Neonatal Complications Flashcards
1
Q
APGAR Score- Predictive?
A
- Lower APGAR score does not mean the child will have long lasting or long term health problems.
- It is a score that “follows” you always. It may give the pediatric therapist a window into how life outside the womb began!
2
Q
Perinatal Care Levels
A
-
Level I: Well Baby Nursery
- “feed and grow” in small community hospitals
- Stabilize ill newborns until transfer to higher level care
-
Level II: Special Care Nursery
- physiologic immaturity and moderate illness in infants ≥32
- weeks and 1500 grams, mechanical ventilation for <24 hours
- Convalescence after intensive care
- Stabilize infants < 32 weeks until transfer to NICU
-
Level III: NICU
- Provide sustained life support and comprehensive care for
- infants born ≤ 32 weeks and 1500 grams, mechanical vent.
- full range of adv. imaging, peds specialists readily available
-
Level IV: Regional NICU
- located in institution where surgical repair of complex conditions
- provided and all peds specialists on site
- Facilitate transport
3
Q
Asphyxia
A
- Results from inadequate oxygen and carbon dioxide exchange
- 1-8/1000 live births
- 60% of VLBW infants
- Associated with PVH/IVH in preemies and HIE in term infants
- Causes hypoxic-ischemic encephalopathy (HIE)
- Hypoxemia: decreased arterial oxygen concentration – can cause bradycardia which causes ischemia(decrease amt of oxygen circulating in blood)
- Ischemia: decreased blood flow (glucose) to brain due to systemic hypotension and decreased cardiac output (decrease in blood flow able to perfuse the brain)
4
Q
HIE
A
- HIE causes (leads to):
- Cognitive impairment
- Muscle tone abnormalities
- Seizure disorder
- Classification of severity
- 1.Mild
- 2.Moderate
- 3.Severe
5
Q
Mild HIE
A
- Mild HIE: infants require resuscitation
- Irritable
- Jittery
- Normal muscle tone
- No long term neurological problems
6
Q
Moderate HIE
A
-
Moderate HIE: infants require resuscitation and need short term assistance with respiration
- Lethargy
- Feeding problems
- Seizures
- At risk for developmental delay
- Need PT eval
7
Q
Severe HIE
A
-
Severe HIE: infants require resuscitation and prolonged mechanical ventilation
- Severe hypotonia
- Decreased movement
- Seizures
- Majority have developmental delay
- May have permanent organ damage
- May cause PVL in premature infants or watershed infarcts in term infants
8
Q
Periventricular Leukomalacia
(PVL)
A
- Decreased cerebral blood flow in premature infants results in PVL
- Bleeding into and around ventricles (white matter) that may form cystic cavities
- Associated with cognitive and visual impairment
- Associated with spastic diplegia cerebral palsy {leading known cause of CP}
- Often associated with IVH
9
Q
Intraventricular Hemorrhage
(IVH)
A
- Bleeding into ventricles
- Most occur within 48 hours after birth (related to fragility of germinal matrix)
- Most common in premature infants (<32 weeks GA)
- Occurs in 45% of preemies weighing 500-750 grams and in 20% of those <1500g
- The lower the birth weight and the more complications, the greater the risk of IVH
- At increased risk if born with
- unstable respiratory status
- breech presentation
- difficult delivery
- Swings in blood pressure cause ischemia that causes IVH
- Detectable with cranial ultrasound through fontanelles
- Neurologic outcome correlated to severity of IVH
10
Q
Grades of IVH
A
I: isolated germinal matrix hemorrhage
II: IVH in only 10-15% of area and no enlargement of ventricles
III: IVH in >50% of area with dilated ventricles
IV: IVH with dilation and spread into the periventricular white matter
***
- Grades I and II:* minimal risk for long term neuro deficits
- Grades III and IV:* significant risk for long-term neuro deficits including hydrocephalus (requiring shunt), CP, cognitive impairment
11
Q
IVH Signs & Symptoms
A
- Changes in level of consciousness
- Changes in muscle tone
- Changes in movement
