L10: Neonatal Intensive Care Unit (NICU)

Question 1

Purpose of NICU

Answer 1

• Treat infants born pre-term/with complications
  
  • **PRE-TERM== any birth <37wks gestation

Question 2

LVLS of NICU

how many

Answer 2

3

Question 3

Lvls of NICU

Lvl 1→

Answer 3

• Lvl 1:
  
  • Routine/basic care to infants 35-37wks
  • Stabilization infants <35wks

Question 4

Lvls of NICU

Lvl 2→

Answer 4

• Lvl 2:
  
  • Specialty care for moderately ill infants <32wks

Question 5

Lvls NICU

Lvl 3→

Answer 5

• Lvl 3:
  
  • Advanced care for severely ill infants born <28wks

Question 6

NICU environment

*NOTE:

Answer 6

Transition of infant from warm, enclosed, dark, relatively quiet uterine environment to a bright, tech. filled, loud hospital room

Question 7

NICU Environment:

Noise should NOT exceed _________

Answer 7

NOT exceed 45db

Question 8

NICU

Noise & Light

Tech’s to limit noise

Answer 8

• Cover incubator/crib w/ blanket and adding sound blocking padding to crib walls

Question 9

Infants <32 wks unable to limit amt of light entering eyes why?

Answer 9

bc thinness of skin of the eyelids

*Lack of typ light/dark cycles (day/night) may impact sleep reg. in infants

Question 10

Lack of typ light/dark cycles may impact sleep in infants ________ bc cannot limit light entering eyes bc eyelids too thin

Answer 10

<32wks

Question 11

Identifying Gestational Age

Use this score

Answer 11

New Ballard Score (NBS)

*Most widely used 20-44wks

Question 12

New Ballard Score

Gestational age

*Most widely used 20-44wks

Components?

Answer 12

1. Neuromotor maturity→ Posture
2. Physical matureity→ presence of lanugo (hair)
3. Genitalia

Question 13

Risk factors for prematurity

Combo of _________

Answer 13

Genetic, social, environ. factors

Question 14

Risk Factors for Prematurity

Answer 14

• 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

Question 15

Pre-term refers to ANY BIRTH ________ weeks gestation

Answer 15

<37 wks

Question 16

Infants born pre-term & small for gestational age (SGA) divided into 3 categories:

Answer 16

1. Low Birth Wt (LBW): 1501-2500g
   
   1. *worse prognosis
2. Very Low Birth Wt (VLBW): 1000-1500g
3. Extremely Low Birth Wt (ELBW): <1000g
   
   1. Micropremie==> born before 26wks AND <800g

Question 17

Avg Birthweight ===

Answer 17

<2500g

Question 18

Large for Gestational Age (LGA)==>

Answer 18

>90th %

Question 19

NICU Dx’s***

Pulmonary

Answer 19

• Respiratory Distress Syndrome (RDS)
• Bronchopulmonary Dysplasia (BPD)/Chronic Lung Disease of Infancy (CLD)
• Meconium Aspiration Syndrome

Question 20

NICU Dx’s***

Pulmonary

Respiratory Distress Syndrome (RDS)

Answer 20

MOST COMMON CAUSE OF NEONATAL DEATH****

• Pulmonary immaturity/limtd surfactant
• Tx→ Mech. vent and surfactant prophylactics for infants <30wks

Question 21

MOST COMMON CAUSE OF NEONATAL DEATH

Answer 21

RDS

Question 22

NICU Dx’s***

Pulmonary

Bronchopulmonary Dysplasia (BPD)/Chronic Lung Disease of Infancy (CLD)

Answer 22

• BOTH result from incomplete/abnorm repair of lung tissue during neonatal pd.
• Can result from RDS

Question 23

NICU Dx’s***

Pulmonary

Meconium Aspiration Syndrome

Answer 23

• Resp distress from infant borth thru meconium strained amniotic fluid
• Leads to resp. distress and hypoxemia
• Prevention: deep suction all babies
• Tx: antibiotics

Question 24

NICU Dx’s***

Neurologic Cond’s

Answer 24

• Periventricular Leukomalacia (PVL)
• Intraventricular Hemorrhage (IVH)
• Hypoxic Ischemic Encephalopathy (HIE)
• Neonatal Seizures

Question 25

NICU Dx's\*\*\* ## Footnote **Neurologic Cond's** **Periventricular Leukomalacia (PVL)**

Answer 25

* **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**

Question 26

BRAIN INJURY MOST COMMONLY KNOWN TO CAUSE CP\*\*\*\*

Answer 26

Periventricular Leukomalacia (PVL)

Question 27

PVL causes

Answer 27

CP

Question 28

NICU Dx's\*\*\* ## Footnote **Neurologic Cond's** **Intraventricular Hemorrhage**

