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Pediatrics > L10: Neonatal Intensive Care Unit (NICU) > Flashcards

L10: Neonatal Intensive Care Unit (NICU) Flashcards

1
Q

Purpose of NICU

A
  • Treat infants born pre-term/with complications
    • **PRE-TERM== any birth <37wks gestation
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2
Q

LVLS of NICU

how many

A

3

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3
Q

Lvls of NICU

Lvl 1→

A
  • Lvl 1:
    • Routine/basic care to infants 35-37wks
    • Stabilization infants <35wks
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4
Q

Lvls of NICU

Lvl 2→

A
  • Lvl 2:
    • Specialty care for moderately ill infants <32wks
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5
Q

Lvls NICU

Lvl 3→

A
  • Lvl 3:
    • Advanced care for severely ill infants born <28wks
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6
Q

NICU environment

*NOTE:

A

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

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7
Q

NICU Environment:

Noise should NOT exceed _________

A

NOT exceed 45db

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8
Q

NICU

Noise & Light

Tech’s to limit noise

A
  • Cover incubator/crib w/ blanket and adding sound blocking padding to crib walls
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9
Q

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

A

bc thinness of skin of the eyelids

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

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10
Q

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

A

<32wks

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11
Q

Identifying Gestational Age

Use this score

A

New Ballard Score (NBS)

*Most widely used 20-44wks

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12
Q

New Ballard Score

Gestational age

*Most widely used 20-44wks

Components?

A
  1. Neuromotor maturity→ Posture
  2. Physical matureity→ presence of lanugo (hair)
  3. Genitalia
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13
Q

Risk factors for prematurity

Combo of _________

A

Genetic, social, environ. factors

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14
Q

Risk Factors for Prematurity

A
  • 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
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15
Q

Pre-term refers to ANY BIRTH ________ weeks gestation

A

<37 wks

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16
Q

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

A
  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
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17
Q

Avg Birthweight ===

A

<2500g

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18
Q

Large for Gestational Age (LGA)==>

A

>90th %

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19
Q

NICU Dx’s***

Pulmonary

A
  • Respiratory Distress Syndrome (RDS)
  • Bronchopulmonary Dysplasia (BPD)/Chronic Lung Disease of Infancy (CLD)
  • Meconium Aspiration Syndrome
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20
Q

NICU Dx’s***

Pulmonary

Respiratory Distress Syndrome (RDS)

A

MOST COMMON CAUSE OF NEONATAL DEATH****

  • Pulmonary immaturity/limtd surfactant
  • Tx→ Mech. vent and surfactant prophylactics for infants <30wks
21
Q

MOST COMMON CAUSE OF NEONATAL DEATH

A

RDS

22
Q

NICU Dx’s***

Pulmonary

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

A
  • BOTH result from incomplete/abnorm repair of lung tissue during neonatal pd.
  • Can result from RDS
23
Q

NICU Dx’s***

Pulmonary

Meconium Aspiration Syndrome

A
  • Resp distress from infant borth thru meconium strained amniotic fluid
  • Leads to resp. distress and hypoxemia
  • Prevention: deep suction all babies
  • Tx: antibiotics
24
Q

NICU Dx’s***

Neurologic Cond’s

A
  • Periventricular Leukomalacia (PVL)
  • Intraventricular Hemorrhage (IVH)
  • Hypoxic Ischemic Encephalopathy (HIE)
  • Neonatal Seizures
25
Q

NICU Dx’s***

Neurologic Cond’s

Periventricular Leukomalacia (PVL)

A
  • 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
26
Q

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

A

Periventricular Leukomalacia (PVL)

27
Q

PVL causes

A

CP

28
Q

NICU Dx’s***

Neurologic Cond’s

Intraventricular Hemorrhage

A
  • 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
29
Q

MOST COMMON FORM NEONATAL HEMORRHAGE

A

INTRAVENTRICULAR HEMORRHAGE (IVH)

30
Q

NICU Dx’s***

Neurologic Cond’s

Hypoxic Ischemic Encephalopathy (HIE)

A
  • Spectrum of neuro impairments w/ high neonatal mortality due to lack of O2 to brain
31
Q

NICU Dx’s***

Neurologic Cond’s

Neonatal Seizures

A
  • MOST FREQ. NEUROLOGICAL SIGN NOTED IN THE NICU****
  • Occur due to:
    • LBW
    • prematurity
    • maternal medical conds
    • HIE
    • CVA
    • Metabolic dis.
    • W/drawal
    • etc…
32
Q

NICU Dx’s***

Cardiac→ Congenital Heart Defects

*LOOK @ CARDIOPULM PEDS LECTURE!!!

A
  • Patent Ductus Arteriosus (PDA)
  • Pulmonary Atresia
  • Tetralogy of Fallot (TOF)
  • Coarctation of the Aorta (COA)
33
Q

NICU Dx’s***

Others

A
  • Necrotizing Enterocolitis (NEC)
  • Retinopathy of Prematurity (ROP)
  • Hyperbillirubinemia
  • Fetal Alcohol Syndrome
  • Neonatal Abstinence Syndrome (NAS)
34
Q

NICU Dx’s***

Necrotizing Enterocolitis (NEC)

A
  • Acute inflammatory bowel condition
    • “necrosis of intestines”
      • Put the words together!!!
  • ***COMMON in infants <2000g in first 6wks of life
  • Tx: IMMEDIATE medical intervent.
35
Q

NICU Dx’s***

Retinopathy of Prematurity (ROP)

A
  • 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
36
Q

NICU Dx’s***

Hyperbillirubinemia

*Billirubin think Jaundice

A
  • Physio jaundice→ excess billirubin 2* to immature hepatic function
  • Tx: Phototherapy
    • *Billirubin lights
37
Q

NICU Dx’s***

Fetal Alcohol Syndrome (FAS)

A
  • Due to maternal subs. abuse
  • ==> Cog, cardiac, developmental, facial (you know the picture from PPT) effects
38
Q

NICU Dx’s***

Neonatal Abstinence Syndrome (NAS)

A
  • 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
39
Q

Pain in NICU

Pain MORE COMMON in _______ infants vs term infants

A

Pre-term infants

*bc pain modulation tracts not fully developed until 36wks gestation

*pain diff. to assess in infants

40
Q

Be aware physiological signs of pain in infants:

A

INCd HR

flushing of skin

diaphoresis

incd mm tone

dilated pupils

41
Q

Measures to assess Pain in infants:

A
  • Neonatal Coding System
  • Neonatal Infant Pain Scales
  • CRIES
  • Premature Infant Pain Profile
  • FLACC
42
Q

PT in NICU

A
  • Extensive knowledge of neonatal pathophys., embryo development and infant behavior
  • Specialized didactic training
43
Q

PT in NICU

Interventions

3 Main Components:

A
  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
44
Q

PT Procedural Interventions

A
  • Positioning
  • State regulation & Infant behaviors
  • Family education and coordination of care
45
Q

Sleep stages of infant

A
  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.)

46
Q

Behavioral States

*Know signs of APPROACH vs AVOIDANCE

A

SEE PICS

47
Q

Developmental Standardized Assessments

A
  • NIDCAP→ Newborn Individualized Developmental Care and Assessment Program
    • ID care strats for ea. newborn
  • TIMP
    • IDs infants @ risk for dev. delays
48
Q

NICU Follow-Up

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

Pediatrics (27 decks)

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