1
Q
pH 7.22
PCO2 62
PaO2 58
HCO3 16
base excess -8
Tran’s blood gas indicates:
a. respiratory acidosis
b. mixed respiratory and metabolic acidosis
c. metabolic alkalosis
d. metabolic acidosis
e. respiratory alkalosis
A
b. mixed respiratory and metabolic acidosis
2
Q
Are babies born prematurely with GA of less than 27 weeks are usually LBW
A
Yes
3
Q
What weight is consider low birth weight?
A
less than 2500 g
4
Q
What is very low birth weight and extrmely low birth weight?
A
- very low birth weight (VLBW): birth weight <1,500 g
- extremely low birth weight (ELBW): birth weight <1,000 g
5
Q
What is the “golden hour”?
A
- The phrase “The Golden Hour” refers to the first hour of life following delivery.
6
Q
What is the goal of the golden hour?
A
- The goals of the golden hour are to provide gentle, timely, and evidence-based interventions and treatments that improve outcomes.
- Much of the literature about the golden hour focuses on communication and collaboration, which includes antenatal counseling with the family and briefing of the resuscitation team.
- While the protocols differ from hospital to hospital, after delivery the focus is on delayed cord clamping, thermoregulation, early vascular access (fluid, glucose, and antibiotic administration), and supporting respiration and family togetherness
7
Q
What are 3 things can occur because of respiratory insufficiency?
A
- Hypercapnia,
- hypoxia, and
- acidosis
8
Q
Pulmonary immaturity includes (5)?
A
These problems arise from pulmonary immaturity:
- lack of alveoli,
- lack of surfactant,
- weak muscles,
- compliant rib cage, and
- distance between alveoli and capillaries.
9
Q
What are complications from mechanical ventilation(4)?
A
The most common complications of mechanical ventilation are
- pneumothorax,
- pulmonary infection,
- bronchopulmonary dysplasia BPD
- subglottic stenosis,
- oral aversion, and
- intraventricular hemorrhage IVH
10
Q
What are 3 complications of CPAP?
A
- abdominal distention,
- septal damage, or necrosis and
- pneumothorax.
11
Q
What is the most notable risk of oxygen therapy?
A
- is retrolental fibroplasia leading to retinopathy of prematurity (ROP).
- ROP is abnormal blood vessel development in the retina of the eye that can lead to vision impairment and blindness and require laser surgery to correct or minimize the damage.
- High concentrations of inspired oxygen are also linked to development of bronchopulmonary dysplasia (BPD).
12
Q
What should be monitor to help prevent complications within respiratory system?
A
Complications within the respiratory system can be prevented or identified by careful monitoring of
- work of breathing,
- colour,
- blood gases,
- chest x-ray results,
- respiratory rate,
- air entry,
- apneas, and
- oxygen saturations.
13
Q
What is a PDA caused by (2)?
A
- by hypoxia and
- immaturity of the muscles in the ductus arteriosus, making it difficult for the duct to constrict.
14
Q
After birth what does PDA lead to (6steps)?
A
- leads to left-to-right shunting of blood,
- leading to pulmonary hyperperfusion
- leads to pulmonary edema
- interfere with adequate oxygenation and ventilation
- hypoxia and acidosis persists
- lead to inadequate perfusion
15
Q
Whats the two type hyvolemia?
A
hypovolemia can be actual or functional
16
Q
What is “actual” hypovolemia due to (vs functional hypovoemia)?
A
Actual hypovolemia is due to excess blood and/or fluid loss.
- Intrapartum hemorrhage is a common culprit.
- Postnatally, frequent sampling of blood for laboratory tests may quickly lead to hypovolemia for the extremely premature infant.
**Recall that preterm infants only have approximately 100 mL/kg of blood volume. In this case Tran has approximately 60 mL of blood.
17
Q
What is functional hypovolemia due to?
A
- Functional hypovolemia occurs due to internal fluid or blood loss, often referred to as “third spacing.”
