Neonatal Intensive Care Unit

Question 1

Prematurity

Answer 1

preterm birth is defined as anything before 37 weeks

Late preterm: 34-36 weeks
Moderately preterm: 32-34 weeks
Very Preterm: less than 32 weeks
Extremely preterm: at or before 25 weeks

Question 2

Different ages for a preterm baby

Answer 2

Gestational age: age from conception to birth

Chronological age: age since birth. Birthdays are celebrations of this.

Corrected age: age the baby would be if they had been born on their due date (take chronological age and subtract number of weeks baby was born prematurely (40 weeks-GA)

Question 3

How long do you need to correct age for a preterm baby

Answer 3

Until baby is two or three years old - this is the time when most children will catch up to their peers developmentally

Question 4

Apnea of Prematurity (AOP)

Answer 4

breathing has stopped for more than 20 seconds; it can happen to full-term babies but is more common in preterm. The more premature the baby, the greater the chances that apnea will occur.

Question 5

A’s and B’s

Answer 5

abbreviation referring to episodes of apnea and bradycardia

Question 6

Bronchopulmonary dysplasia (BPD)

Answer 6

form of chronic lung disease that develops in preterm neonates treated with oxygen and positive-pressure ventilation; causes long-term breathing problems; no cure, but can be managed.

Question 7

Central line (catheter)

Answer 7

thin, flexible tube placed in a larger vein or artery to deliver medications or necessary fluids and nutrients to the body

• Broviac Catheters: placed in the upper chest and tunnel under the skin to enter the vena cava
• PICC line (percutaneously inserted central catheters): usually threaded through a vein in the arm to the vena cava.
• Umbilical venous and umbilical artery catheters: inserted into the vein or artery in the umbilical stump

Question 8

CPAP- Continuous positive airway pressure

Answer 8

a form of ventilator assistance that helps to keep the baby’s lungs properly expanded. Does not breathe for the baby but allows the baby to breathe (into a wind)

Question 9

Gavage Feedings

Answer 9

Feedings are delivered by a small plastic tube placed through the nose or mouth and down into the stomach when the baby is too weak or too premature to suck and swallow

Question 10

heel stick

Answer 10

a quick prick of the heel with a sterile instrument to obtain small blood samples for tests

Question 11

Intraventricular hemorrhage (IVH)

Answer 11

bleeding inside or around the ventricles in the brain; most common in premature babies. 4 grades of IVH

Grade 1: bleeding occurs just in a small area of the ventricles
Grade 2: bleeding also occurs inside the ventricles
Grade 3: Ventricles are enlarged by the blood
Grade 4: bleeding occurs in the brain tissues around the ventricles

*Grades 1 and 2 are most common- often no other complications; grades 3 and 4 may result in long-term brain injury to the baby.

Question 12

Meconium

Answer 12

The first bowel movements that a baby has which are thick, sticky, and dark green to black color

Question 13

Meconium aspiration

Answer 13

the inhalation of meconium into the lungs; may causes problems with breathing (meconium aspiration syndrome- MAS)

Question 14

Necrotizing enterocolitis (NEC)

Answer 14

disease of the GI tract in preemies that results in inflammation and bacterial invasion of the bowel wall.

Question 15

Oxyhood (O2 hood)

Answer 15

A clear plastic hood placed over baby’s head through which oxygen is given

Question 16

Patent ductus arteriosus (PDA)

Answer 16

heart defect found in the days or weeks after birth; ductus arteriosus is a normal part of fetal blood circulation before a baby is born. its an extra blood vessel that connects 2 arteries: pulmonary artery and the aorta; before birth, the ductus arteriosus lets the blood bypass the lungs because baby gets oxygen from the mother.

Question 17

Peak inspiratory pressure (PIP)

Answer 17

the highest pressure that is delivered to the baby by the ventilator during a forced breath

Question 18

Peripherally inserted central line (PICC)

Answer 18

inserted through a vein and then advanced through increasingly larger veins towards the heart. Used when IV therapy, antibiotics, or nutrition are administered for a long period of time

Question 19

PKU

Answer 19

A rare disorder in which one of the amino acids cannot be handled normally by the baby, leading to elevated levels in the blood; babies with PKU require a special diet. All babies are routinely tested for PKU, as well as several other disorders before going home from the nursery. This test is required by law.

Question 20

Pneumomediastinum

Answer 20

Air leakage from the normal passageways of the lung into the space surrounding the heart inside the chest. Usually harmless, but is often associated with a pneumothorax, which can be life-threatening.