- Changes in respiratory function
- Changes in eye movement
TO
- Stupor à coma
- Respiratory distress à apnea
- Seizures
- Decerebrate posturing
- Flaccid quadriplegia
12
Q
PVL & IVH
A
- Vergani et al’s 2004 study indicates that spontaneous prematurity and GA predict up to 2/3s of PVL & IVH
- PVL causes greater degree of developmental delay than IVH
- PVL believed to occur due to too little cerebral blood flow (ischemia) vs too much cerebral blood flow (high BP) with IVH
13
Q
Preeclampsia:
A
- maternal condition 20-40 weeks gestation and 1 week post-partum that results in development of maternal hypertension or edema; can lead to eclampsia
14
Q
Eclampsia:
A
- maternal condition arising from uncontrolled or undetected preeclampsia resulting in a stroke, coma, or convulsion
15
Q
ECMO:
A
- extracorporeal membrane oxygenation; used in infants or young children who have very poor cardiopulmonary status – buy time for healing or transplant
16
Q
Meconium aspiration
A
- meconium (1st stool) passed in utero and ingested by infant with 1st breath
- Causes airway obstruction and results in respiratory distress syndrome
17
Q
Respiratory Distress Syndrome
A
- RDS also called hyaline membrane disease (HMD)
- Most common single cause of death and illness in preemies (50-60% if <29 wks)
- Results from insufficient surfactant in preemies
- Surfactant develops >35 (32) weeks GA (corticosteroids induce surfactant synthesis to help ready lungs for birth)
- Sufficient levels of surfactant at 37-38 weeks GA
18
Q
Clinical signs of RDS
A
- Grunting respirations
- Retractions
- Nasal flaring
- cyanosis
- If persists for several months, can result in bronchopulmonary dysplasia (BPD)
19
Q
bronchopulmonary dysplasia (BPD)
A
- Lower gestational age
- Mechanical ventilation still on day 7 (lung injury due to mechanical injury)
- Over-reactive airways
- Lung fluid retention
- Oxygenation defect
20
Q
BPD characterized by…
A
- Destruction of cilia in respiratory tract
- Necrosis of respiratory epithelial cells
- Pulmonary fibrosis occurs due to scar formation from healing
***Often associated with neurological deficits due to impaired oxygenation
21
Q
Chronic lung disease (CLD)
A
- Believed to occur due to
- Barotrauma associated with mechanical ventilation
- Elevated concentrations of oxygen
- Endotracheal tube intubation
22
Q
Retinopathy of Prematurity
A
- ROP occurs in preemies due to incomplete growth of retinal blood vessels after birth→hypoxia→ growth of new blood vessels that are fragile and can leak→scar retina→detach retina
- More common in LBW infants, lower GA, and BPD
- Graded from I-V (mildest-most severe)
23
Q
ROP treatment
A
- May be treated with cryotherapy or laser therapy to arrest progression
- May result in
- Nearsightedness
- Strabismus
- Scarring of retina
- Retinal detachment
- Cortical visual impairment
- Blindness
24
Q
Gastroesophageal Reflux
A
- GER or GER(D)?
- relaxation of lower esophageal sphincter
- Elevation of infant to at least 30 degrees for at least 30 minutes after a feed
- Left side-lying effective
25
Hyperbilirubinemia
* Definition: excessive amount of bilirubin in blood
* Bilirubin is byproduct of hemoglobin in red blood cells (excessive due to pregnancy)
* Physiologic jaundice – treated with UV
* Seen in preemies with immature hepatic function
* If untreated, can result in kernicterus that causes brain damage to basal ganglia, etc. that causes athetosis
26
Necrotizing Entercolitis (NEC)
* Pathologic condition – acute inflammatory disease of the bowel
* Occurs in 1st 6 weeks post-partum in infants who weigh \<2000 grams
* Occurs in infants who have asphyxia, hypoxia, respiratory distress; impaired blood flow to intestineàmucosal cell deathàinvasion of gas-forming bacteria
27
NEC Signs & Symptoms
* Vomiting
* Abdominal distension
* Increased gastric ascites
* Bloody stools
* No stools
* Lethargy
* Decreased urine output
* Respiratory alterations
