NICU Flashcards
LBW
Low Birth Weight
1501-2000 g
VLBW
Very Low Birth Weight
Below 1501 g
ELBW
Extremely Low Birth Weight
Below 1000 g
AGA
Appropriate for Gestational Age
An infant whose weight at birth falls within the 10th and 90th percentiles for his or her age
SGA
Small for Gestational Age
LGA
Large for Gestational Age
G
Gravida
Number of pregnancies
P
Para
Number of outcomes
F
Full term
P
Preterm
A
Abortions
L
Living children
RDS
Respiratory Distress Syndrome
BPD
Bronchopulmonary Dysplasia
PVL
Periventricular Leukomalacia
IVH or GMIVH
(Germinal Matrix) Intraventricular Hemorrhage
HIE
Hypoxic - Ischemic Encephalopathy
NEC
Necrotizing Enterocolitis
Breakdown of intestines
ROP
Retinopathy of Prematurity
Too much O2
Not very common now
Hyperbilirubinemia
Hyper bilirubin production from the liver
Jaundice
Rh incompatibility issue
Oxyhood
No intubation, but still receiving O2
Fetal Alcohol Syndrome
Alcohol mom
Fetal Abstinence (Withdrawal) Syndrome
Methadone
Crack
Heroine
Poor sleeping
HIV-AIDS
From childbirth or breastfeeding
Six Stages in Babies
Deep sleep or quiet sleep
Light sleep or active sleep
Drowsy or semi-dozing
Alert or quiet alert
Active or active awake
Crying
Best states to bother kiddos
Alert or quiet alert
Active or active awake
Brazelton States of Arousal
During exam look at…
Range of behavior
Variety of behavior
Duration of state
Why assess?
ID impairments, neuromotor, and feeding that requires intervention
ID needs for positioning and handling
Determine how to adapt the environment to optimize development
Tests and Measures for Preterm
Dubowitz Neurological Assessment of the preterm
NIDCAP by Als
NAPI Neurobehavioral assessment for preterm infants
TIMP Test of Infant Motor Performance
Tests and Measures for Full-term
Dubowitz Neurological Assessment of the Full term
NBAS Neonatal Behavior Assessment Scale (Brazelton)
Morgan Neonatal Assessment Scale
Assessment of General Movements
Developed in EU (Vienna?)
Video tape babies as they move
They can qualify types of movements and have been able to make some dx recommendations
Oral-Motor Assessment
NOMAS Neonatal Oral-Motor Assessment Scale
NCAFS Nursing Child Assessment Feeding Scale
Goals/Objectives in NICU
Limit impairment in mm tone, ROM, postural adaptation
Improve extremity movement control
Improved regulation of motor behavior and states
These should improve motor behavior and the ability to interact with caregivers and the environment
Interventions in NICU
Environmental Modification
Positioning
Handling/massage
Sensorimotor stimulation
Extremity taping/splinting/casting
Hydrotherapy
Oral Motor Therapy
Parent Education and Support
History taking
Medical chart
Nurses
Physician staff
Prenatal history
Birth history
Frequency and severity of episodes of apnea, bradycardia, and O2 sat, as well as interventions needed
Examination
CNS, Respiratory, and GI systems
Look at baby’s initial means of getting nutrition, how it’s been tolerated, modified, regressed, and/or progressed should be understood
MEDS (seizure)
Dialogue with nursing
Observe infant at rest and during care activities
Recommend sound minimizing strategies
Parent Education
Explain behaviors of a preterm baby
Explain the course of typical development and what to expect in the future
Teach them how to read their infants and respond supportively to them
Assist parents as they parent the infants
SGA
Small for Gestational Age
Infants that weigh below the 10th percentile of published norms - can be term and pre-term
Kangaroo Care
Skin-to-skin
Supports infant physiologic and behavioral stability and maturity as well as parent-infant interaction and attachment
Involves parent holding diaper clad infant underneath his/her clothing skin-to-skin, chest-to-chest
Gained wider acceptance in US for use in NICU over past decade
Preterm Positioning
Avoid extension postures
Promote neutral head and neck
Slight chin tuck, scapular protraction to promote UE flexion and hands to midline
Use blanket rolls or commercially available devices
Prone positioning
Unsupported prone px promotes shoulder retraction, neck hyperext, truncal flattening, and hip ABD and ER
Side-lying positioning
Demonstrates decreased stress behaviors more than supine
Respiratory diaphragm is placed in gravity-eliminated plane, which lessens work of breathing
GER is decreased in left side-lying, and gastric emptying is increased in RIGHT side-lying
Supine positioning
Allows maximal observation and access to the infant by caregivers
Poses the most challenges to the infant
Does not promote calming and self-regulation
Supported supine positioning
Should be supported with rolls to promote midline symmetrical flexion with head and trunk in midline, hands near mouth and fact, and legs tucked close to the body with neutral hip position
Unique potential for WB on posterior skull
Affects cranial molding and head shapes
Risk of cranial deformations as they have softer, thinner skulls than full-term infants
In sleep state….
