NICU Flashcards
prematurity and the NICU
complex subspecialty of pediatric PT
knowledge beyond entry level- advanced education- fellowship programs
most fragile patients that PT will treat!
CA=
chronological age
AA=
age adjusted
viability=
23-24 weeks
SGA=
small for gestational age
AGA=
average for gestational age
LGA=
larger for gestational age
gestational diabetes
LBW=
low body weight
1501-2500 g= 3.5-5.5 lbs
VLBW=
very? low body weight
1001-1500 g= 2.2-3.5 lbs
ELBW=
extreme? low body weight
<2.2 lbs
micropremies=
<800g
what is average baby weight?
~7 lbs (3.25 kg)
500g=
- 5 kg
1. 1 lb
1000g=
- 0 kg
2. 2 lbs
1500g=
- 5kg
3. 5 lbs
2500g=
- 5 kg
5. 5 lbs
what are the 5 components of APGAR scores?
heart rate resp rate muscle tone reflex irritability color
what are the APGAR scores for heart rate?
0= absent 1= 100
what are the APGAR scores for resp rate?
0= absent 1= slow and irregular 2= good, crying
what are the APGAR scores for muscle tone?
0= limp 1= some flexion and ext 2= active movement
what are the APGAR scores for reflex irritability?
0= no response 1= grimace 2= cough or sneeze
what are the APGAR scores for color?
0= blue 1= pink, blue extremities 2= pink
neonatal care began in..
1880 in France with development of the incubator
increase in survival 1988-2002 for VLBW and ELBW due to antenatal steroids, aggressive resuscitation, surfactant therapy
what are the main principles of neonatal care?
support body temp
control infection
minimal handling
special care nursing
what are the nursery levels?
level 1: basic care
level 2: specialty care
level 3: subspecialty care
what is nursery level 1?
Basic care
35-37 weeks GA
stabilize infants less than 35 weeks until transfer
what is nursery level 2?
Specialty care (moderately ill)
2a: >32 weeks
2b: mechanical ventilation for brief period
what is nursery level 3?
Subspecialty care
3a: >28 weeks, minor procedures
3b: <28 weeks, high frequency ventilation/ pedi surgical specialists
3c: ECMO and complex cardiac surgery; cardiopulm bypass
what are the 6 environmental changes from in utero to NICU?
visual auditory gravity tactile proprioception thermo-reg
what is the environmental change from utero to NICU for visual?
in utero: dim red glow
NICU: bright lights
what is the environmental change from utero to NICU for auditory?
in utero: rhythmic heart beats, respiratory sounds, muted voices
NICU: constant offensive noise-equipment alarms, voices, etc
drugs commonly used in the NICU increase risk for hearing loss
what is the environmental change from utero to NICU for gravity?
in utero: amniotic fluid= gravity eliminated, random movements
NICU: gravity makes movement into flexion difficult for hypotonic neonate
what is the environmental change from utero to NICU for tactile?
in utero: N/A
NICU: adverse tactile input from necessary medical interventions
causes sustained arousal causing a physiological toll on the child. In utero- sleeps 80% of the time vs. being on avg disturbed 23x in 24 hours– begins to respond negatively to touch b/c unable to discern medical necessity
what is the environmental change from utero to NICU for proprioception?
in utero: deep proprio input by uterine wall as moves
NICU: decreased proprio feedback
what is the environmental change from utero to NICU for thermo-reg?
in utero: well controlled
NICU: at risk for problems
premie vs. full term:
hypotonia
extremities: ext and ABD
decreased midline and flexor activity
decreased spontaneous movements
reflexes: absent, decreased or variable
medical concerns:
- respiratory issues
- cardiopulm issues
- feeding problems
- temp regulation
- BP instability
what are other medical categories associated with motor risk?
neurological
IVH: intraventricular hemorrhage
respiratory
metabolic
congenital heart disease
viral/infection
substance exposure
other
orthopedic
neurological conditions:
HIE: hypoxic ischemic encephalopathy
PVL: periventricular leukomalacia
PVHI: hemorrhagic infarct necrosis
what is HIE?
hypoxic ischemic encephalopathy: episode of asphyxia on neonate’s brain (can occur concurrently or serially)
- cerebral ischemia
- hypoxemia
interference with umbilical BF (ischemia) resultant systemic hypotension and decreased cardiac output.
and poor gas exchange (hypoxemia) from the mother’s circulation through the placenta to the fetus, recurrent apnea, or severe respiratory disease. Hypoxemia also decreases myocardium causing bradycardia and hypotension which leads to further ischemia.
after severe HIE, stupor or coma requiring mechanical vent. 12-14 hours- seizures and apnea, then out of stupor/coma and increased seizure activity. May re-enter stupor/coma state at 24-72 hours of life. moderate HIE may improve arousal level in 2-3 days and are at much less risk for mortality and longterm neuo problems than severe. Mild-asphyxia immediately before birth and usually recover well requiring minimal resuscitation. Initially lethargic then hyper alertness, irritability, exaggerated moro and DTR.
what is PVL?
periventricular leukomalacia
- symmetrical, non-hemorrhagic, bilateral lesion
- spastic diplegia
- most common
ischemic lesion to the brain of the premature infant
motor tracts involving the LEs are closest to the ventricles.
may be transient or may reduce to cystic cavities that are highly correlated with CP. SDI-because of proximity of the ventricular system of descending motor fibers that innervate the LEs (if more lateral can involve UEs also)
