L10: Neonatal Intensive Care Unit (NICU) Flashcards
Purpose of NICU
- Treat infants born pre-term/with complications
- **PRE-TERM== any birth <37wks gestation
LVLS of NICU
how many
3
Lvls of NICU
Lvl 1→
-
Lvl 1:
- Routine/basic care to infants 35-37wks
- Stabilization infants <35wks
Lvls of NICU
Lvl 2→
-
Lvl 2:
- Specialty care for moderately ill infants <32wks
Lvls NICU
Lvl 3→
-
Lvl 3:
- Advanced care for severely ill infants born <28wks
NICU environment
*NOTE:
Transition of infant from warm, enclosed, dark, relatively quiet uterine environment to a bright, tech. filled, loud hospital room
NICU Environment:
Noise should NOT exceed _________
NOT exceed 45db
NICU
Noise & Light
Tech’s to limit noise
- Cover incubator/crib w/ blanket and adding sound blocking padding to crib walls
Infants <32 wks unable to limit amt of light entering eyes why?
bc thinness of skin of the eyelids
*Lack of typ light/dark cycles (day/night) may impact sleep reg. in infants
Lack of typ light/dark cycles may impact sleep in infants ________ bc cannot limit light entering eyes bc eyelids too thin
<32wks
Identifying Gestational Age
Use this score
New Ballard Score (NBS)
*Most widely used 20-44wks
New Ballard Score
Gestational age
*Most widely used 20-44wks
Components?
- Neuromotor maturity→ Posture
- Physical matureity→ presence of lanugo (hair)
- Genitalia
Risk factors for prematurity
Combo of _________
Genetic, social, environ. factors
Risk Factors for Prematurity
- Mothers w/ hx of having premie, under 18yo, over 30yo
- Twins, triplets
- Uterine/Cervical probs, maternal chronic high BP, DM
- Smoking, ETOH/subs abuse, poor nutrition, lack of prenatal care, infections
Pre-term refers to ANY BIRTH ________ weeks gestation
<37 wks
Infants born pre-term & small for gestational age (SGA) divided into 3 categories:
- Low Birth Wt (LBW): 1501-2500g
- *worse prognosis
- Very Low Birth Wt (VLBW): 1000-1500g
- Extremely Low Birth Wt (ELBW): <1000g
- Micropremie==> born before 26wks AND <800g
Avg Birthweight ===
<2500g
Large for Gestational Age (LGA)==>
>90th %
NICU Dx’s***
Pulmonary
- Respiratory Distress Syndrome (RDS)
- Bronchopulmonary Dysplasia (BPD)/Chronic Lung Disease of Infancy (CLD)
- Meconium Aspiration Syndrome
NICU Dx’s***
Pulmonary
Respiratory Distress Syndrome (RDS)
MOST COMMON CAUSE OF NEONATAL DEATH****
- Pulmonary immaturity/limtd surfactant
- Tx→ Mech. vent and surfactant prophylactics for infants <30wks
MOST COMMON CAUSE OF NEONATAL DEATH
RDS
NICU Dx’s***
Pulmonary
Bronchopulmonary Dysplasia (BPD)/Chronic Lung Disease of Infancy (CLD)
- BOTH result from incomplete/abnorm repair of lung tissue during neonatal pd.
- Can result from RDS
NICU Dx’s***
Pulmonary
Meconium Aspiration Syndrome
- Resp distress from infant borth thru meconium strained amniotic fluid
- Leads to resp. distress and hypoxemia
- Prevention: deep suction all babies
- Tx: antibiotics
NICU Dx’s***
Neurologic Cond’s
- Periventricular Leukomalacia (PVL)
- Intraventricular Hemorrhage (IVH)
- Hypoxic Ischemic Encephalopathy (HIE)
- Neonatal Seizures
NICU Dx’s***
Neurologic Cond’s
Periventricular Leukomalacia (PVL)
- Brain injury most commonly known to cause CP**** + cog. deficits
- Symmetrical non-hemorrhagic lesion caused from ischemia
- white matter necrosis
- spastic diplegia common, UE impairs may result
BRAIN INJURY MOST COMMONLY KNOWN TO CAUSE CP****
Periventricular Leukomalacia (PVL)
PVL causes
CP
NICU Dx’s***
Neurologic Cond’s
Intraventricular Hemorrhage
- MOST COMMON FORM OF NEONATAL INTRACRANIAL HEMORRHAGE****
- Occurs w/in first 24hrs post-natal
- Graded I→ IV
- ==> Brain dmg, neuro dis’s (CP, cog probs, attn disorders****) w/ inc’d grade
MOST COMMON FORM NEONATAL HEMORRHAGE
INTRAVENTRICULAR HEMORRHAGE (IVH)
NICU Dx’s***
Neurologic Cond’s
Hypoxic Ischemic Encephalopathy (HIE)
- Spectrum of neuro impairments w/ high neonatal mortality due to lack of O2 to brain
NICU Dx’s***
Neurologic Cond’s
Neonatal Seizures
- MOST FREQ. NEUROLOGICAL SIGN NOTED IN THE NICU****
-
Occur due to:
- LBW
- prematurity
- maternal medical conds
- HIE
- CVA
- Metabolic dis.