- This type of loss may present in the form of edema, intraventricular hemorrhage, or pulmonary edema.
- is often compounded by changes in vascular tone
18
Q
In extremely premature babies, hypotension is due to what?
A
- most hypotension in extremely preterm infants is not due to hypovolemia, but myocardial dysfunction related to an immature myocardium, which leads to poor contractility and decreased cardiac output.
- Sepsis, profound hypoxia, and surgery are also common culprits of hypotension because they can lead to systemic vasodilation, impaired autoregulation, and myocardial dysfunction
19
Q
How can complications within cardiovascular system be prevented?
A
Complications within the cardiovascular system can be prevented or identified by careful monitoring of
- heart rate,
- pulse pressure,
- precordium,
- murmur,
- saturations,
- blood pressure,
- capillary refill,
- central and peripheral perfusion,
- edema, and
- urine output.
20
Q
What are the 3 layers of the skin?
A
- epidermis
- dermis
- subcutaneous tissue
21
Q
What is the blood-brain barrier function of the CNS vascular permeability?
A
- The blood–brain barrier functions to contain substances such as bilirubin and microorganisms within the vascular space, preventing these substances from damaging brain tissue.
22
Q
What are 2 consequences of underdevelopment of stratum corneum (outer layer of epidermis)?
A
- minimal control of transepidermal water losses (TEWL)
- minimal protection against toxins and infections
23
Q
Why is it easy for bilirubin and microorganisms to pass from blood into brain?
A
- The blood–brain barrier of preterm, and particularly extremely premature infants, is poorly developed.
- This makes it easy for bilirubin and microorganisms to pass from the blood into the brain.
- Once in the brain, these substances can be very damaging to brain tissue.
24
Q
What are consequences of dermal instability?
A
- tendency to become edematous due to less collagen and fewer elastin fibers
- prone to necrotic injury due to edema and alteration in blood flow and perfusion to the epidermis
25
What is a consequence for premature infant's autonomic nervous system to be immature?
- It responds unpredictably and is dominated by parasympathetic responses.
- This means that preterm infants are particularly prone to vagal stimulation and accompanying apnea and bradycardia.
- Often preterm infants respond to hypoxia with apnea instead of the expected tachypnea
26
What are 2 consequences of diminished cohesion between the epidermis and dermis?
- prone to blistering from injury
- epidermal stripping with adhesive removal
** ECG leads can cause injury to the skin and can be avoided for the first several days of life as the same information can be captured from Sp02 monitoring and arterial lines.
27
What is the consequence of preterm infants having difficulty with habituation and self-regulation?
- This means that they are unable to decrease their responses to environmental stimulation, putting them at risk for overstimulation
28
What are the consequences of skin pH?
- preterm infants have a more alkaline skin pH, which may reduce stratum corneum integrity, increasing the risk for damage.
- A more acidic pH also inhibits growth of pathogenic microorganisms.
29
What can overstimulation lead to in preterm infants (3)?
Overstimulation can result in
- sleep deprivation,
- decreased growth, and
- respiratory problems (apneas and so on).
30
What are 2 consequences of nutritional deficiencies?
- Essential fatty acids: decreased fat stores that can cause irritation/peeling of skin around the neck, perineum, and groin as well as a decrease in platelet function
- Zinc deficiency: due to low or absent zinc stores due to missed maternal transfer
31
What is the consequence of preterm infants lacking the ability to auto-regulate cerebral blood flow?
- can experience wide fluctuations in cerebral blood flow,
- leading to problems such as cerebral ischemia and intraventricular hemorrhages.
***Term infants and adults are able to maintain fairly constant cerebral blood flow despite fluctuations in systemic blood pressure.
32
What is Transepidermal Water Loss (TEWL)?
TEWL refers to water lost through the skin.
33
What does it mean for preterm infants to be poorly differentiated in terms of functions?
- means that these infants tend to respond to stimuli in very diffuse or global ways.
- For example, pain responses are often quite unspecific and generalized.
- Seizure activity is often very generalized.