Answer 28

* 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**

Question 29

MOST COMMON FORM NEONATAL HEMORRHAGE

Answer 29

INTRAVENTRICULAR HEMORRHAGE (IVH)

Question 30

NICU Dx's\*\*\* **Neurologic Cond's** **Hypoxic Ischemic Encephalopathy (HIE)**

Answer 30

* **Spectrum** of neuro impairments w/ high neonatal mortality **due to lack of O2 to brain**

Question 31

NICU Dx's\*\*\* ## Footnote **Neurologic Cond's** **Neonatal Seizures**

Answer 31

* MOST FREQ. NEUROLOGICAL SIGN NOTED IN THE NICU\*\*\*\* * **Occur due to:** * **LBW** * **prematurity** * **maternal medical conds** * **HIE** * **CVA** * **Metabolic dis.** * **W/drawal** * **etc…**

Question 32

NICU Dx's\*\*\* ## Footnote **Cardiac→ Congenital Heart Defects** **\*LOOK @ CARDIOPULM PEDS LECTURE!!!**

Answer 32

* **Patent Ductus Arteriosus (PDA)** * **Pulmonary Atresia** * **Tetralogy of Fallot (TOF)** * **Coarctation of the Aorta (COA)**

Question 33

NICU Dx's\*\*\* ## Footnote **Others**

Answer 33

* Necrotizing Enterocolitis (NEC) * Retinopathy of Prematurity (ROP) * Hyperbillirubinemia * Fetal Alcohol Syndrome * Neonatal Abstinence Syndrome (NAS)

Question 34

NICU Dx's\*\*\* ## Footnote **Necrotizing Enterocolitis (NEC)**

Answer 34

* **Acute inflammatory _bowel_ condition** * **“necrosis of intestines”** * Put the words together!!! * **\*\*\*COMMON in infants \<2000g in first 6wks of life** * **Tx: IMMEDIATE medical intervent.**

Question 35

NICU Dx's\*\*\* ## Footnote **Retinopathy of Prematurity (ROP)**

Answer 35

* **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**

Question 36

NICU Dx's\*\*\* **Hyperbillirubinemia** \***Billirubin** think **Jaundice**

Answer 36

* **Physio jaundice→** excess billirubin **2\* to immature hepatic function** * **Tx: Phototherapy** * **\*Billirubin lights**

Question 37

NICU Dx's\*\*\* ## Footnote **Fetal Alcohol Syndrome (FAS)**

Answer 37

* Due to maternal subs. abuse * ==\> **Cog, cardiac, developmental, _facial_ (you know the picture from PPT) effects**

Question 38

NICU Dx's\*\*\* ## Footnote **Neonatal Abstinence Syndrome (NAS)**

Answer 38

* 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

Question 39

Pain in NICU ## Footnote **Pain MORE COMMON in _______ infants vs term infants**

Answer 39

Pre-term infants \***bc pain modulation tracts _not fully developed_ until 36wks gestation** **\*pain diff. to assess in infants**

Question 40

Be aware physiological signs of pain in infants:

Answer 40

INCd HR flushing of skin diaphoresis incd mm tone dilated pupils

Question 41

Measures to assess **Pain** in infants:

Answer 41

* Neonatal Coding System * Neonatal Infant Pain Scales * CRIES * Premature Infant Pain Profile * FLACC

Question 42

PT in NICU

Answer 42

* Extensive knowledge of neonatal pathophys., embryo development and infant behavior * Specialized didactic training

Question 43

PT in NICU ## Footnote **Interventions** **3 Main Components:**

Answer 43

1. Communication 2. Information Sharing 3. Procedural Intervents 1. **Primary role:** 1. Promote mvmt/postural control 2. Assist infant to adapt outside uterus 1. State regulation 2. Feeding support 3. Handling support for families 3. Lots of **observation/recommendation→** Developmentally supportive care

Question 44

PT **Procedural Interventions**

Answer 44

* Positioning * State regulation & Infant behaviors * Family education and coordination of care

Question 45

Sleep stages of infant

Answer 45

1. Deep Sleep\* 2. Light Sleep 3. Drowsy 4. Quiet Awake\* 5. Active Awake 6. Crying \*NOTE: **Want to intervene/interact during DEEP SLEEP (reposition, PROM) & QUIET AWAKE (feeding, contact, etc.)**

Question 46

Behavioral States \***Know signs of APPROACH vs AVOIDANCE**

Answer 46

SEE PICS

Question 47

Developmental Standardized Assessments

Answer 47

* NIDCAP→ Newborn Individualized Developmental Care and Assessment Program * **ID care strats for ea. newborn** * **TIMP** * **IDs infants @ risk for dev. delays**

Question 48

NICU Follow-Up

Answer 48

* “Follow-Up Clinic"→ do routine check ins for @ risk infants * PTs assess **gross motor dev.; can recommend Early Intervent (EI) programs**