- W/drawal
- etc…
NICU Dx’s***
Cardiac→ Congenital Heart Defects
*LOOK @ CARDIOPULM PEDS LECTURE!!!
- Patent Ductus Arteriosus (PDA)
- Pulmonary Atresia
- Tetralogy of Fallot (TOF)
- Coarctation of the Aorta (COA)
NICU Dx’s***
Others
- Necrotizing Enterocolitis (NEC)
- Retinopathy of Prematurity (ROP)
- Hyperbillirubinemia
- Fetal Alcohol Syndrome
- Neonatal Abstinence Syndrome (NAS)
NICU Dx’s***
Necrotizing Enterocolitis (NEC)
-
Acute inflammatory bowel condition
-
“necrosis of intestines”
- Put the words together!!!
-
“necrosis of intestines”
- ***COMMON in infants <2000g in first 6wks of life
- Tx: IMMEDIATE medical intervent.
NICU Dx’s***
Retinopathy of Prematurity (ROP)
- Proliferation abnorm blood vessels in retina
- Can cause mild vision dmg or comp. vision loss
- Premie + LBW greatest risk factors
- IVH, supplemental O2 need, sepsis=> also assoc’d
NICU Dx’s***
Hyperbillirubinemia
*Billirubin think Jaundice
- Physio jaundice→ excess billirubin 2* to immature hepatic function
-
Tx: Phototherapy
- *Billirubin lights
NICU Dx’s***
Fetal Alcohol Syndrome (FAS)
- Due to maternal subs. abuse
- ==> Cog, cardiac, developmental, facial (you know the picture from PPT) effects
NICU Dx’s***
Neonatal Abstinence Syndrome (NAS)
- Maternal narcotic use transferred to infant
- ==> infant dependency and w/drawal w/in 72hrs post-natally
- ==> irritable, tremors, SZs, insomnia, hyperactive reflexes, impaired suck/swallow, shrill cries***
- Tx: supportive care to wean from drug
Pain in NICU
Pain MORE COMMON in _______ infants vs term infants
Pre-term infants
*bc pain modulation tracts not fully developed until 36wks gestation
*pain diff. to assess in infants
Be aware physiological signs of pain in infants:
INCd HR
flushing of skin
diaphoresis
incd mm tone
dilated pupils
Measures to assess Pain in infants:
- Neonatal Coding System
- Neonatal Infant Pain Scales
- CRIES
- Premature Infant Pain Profile
- FLACC
PT in NICU
- Extensive knowledge of neonatal pathophys., embryo development and infant behavior
- Specialized didactic training
PT in NICU
Interventions
3 Main Components:
- Communication
- Information Sharing
- Procedural Intervents
-
Primary role:
- Promote mvmt/postural control
- Assist infant to adapt outside uterus
- State regulation
- Feeding support
- Handling support for families
- Lots of observation/recommendation→ Developmentally supportive care
-
Primary role:
PT Procedural Interventions
- Positioning
- State regulation & Infant behaviors
- Family education and coordination of care
Sleep stages of infant
- Deep Sleep*
- Light Sleep
- Drowsy
- Quiet Awake*
- Active Awake
- Crying
*NOTE: Want to intervene/interact during DEEP SLEEP (reposition, PROM) & QUIET AWAKE (feeding, contact, etc.)
Behavioral States
*Know signs of APPROACH vs AVOIDANCE
SEE PICS
Developmental Standardized Assessments
- NIDCAP→ Newborn Individualized Developmental Care and Assessment Program
- ID care strats for ea. newborn
-
TIMP
- IDs infants @ risk for dev. delays
NICU Follow-Up
- “Follow-Up Clinic”→ do routine check ins for @ risk infants
- PTs assess gross motor dev.; can recommend Early Intervent (EI) programs