34
Why is that the smaller the infant, the greater the TEWL?
- because at a lower gestational age, the percentage of body weight that is composed of fluid is greater.
- Most of this fluid is located in the extracellular fluid compartment as interstitial fluid.
35
How can complications within the CNS be prevented or identified?
careful monitoring of an
- infant’s tone,
- posture,
- activity level,
- fontanels,
- cry,
- abnormal movements,
- sleep/wake states,
- the presence of apneas and desaturations
- use of a validated pain assessment tool.
36
What 4 factors are important to assess as it can lead to further TEWL?
- ambient temperature,
- humidity,
- activity, and
- body temperature
37
How is the gastrointestinal tract in low gestational age infants (3)?
the gastrointestinal tract is not equipped to tolerate feedings.
- Gastric emptying time is often very long, leading to residual formula/EBM in the stomach.
- Peristalsis is slowed, leading to delayed stool passage, and
- the amount of GI enzymes and normal flora is decreased.
- The ability of these infants to digest and absorb fats is limited.
- Glucose tolerance is often decreased because of immature liver and pancreatic function.
- Protein intolerance may lead to metabolic acidosis.
38
What does increased permeability of premature infants skin causes (3)?
Increased permeability of a premature infant’s skin favours:
- heat dissipation and
- cutaneous-insensible water loss and
- difficulty in maintaining body temperature
39
How does Respiratory and CVS instability impact the blood flow to the GI tract (3)?
- Leaving it vulnerable to damage and necrosis,
- increasing the risk for feeding intolerance and
- necrotizing enterocolitis.
40
Where on the infant is TEWL the greatest?
abdomen
41
What puts preterm infants at risk for reflux and aspiration?
- weak or absent suck reflex,
- weak or absent cough and gag reflexes, and lax gastroesophageal sphincter mean these infants cannot nipple feed
42
What are 3 things TEWL lead to?
- oliguria,
- rapid weight loss, and
- electrolyte imbalance.
43
How can complications within the gastrointestinal system be prevented or identified?
by careful monitoring of
- feeding tolerance,
- stools, and
- abdominal assessment (distention, ropey, girth), as well as
- trophic feeds,
- use of EBM,
- oral immune therapy, and
- limiting fluctuations in oxygen saturation and BP.
44
What 2 techniques can be used to minimize TEWL?
- plastic blankets and
- high humidity in conjunction with higher ambient temperatures.
45
What is acute kidney injury (AKI)?
AKI is a sudden impairment of kidney function,
- which can lead to the inability to maintain water balance, electrolyte balance, acid–base regulation and waste product elimination
46
What are 3 reasons that makes premature infants prone to water loss?
- permeability of their skin,
- their lack of maturity,
- their large surface-to-body ratios
**increased risk for thermoregulation imbalances
47
Why are preterm infants vulnerable to acute kidney injury AKI (3)?
Preterm infants are especially vulnerable as they
- lack adequate nephrons and
- have inconsistent autoregulation and
- poor urine concentrating ability.
48
What effects will hypothermia have on infants condition (respond in 3 ways)?
- The effects of cold stress can be detected in all aspects of body functioning.
- An infant responds to cold stimulus with increased oxygen consumption, glucose utilization, and acid production.
- The prevention of cold stress is essential in protecting the infant from multisystem stress.
49
What are some risk factors for acute kidney injury AKI (4)?
Risk factors for AKI include
- sepsis,
- prematurity,
- hypoxia,
- low birth weight,
- congenital heart defects,
- ECMO, and
- renal anomalies.
50
What happens when theres disorders in glucose supply or metabolism?
can result in hypoglycemia or hyperglycemia
51
What is the major function of the kidneys?
maintain fluid and electrolyte balance
52
What are 4 adverse outcomes of hyperglycemia in infants?
- increased mortality,
- sepsis,
- vision problems, and
- intraventricular hemorrhages
**Hyperglycemia in infants occurs less frequently than hypoglycemia
53
What is overhyrdation in premature infant due to?
iatrogenic fluid overload
54
How does kidney function in premature infants put them at risk for dehydration?