Question 21

Positive end-expiratory pressure

Answer 21

The lowest pressure that is delivered by the ventilator to the baby between forced breaths

Question 22

Respiratory distress syndrome (RDS)

Answer 22

This is caused by pulmonary surfactant deficiency in the lungs of neonates, most commonly those born at < 37 weeks gestation. Risk increases with the degree of prematurity. Symptoms and signs include grunting respirations, use of accessory muscles, and nasal flaring appearing soon after birth

Question 23

Retinopathy of prematurity (ROP)

Answer 23

A disease that affects immature vasculature in the eyes of premature babies. Can be mild or aggressive with new blood vessel formation and progress to retinal detachment and blindness.

risk factors: birth before 32 weeks gestations, especially before 30 weeks, and birth weight of less than 1500 g.

Possible risk factors include supplemental oxygen, hypoxemia, hypercarbia, concurrent illness

Question 24

Warmer

Answer 24

Also known as a radiant warner, an open bed allows maximum access to a sick or newly born infant. Radiant heaters above the bed keep the baby warm

Question 25

TPN or total parenteral nutrition

Answer 25

A type of IV fluid that provides total nutrition to someone who cannot take any nourishment by mouth. TPM is nutrition outside of the digestive system. TPM contains sugars, electrolytes, vitamins, and proteins and can supply all of the nutrients that the body needs.

Question 26

OT’s role and goals of intervention #1

Answer 26

Goal: adapting and modifying the stimuli that the premature or newborn baby is exposed to, and providing the appropriate stimuli and guidance needed to encourage the development of sensory modulation.

Examples:
- dimming lighting/covering incubator
- providing the neonate with boundaries (cocooning)
- Giving infants the opportunity to explore hands to face and mouth
- opportunities for infants to smell mother’s milk
- suck on a pacifier for self-regulation

Question 27

OT’s role and goals of intervention #2

Answer 27

Promoting oral feeding

Examples: Skin to skin with mom and opportunities to practice latching at the breast; provide external stability for baby by supporting their chin or cheeks (sucking pads) to aid feeding; assist the pacing of the feed (remove nipple slightly to prompt the infant to breathe

Question 28

OT’s role and goals of intervention #3

Answer 28

Goal: maintaining adaptive positions that support the infant’s development, including methods of handling and positioning

Examples: promote a flexed posture and facilitate hands to midline- the infant would normally be in physiological flexion if born at full-term; swaddling; side-lying

Question 29

OT’s role and goals of intervention #4

Answer 29

Goal: guiding parents to be actively involved in the day-to-day care of their premature or newborn baby

Examples: kangaroo care (method of holding a baby that involves skin-to-skin contact. Baby is naked except for a diaper and a piece of cloth covering his or her back; baby is placed in an upright position against a parent’s bare chest.

Question 30

Feeding in the NICU

Answer 30

• infant should be at least 32-34 weeks gestation before oral feeds can be introduced, depending on their clinical status
• Coordination of swallowing with sucking and breathing reflects the infant’s skill at managing fluid while adequately protecting their airway. they learn to swallow efficiently as they mature.
• Coordinated swallowing includes matching sucking pressure and burst length with efficient swallowing and also completing swallowing before initiating the next breath.

Question 31

oral-motor and feeding assessment

Answer 31

Goal: infant maintains a smooth, rhythmic sucking pattern throughout the feeding, and physiologic stability

Steps:
1. observe if infant opens mouth promptly when rooting reflex elicited
2. evaluate: palate, tongue (able to protrude beyond lips and able to cup nipple), lip closure (good seal around nipple/soother/examiner’s gloved finger), sucking (strong, sustained and rhythmical), safety to swallow liquid needs to be assessed (introduce small amount of milk, if no concerns about swallowing, then proceed with oral feed.
3. determine ability to coordinate sucking with swallowing and breathing (SSB).
4. once feeding is under way, establish ability to maintain a smooth, rhythmic pattern of sucking. A well-coordinated SSB is typically an ability to engage in long sucking bursts (7-10 sucks) without demonstrating behavioral stress signs or an adverse cardiorespiratory response.
5. The ability to maintain physiologic stability is vital and can typically be established in the first 30 seconds into feeding; O2 saturation is stable, and behavioral stress cues are absent.

Question 32

Signs of stress in the NICU

Answer 32

• using the stop sign by extending upper limb and splaying fingers
• arching their back
• frowning or scowling
• spreading their fingers and toes out
• Gaze aversion
• excessive hiccups and sneezes

Question 33

Optimizing feeding position

Answer 33

• feeding position: baby in “football hold”, semi-upright position
• Bottle and nipple type: change shape/flow of the nipple
• Consistency and/or temperature of mild (thicken milk, cold liquids
• Pacing: allows sufficient opportunity and time to breathe during feeding by interrupting the flow. For feeding-induced apnea, stop flow after 2-3 sucks

Question 34

reflux management

Answer 34

• very common among pre-term infants and the presence of NG or OG tube through the gastroesophageal junction can exacerbate it.

Strategies to control reflux:
- positioning: inclined surface so head is higher than body
- Thickening milk which creates a more solid bolus and slows transit time
- Do not typically consider thickening as an option until infant is 42-44 weeks
- smaller feeds, more frequently.