NICU Flashcards
Cerebellar Growth
- rapid growth during late gestation (28 - 40 weeks)
- impeded by premature birth or early brain injury
- interruption in growth alters proliferation & migration
- links secondary impairment & functional disabilities in cerebellar brain injury
Principle of Sensory Interference
- introducing sensory stimuli out of sequence disrupts organizational pathways related to that sense & others that precede it
Predictable Sequence of Sensory System Development
- Skin (touch): 2.5 - 18 weeks
- Taste (smell): 12 - 14 weeks
- Audition: 18 - 36 weeks
- Movement & Position: 20 - 25 weeks
- Vision: 38 weeks - 2 years after birth
Impact of Preterm Birth
- = 25 weeks gestation have very low likelihood of surviving with little or no impairment
- near 50% extreme premise have significant neuro development disabilities on short and/or long-term follow up
Intraventricular Hemorrhage
Grade I - germinal matrix hemorrhage
- often no further complications
Grade II - small IVH with normal ventricle size
- often no further complications
Grade III - IVH with enlarged ventricles
- possible long-term brain injury (developmental delay, CP, deafness, blindness, or neurosensory impairment)
Grade IV - IVH with enlarged ventricles, into brain tissue
- possible hydrocephalus
Hypoxia Ischemic Encephalopathy (HIE)
- profound metabolic or mixed academia
- Apgar score 0-3 > 5 minutes
- neonatal neurologic sequelae
- multiple organ involvement
- total body cooling if moderate to severe HIE
Long-term Outcomes of Premies
(Demonstrated by 50% of premies)
- learning disability
- attention deficits
- motor control & coordination problems
- behavior problems
- emotional issues
- school failure
Developmental Care
- Awareness (infant, family, environment)
- Framework that supports infant neuro development
- Encompasses prevention
- Infant driven
- Structured care environment
- Collaborative
What CAN Be Changed in the NICU
- encourage kangaroo
- supportive positioning
- 2-person care
- cover incubator
- low lighting
- day/night cycling
- gently close portholes
- limiting lifting top of bed
- gentle movements with baby
- midline
- close doors
- talk softly
- involve parents
- cue-based feeding
- holding baby
- age-appropriate interaction
- protected sleep
Neuroprotective Core Measures
- healing environment
- partnering with families
- positioning & handling
- safeguarding sleep
- minimizing stress & pain
- protecting skin
- optimizing nutrition
Synactive Theory of Developmental Care
- Wiring of brain is important for the development of stability & organization of subsystems
- Core system: autonomic
- All 4 subsystems are interconnected
- Autonomic
- motor
- State organizational
- attention/interactive
- stability in 1 system promotes stability in another system
- instability in 1 system can destabilize another system
- our interactions with the baby may disturb subsystems or enhance integration
Regulatory Behaviors (help stabilize)
- hands to face/mouth
- hand clasping
- foot clasping
- holding on
- bracing feet
Behavioral Stress Signs
- eyebrow raise
- autonomic instability
- worried look
- gaze aversion
- blinking
- finger splay
- swipe/flailing
- movement away from midline
- arching
Importance of Sleep
Organized vs. Active/Disorganized Sleep
- improved executive functioning
- improved symbolic competence
- improved verbal IQ
- REM stimulates growth hormone production
Two-Person Support
- hands to face
- going where baby needs support
- offer finger to hold if baby is grasping
- never take hands off baby
- steady pressure
- cue break if baby’s saturation’s not in range