- Kidney function in the extremely premature infant is impaired
- this is frequently manifested as an inability to conserve water and sodium.
55
Why is Tran, being 24 weeks gestation and ELBW, is at risk for hyperglycemia because?
a. He has limited ability to secrete insulin.
b. He is receiving dextrose via IV infusion.
c. He is not at risk for hyperglycemia, only hypoglycemia.
d. Stress and hypoxia increase hepatic glucose production.
e. Delayed onset and slow advancement of oral feeding potentially affect stimulation of insulin secretion.
f. He secretes too much insulin.
A) He has limited ability to secrete insulin.
B) He is receiving dextrose via IV infusion.
D) stress and hypoxia increase hepatic glucose production.
E) Delayed onset and slow advancement of oral feeding potentially affect stimulation of insulin secretion.
56
What are 3 potential risks of iatrogenic fluid overload dangerous to premature infants?
potentiates the risk for
- patent ductus arteriosus,
- intraventricular hemorrhage, and
- pulmonary edema
57
Tran is at risk for hypoglycemia because:
a. He secretes too much insulin.
b. In utero he receives a steady supply of glucose, which is then cut off at birth.
c. He has limited fat stores and glycogen stores.
d. The lipid in his TPN predisposes him to hypoglycemia.
e. He has higher metabolic demands.
- b. In utero he receives a steady supply of glucose, which is then cut off at birth.
- c. He has limited fat stores and glycogen stores.
- e. He has higher metabolic demands.
58
Where is most of fluid in premature infants located?
- extremely premature infants can be as much as 90% water.
- Most of this fluid is located in the extracellular fluid compartment as interstitial fluid.
- The thin skin of these infants allows this interstitial fluid to evaporate through the skin.
59
What is insulin?
- Insulin is a hormone,
- produced by the pancreas,
- which is central to regulating carbohydrate and fat metabolism in the body.
60
How can complications within cardiovascular system be prevented or identified?
by careful monitoring of
- intake and output,
- mean urine output,
- weight,
- edema,
- electrolytes,
- BUN, and CR levels.
61
How does insulin work in the body?
- Insulin causes cells in the liver, muscle, and fat tissue to take up glucose from the blood,
- storing it as glycogen inside these tissues.
62
How is the skin of extremely premature infant (5)?
- thin,
- almost transparent,
- gelatinous,
- moist
- very permeable.
63
How is insulin given to infants?
- Insulin is given by a continuous infusion and is
- titrated in response to blood sugar values
64
What is insensible water loss due to?
- due to evaporation of fluid through the skin ( which is high)
65
What are 4 side effects on insulin?
The side effects of insulin are
- hypoglycemia and
- highly variable glucose concentrations,
- which can lead to adverse neurodevelopmental outcomes, and
- hypokalaemia because excess insulin causes potassium to be shifted into the cells.
66
What 2 things can happen when insensible water loss is due to evaporation of fluid through the skin is high?
can lead to both:
- dehydration and
- cold stress,
*** both fluid and heat are lost with evaporation.
67
Why is it important that insulin is infusing in the same line as TPN?
- When infusing insulin, ensure that it is in the same line as TPN to ensure that they are infusing together;
- in other words, if the line goes interstitial or is blocked, then neither the TPN nor insulin are infusing without the other.
68
What is the most common group of congenital diseases affecting live births worldwide?
Congenital heart disease CHD
- affects 19 in 1,000 live births worldwide
69
How is extremely premature infant skin very fragile?
- the dermis is not well connected to the epidermis
***heat, tape, electrodes, and touch can damage the skin
70
When does heart defects occur during pregnancy?
- During the first six weeks of pregnancy, the heart begins to develop and starts beating.
- The aorta and pulmonary artery also begin to take shape during this time.
- This is when heart defects may occur.
