in the more severe cases extracorporeal membrane oxygenation (ECMO).
ECMO
form of cardiopulmonary bypass that mechanically replaces oxygen in the blood (outside the body) allowing the lungs to rest and mature.
Hyperbilirubinemia (jaundice)
- excess accumulation of bilirubin.
- Bilirubin is a product of the breakdown of hemoglobin from red blood cells.
- may also be due to maternal-fetal blood group incompatibility which results in excessive hemolysis of red blood cells and, therefore, increased levels of bilirubin.