Serial responses to repeated light (flashlight across the eyes) and sound (a soft rattle) are used to assess the baby’s ability to filter repetitive stimuli
Provides info regarding the stability of the sleep state
Gives therapist a chance to determine the readiness for handling
Babies likely to experience rapid changes in physiological and behavioral states during routine care due to…
Metabolic instability
Incomplete development of neuromm, cardiopulmonary, and integumentary systems
Risks of routine care
Hemodynamic complications Respiratory complications Cardiac Metabolic Orthopedic Integumentary Risk of infection
Preparation to Work in NICU
Observe healthy, term infants in nursery, home, or daycare
Provide direct service to hospitalized children on physiologic monitoring equipment, supplemental O2, vents, or with augmentative feeding
Participate in NICU follow-up clinics
Complete preempted training with an experienced PT in NICU and intermediate care units (2-6 mos)
Biggest risk?
Bonding process is at risk between preterm infant and family
Problems with NICU environment
Light disrupts normal sleep wake cycles
Sound-harsh sounds increase startle, speech sounds muffled, less ability to localize sound
Medical procedures disrupt sleep
Infant learns to respond negatively to touch
Environmental Changes to NICU
Dimming lights, covering isolettes, day/night cycling of lights, not placing items on isolettes
Clustering of medical care, having specific rest periors
Nesting, kangaroo care, hammocks, put twins together
Music, clocks, mother’s clothing/smells
Environmental changes to NICU can…
Produce changes in state, behavior, weight gain, days on vent, OR days in NICU
Infants Classified by…
Weight
Gestational Age
Pathology
Clinical Assessment of Gestational Age
Most often used to determine gestational age based on external signs
Level I Nursery
Well-baby nursery
Newborns who require minimal observation of care
Warming in an isolette, phototherapy, circumcision
Located in small community hospitals
Level II Nursery
Intermediate
Step-down from a Level IIl Nursery
Intravenous medications, tube feedings, O2 support
Neonatologists and neonatal nurses
Contained in regional or community hospitals
Level III Nursery
Neonatal intensive care unit
True NICU
Provides highly specialized services
Neonatologists, fellows, specially trained nurses
Provides complex medical interventions, advanced diagnostic testing, surgery, and respiratory support
Level IV Nursery
Level III Nursery
Provides extracorporeal membrane oxygenation therapy (ECMO)
Family-Centered Care
Address the loss of the final stages of pregnancy and preparation for infant
Foster hope
Encourage the positive
Facilitate bonding between parents and babies
Competencies of a term baby
Physiologic
Sensorimotor
Affective/communication
Complex
Physiologic competencies
Include the functional maturity capability of all organ systems to allow breathing, feeding, and growing
Sensorimotor Competencies
Include rooting, sucking, grasping, clearing the airway in prone
Horizontal and vertical tracking
Affective/Communication Competencies
Include crying Self-consoling Eye contact Facial animation Eye aversion
Complex competencies
Newborn’s auditory preferences (mother’s voice)
Taste preferences (mother’s breast milk)
Visual preferences (faces)
Imitative capacities (sticking tongue out)
Preterm infant characteristics
Age of viability is 23-24 weeks
Perceived as small and unattractive
Less responsive
More difficult to calm
Cry elicits negative emotions in the caregiver