71
What is the result of premature infants decreased ability to resist particles, parasites, viruses, and bacteria in an extrauterine environment?
- leaving a premature infant readily susceptible to skin infection and irritation.
72
What may play a role in heart defects in infants (3)?
exact cause of these defects is unknown, links to:
- genetics,
- certain maternal medical conditions (gestational diabetes),
- some medications and
- environmental factors, such as smoking
73
How can complications within the integumentary system be prevented and identified?
careful monitoring of
- skin integrity,
- edema, and
- minimal use of tape
- abrasive cleaners on skin.
74
What is acyanotic heart defects subdivided into?
subdivided into
- ones that shunt left to right,
- or no shunting at all.
75
What are some sources of infection antenatal (3) and postnatal (3)?
antenatal
- placental
- circulation,
- amniotic fluid,
- vaginal canal
postnatal
- umbilicus,
- respiratory tract,
- gut,
- IV sites,
- surgical wounds).
76
What are 3 acyanotic heart defects that are left-to-right shunting?
- Ventricular Septal Defect (VSD)
- Atrial Septal Defect (ASD)
- Atrioventricular Septal Defect(AVSD)/Endocardial Cushion Defect
77
How does extensive use of broad-spectrum antibiotics place infant at risk?
- at risk for bacterial super infections and/or fungal infections such as candida albicans
78
What is Ventricular Septal Defect (VSD)?
- a common heart defect, in which a hole is present between the left and right ventricles.
- This defect allows the blood to pass from the left to the right side of the heart.
- The oxygen-rich blood will then get pumped back to the lungs instead of out to the body, eventually leading to pulmonary edema and right-sided heart failure in larger defects
79
How does the use of total parenteral nutrition put infant at risk for infection?
high glucose concentration makes these fluids an excellent culture medium
80
What are some symptoms of Ventricular Septal Defect (VSD)?
- fatigue,
- edema,
- dusky colour,
- weak pulse,
- bounding heart,
- increased work of breathing (WOB),
- irritability,
- pulmonary edema and
- hypertension,
- tachypnea,
- arrhythmias,
- murmur,
- shock,
- poor feeding, and
- slow weight gain
81
How can complications within the immune system be prevented or identified?
careful monitoring of
- blood work results (CBC, cultures, CRP),
- temperature,VS,
- limiting invasive procedures,
- careful management of central lines,
- encouraging skin-to-skin contact, and
- impeccable hand washing.
82
What is Atrial Septal Defect (ASD)?
- ASD is a hole between the left and right atria.
- Depending on co-morbidities and other cardiac anomalies, an ASD can cause no problems or can lead to right-sided heart failure, pulmonary hypertension, and arrhythmias.
- Some neonates with an ASD and other cardiac defects may depend on the patency of the ASD to ensure mixing of oxygenated and deoxygenated blood occur, until the cardiac condition can be repaired.
83
How are preterm infants at risk for developing hyperbilirubinemia (5)?
- due to higher circulating red blood cell volume,
- less developed hepatic enzymes,
- less ability to feed,
- decreased blood supply to the liver, and
- bacteria flora that is not well established
84
What symptoms can Atrial Septal Defect (ASD) lead to?
ASD can result in
- fatigue,
- edema,
- dusky colour,
- weak pulse,
- bounding heart,
- pulmonary edema and
- hypertension,
- arrhythmias,
- murmur,
- shock,
- tachypnea,
- increased oxygenation needs,
- increased WOB,
- irritability,
- poor feeding,
- slow weight gain, and
—> eventually right-sided heart failure.
85
What can Hyperbilirubinemia lead to?
- bilirubin encephalopathy (kernicterus)
- when unconjugated bilirubin passes through the blood–brain barrier —> causing damage to the brain.
86
What is Atrioventricular Septal Defect(AVSD)/Endocardial Cushion Defect?
- Atrioventricular septal defect (AVSD) is characterized by a large hole in the centre of the heart, located in the endocardial cushion, allowing blood to freely flow among all four chambers.
- A left-to-right shunt through the atrial and ventricular chambers is present.
- Mitral and tricuspid valves are also altered, resulting in a single common valve for both sides of the heart
**occurs in approximately 70% of infants born with trisomy 21
87
What makes preterm infants at higher risk for hypothermia and cold stress / What can increase the risk of cold stress (5)?
- due to less white and brown fat stores,
- thin skin,
- higher surface area in relation to body weight,
- inefficient ability to generate heat, and
- immature compensatory mechanisms to prevent heat loss
- when insensible water loss due to evaporation of fluid through the skin is high
- surface area to body weight ratio is very high
- decreased subcutaneous fat
88
Which acyanotic heart defects is the one without shunting?
Aortic Valve Stenosis AVS
89
What are the three layers of the skin?
- epidermis
- dermis
- subcutaneous tissue
90
What is Aortic Valve Stenosis
- characterized by obstruction of circulation from the left ventricle to the aorta, impacting systemic perfusion.
**occurs in approximately 3%–6% of infants with CHD, and males are affected more often than females
91
What are the symptoms of Aortic Valve Stenosis (4)?
Symptoms of aortic valve stenosis are
- poor weight gain,
- murmur,
- fatigue,
- increased WOB,
- bounding heart,
- arrhythmias,
- tachypnea,
- dusky colour,
- irritability, and
- shock.
92
How does cyanotic heart defects occur?
- occur as a result of deoxygenated blood bypassing the lungs and entering into the systemic circulation, causing the neonate to be cyanotic.
**Cyanotic heart defects account for approximately 25% of all CHDs.
93
What are 11 types of cyanotic heart defects?
- Coarctation of the Aorta
- Pulmonary Atresia/Stenosis
- Stenotic Pulmonary Valve
- Tetralogy of Fallot
- Truncus Arteriosus
- Transposition of the Great Arteries (TGA)
- Ebstein’s Anomaly
- Total Anomalous Pulmonary Venous Return (TAPVR)
- Tricuspid Atresia
- Interrupted Aortic Arch
- Hypoplastic Left Heart Syndrome (HLHS)
94
What is Congestive Heart Failure (CHF)?
- condition in which the “blood supply to the body is insufficient to meet the metabolic requirements of the organs”
95
When Congestive Heart Failure (CHF) signs and symptoms showing, it means hearts unable to?
CHF is a set of signs and symptoms related to the heart’s inability
- to adequately dispose of venous return,
- to provide sufficient cardiac output/systemic perfusion to meet the body’s metabolic demands,
- or a combination of the two
96
How does Congestive Heart Failure (CHF) effects on the already vulnerable newborn?
- When the right ventricle is unable to pump blood into the pulmonary artery, less blood is oxygenated by the lungs, there is increased pressure in the right atrium and systemic venous circulation, and edema occurs in the extremities and viscera.
- When the left ventricle is unable to pump blood into the systemic circulation, there is increased pressure in the left atrium and pulmonary veins.
- The lungs therefore become congested with blood, causing elevated pulmonary pressures and pulmonary edema.
97
What are 4 end effects of congestive heart failure CHF include?
- decreased cardiac output,
- decreased renal perfusion,
- systemic venous engorgement,
- pulmonary venous engorgement
98
What physical assessment may indicate congenital heart defect CHD (4)?
- RR: respiratory rate >60 without signs of resp distress (tachypnea)
- HR: bradycarida <70, tachycardia >180, murmurs, irregular heart sounds/ heart beats
- BP: best practice is to do a four-limb BP, If arm BP is more than 15 mmHg higher than the leg BP or the right arm BP is significantly higher than the left arm BP
- colour and perfusion: look at capillary refill time centrally and peripherally
- enlarged liver: enlarged liver greater than 3 cm below the right costal margin, Active precordium
- urine output: Poor cardiac output leads to decreased renal perfusion, low urine output, elevated BUN and creatinine, and low GFR.
- echo: heart structures are assessed, how the direction of blood flow through shunts
- CXray: assess the size and location of the heart and pulmonary edema or other lung pathology
99
What does an echocardiogram ECHO show?
An echo also will:
- show direction of blood flow through shunts such as a PDA and PFO,
- giving information on pressure gradients between the pulmonary and systemic system.
100
How is Prostaglandin E1 (PGE1) administered?
- Prostaglandin E1 is administered intravenously, ideally through a central line,
- in order to maintain patency of the ductus arteriosus when these cardiac conditions occur
101
What is Interrupted Aortic Arch?
There is complete discontinuity of the proximal and distal portions of the aortic arch.
102
What is Atrioventricular Septal Defect AVSD?
The heart has a large hole in the centre that allows blood to freely flow among all four chambers.
103
What is Coarctation of the Aorta
The heart has a narrowing of the aorta, most commonly near the aortic arch
104
What is Hypoplastic Left Heart Syndrome?
- All of the structures of the left side of the heart are severely underdeveloped.
- The mitral and aortic valves are either completely atretic (closed) or very small.
- The left ventricle itself is tiny, and the first part of the aorta is very small.
105
What is Transposition of the Great Arteries?
- The aorta arises from the right ventricle and the pulmonary artery arises from the left ventricle.
- The two sides of the heart act as separate “parallel circulation” systems, where the right side of the heart re-circulates deoxygenated blood back to the body and the left side of the hear re-circulates oxygenated blood back to the lungs.
106
What is Total Anomalous Pulmonary Venous Return?
- This is a rare condition in which the pulmonary veins do not connect normally to the left atrium.
- Instead, the pulmonary veins drain into the right atrium by way of an abnormal connection.
- Pulmonary venous return circulates through the left atrium through a left-to-right shunt across the foramen ovale or atrial septal defect.
107
What is Tetralogy of Fallot?
Four anomalies:
- a large ventricular septal defect (VSD),
- right ventricular hypertrophy,
- right ventricular outflow tract obstruction (pulmonary stenosis), and
- overriding aorta
108
What is Ventricular Septal Defect VSD?
- A hole is present between the left and right ventricles.
- This defect allows the blood to pass from the left to the right side of the heart.
109
What is patent ductus arteriosus (PDA)?
- The ductus arteriosus is a normal pathway in fetal circulation allowing blood to bypass the lungs (right-to-left shunt).
- After birth, because of decreased pulmonary vascular resistance and increased systemic vascular resistance, the blood flow through the PDA is predominantly aorta to pulmonary artery (left-to-right shunt).
110
What happens to the ductus arteriosus DA in presence of hypoxia?
- In the presence of hypoxia, the ductus arteriosus remains patent, which, in turn, leads to left-to-right shunting of blood, causing pulmonary hyperperfusion.
- Pulmonary hyperperfusion, combined with an ELBW infant’s increased vascular permeability, leads to pulmonary edema.
- Pulmonary edema can significantly interfere with adequate oxygenation and ventilation
- As a result, hypoxia and acidosis persist, which can lead to inadequate perfusion of vital organs.
- Anaerobic metabolism, which results from hypoxia and acidosis, is further perpetuated by poor perfusion to vital organs.
111
What is “Infant medical trauma in the NICU” (IMTN) ?
- to describe the infants experience in the NICU
- Infant medical trauma in the NICU is defined as, “the intertwined and cumulative early life experiences of stress, parental separation, and pain”
- IMTN model considers that the individual’s genetic susceptibility plays a role in their ability to cope, but points out that this is not modifiable
- what is modifiable is the infants experience if care in the NICU
***up to us caregivers to recognize pain, stress and parental separation are traumatic and play role in determining health outcomes of preterm infants
- we must modify and change their environment and experience of care
112
What is trauma-informed care?
- is a concept widely used to describe an approach to care that recognizes that traumatic events can lead to long-term physical and psychological effects.
- The term age-appropriate care was introduced in order to assist caregivers in recognizing that patients’ needs are unique at each developmental stage and change over time, requiring care that is adaptive.
113
What is trauma-informed age-appropriate care in the NICU aims to reduce?
- aims to reduce the adverse effects associated with the trauma experienced by infants in the NICU
- NICU environment infant exposed to maternal separation, pain, stress, isolation, sleep deprivation, anxiety, fear
- can be traumatic and contribute to significant and permanent psychological, physiological, emotional damage
114
What are the 5 core measure for developmentally supportive care in the NICU?
- pain and Stress Assessment and Management
- Family-Centred Care
- Protected Sleep
- The Healing Environment
- Age-Appropriate Activities of Daily Living (ADLs)
115
What is Pain and Stress Assessment and Management of the 5 core measures?
The research is very clear that unmanaged pain and stress lead to negative and potentially life-long neurodevelopmental consequences.
- Infants who are exposed to repeated or prolonged pain have been shown to have poor cognition, motor function, lower IQs, and impaired brain growth and function (Eliades, 2018).
- Pain assessment tools should be implemented to monitor and document pain, and strategies to decrease pain such as skin-to-skin contact, facilitated tucking, swaddling, and sucrose administration should be used when appropriate.
116
What is family-centred care of the 5 core measures?
A trauma-informed approach to family-centred care in the NICU is a commitment to
- supporting families in crisis,
- protecting infant–parent attachment, and
- supporting parental-role development to foster short- and long-term family unity.
117
What is protected sleep of the 5 cores meausres?
Protected sleep as a core measure incorporates assessing sleep–wake states, supporting sleep, and educating families about the importance of sleep.
- Well-organized sleep is associated with improved cognitive and psychomotor development as well as stress reduction, increased immune function, improved growth, stable oxygenation, and autonomic stability.
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What is the The Healing Environment of the 5 core measures?
Mary Coughlin (2014) defines a healing environment as “a soothing, spacious, and aesthetically pleasing environment conducive to rest, healing and recovery.”
- The healing environment also includes the infant’s sensory environment (tactile, vestibular, gustatory, olfactory, auditory, and visual systems), as well as a collaborative healthcare team.
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What is Age-Appropriate Activities of Daily Living (ADLs) of the 5 cores measures?
In the NICU, ADLs refer to everyday tasks such as bathing, feeding, postural support skin care, and diapering. These tasks are especially important in infants because it is also their initial contact with parents and caregivers and teaches the infant about trust, caring, compassion, and social interaction. If these experiences are unpleasant, stressful, or painful, it sets the stage to jeopardize future behaviour and development.
In the NICU we have the special responsibility of caring for infants and their families during very critical and sensitive periods of development. The care we provide or do not provide has the potential to impact the future outcomes of our tiny patients. Skin-to-skin contact (SSC) of infants with their parent or other caregiver is a nursing intervention that provides significant benefits and can mitigate the negative consequences of the infant’s traumatic experiences in the NICU. SSC improves attachment and lactation, supports sleep, decreases stress and pain, improves physiological stability, and improves neurologic outcomes. There is extensive data on the benefits of SCC in the literature, even in extremely preterm, low birth weight, and mechanically ventilated infants, although there may be times when an infant is too critically ill or unstable to experience SSC. In these cases, it’s important to have clear, evidence-based eligibility criteria and identify when the infant becomes stable enough to meet the criteria (this may vary unit to unit) (Eliades, 2018).
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What are some interventions to maintain normothermia?
- delivery room: increased room temperature,
- dcc and skin to skin
- radiant warmers
- caps/hats
- plastic bag and wrap
- exothermic mattress
- humidified and heated gases
- combination of interventions
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What are some signs of a PDA?
- widen pulse pressure
- active precordium
- murmur
- bounding pulses
- labile saturations
- cyanosis
- trouble feeding
**diagnosed with ECHO
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What can MODS be triggered by?
- severe hypoixa (caitlyn)
- sepsis (mai)
- surgery
- extreme prematurity (tran at 24weeks GA)
- perinatal HIE (max)
NS7920
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