NICU Flashcards
NICU
-Specialty area of OT practice
Competencies of NICU OT
Good understanding of pediatric practice
- Must be knowledgeable about medical conditions associated with prematurity and the vulnerabilities associated with neonates
- Good understanding of family needs and stressors due to NICU environment and prematurity circumstances
- Understanding of pre-term infant neuromotor and neurobehavioral development
- Must be a collaborative, competent member of NICU team
OT role in NICU
Individualized developmentally supportive care
- Promote physiologic stability, decreased stress above all
- Environmental modifications and education based on sensory processing
- Family education and collaboration training caregivers and families about calming strategies
- Neurodevelopmental intervention
- Positioning
- Splinting
- Feeding evaluation and training.
Radiant warmer
open bed with open heat source
Incubator
Clear, plastic heated box that encloses the mattress and infant
Open crib
Bassinet style bed, no external heat source provided; infant is dressed in clothes and swaddled in blankets.
oxygen
Bag and Mask ventilation
Bag attached to face mask is rhythmically squeezed to deliver positive pressure and oxygen.
Continuous positive airway pressure (CPAP)
steady stream of pressurized air given through endotracheal tube, nasopharyngeal tube, nasal prongs, or small nasal mask.
Mechanical ventilation (OXYGEN)
machine controls or assists breathing by mechanically inflating the lungs, increasing alveolar ventilation, and improving gas exchange.
Extracorporeal Membrane Oxygenation (ECMO)
Sophisticated life support system uses modified heart lung bypass to provide nearly total lung rest and minimize barotraumas (lung damage from prolonged ventilation)
Vapotherm
Respiratory therapy device attached to a nasal cannula that allows very high nasal flows of warmed and moist air.
Oxygen hood
Plastic hood that provides a flow of warm, humidified oxygen placed over infant’s head.
Nasal cannula
Humidified oxygen delivered by flexible NC with small prongs that fit into the nares.
Intrauterine Environment
- TACTILE- constant proprioceptive input; smooth, wet, comfortable, boundaries
- VESTIBULAR- maternal movements, dinural cycle, amniotic fluid creates gentle oscillating environment, flexed posture
- AUDITORY- biological sounds, muffed environmental sounds
- VISUAL- Dark; occasional red dim spectrum light
- THERMAL- constant warmth consistent temperature
Extrauterine Environment
- TACTILE- Painful and invasive; dry cool air, medical touching, some social touching
- VESTIBULAR- Flat postures, rapid position changes; influence of gravity; restraints due to equipment
- AUDITORY- Loud, non-contingent, mechanical frequent harsh intermittent impulse noise
- VISUAL-Bright lights, eyes unprotected; often no diurnal rhythm
- THERMAL- environmental temperature variations, high risk of neonatal heat loss from thin skin and lack of subcutaneous fat
Light exposure in the NICU
Fluorescent light exposure can lead to:
- Chromosomal damage
- Disruption of dinural rhythms
- Over stimulation leading to physiological distress.
Pre-30 wk infants unable to close eyelids tightly or filter light properly.
Constant lighting affects development of natural circadian rhythms
Environmental modifications for light
Environmental lighting should be:
- Dimmed especially during night
- Only use moderate lighting
- Shield infant eyes with bedside draping or phototherapy eye mask or isolate cover
- Focused lighting for procedures needing more light.
Sound in the NICU
- Constant environmental noise usually 50-90 dB (same as street traffic with light machinery)
- Noise increases arousal and can increase physiological distress.
Tactile exposure in the NICU
Frequent medical touch for procedures including ventilation, tube adjustments and suctioning.
- Increased pain response in pre-term infants -> increased physiological distress.
- Uncomfortable bedding
Environmental modification of touch in the NICU
Let infant determine schedule
Avoid unnecessary touching-bathe every other day, check vitals from monitors, suction PRN not on schedule
Speak softly to infant prior to physical handling
Swaddling during painful procedures and baths
Containment- calming strategies
The use of materials or humans to provide physical boundaries for the infant . I.e.: Z-flo fluidized positioners
Kangaroo Care- Calming
Involves skin to skin contact with parent (better for non-ventilated infants); yields increased feeding time, reduction of physiological stress, and improved attachment
Swaddling- calming
A type of containment that provides the infant deep pressure and simulation of womb positioning through the wrapping of a blanket around the baby
Infant massage- calming
A technique in which parent provides gentle tactile stimulation or prolonged placement of the hands WITH the infant (Best for children 32 wks PCA
Family education and collaboration
Stressors
- health of infant
- unfamiliar environment/technology
- financial burdens
- Transportation issues
- Return to work
family education
Vygotsky’s scaffolding method to train family to:
- Detect physiological signs of stress
- Reduce aversive sensory stimuli
- Perform calming techniques
- Position the baby therapeutically
- Provide feeding instruction and support
Standardized NICU assessments
- Naturalistic observations of newborn behavior (NONB)
- Assessment of Pre-term infant behavior
- NICU Network Neurobehaviroal Scale
- Infant behavioral assessment
- Neonatal Oral motor assessment scales
- Bayley infant toddler developmental motor assessment
evaluation and interventions
-review preemie development notes
-
intervention
- reflex testing often unnecessary with early preemies
- muscle tone- hypotonia typical for preemie, may be affected by arousal state or medication
- Therapeutic positioning (without positioning infant presents with W-posturing of arms, froglike posturing of legs, and asymmetrical head position.
Therapeutic Positioning
Plagiocephaly
Development of abnormal head shape in infants resulting from externally enforced molding surfaces (prolonged position of head towards one direction)
Therapeutic positioning
Brachycephaly
Flattening of the back of the head due to prolonged supine position
Therapeutic positioning
Scaphocephaly
Narrowing of the head along the sides due to progressive time spent with head turned to one side while in prone position (preemies lack the musculature to extend neck and freely move head so it remains in this position
therapeutic positioning
- Increase flexion positing (fetal position)
- Sidelying position supported with snuggle wraps and blanket rolls
- Sleeping position- safest sleeping position to avoid SIDS is supine, but at risk for brachycephaly
- Watch for extensor tone in neck due to trach and vent tubing- eventually work on neck flexion as these are removed.
Nesting-
Place infant in flexed position inside a concave space made by blankets and towel rolls with high, steep boundaries.
- soft, secure surface- Gel mattress to relieve pressure
- Commercial products will reduce positioning errors by different caregivers
Feeding in the NICU
-Parent education for increasing breast or bottle feeding.
Supportive positioning
Nipple selection
Oral motor stimulation for the older preemie
Complications of feeding- reflux – suck/swallow/breathe develops at 34 wks gestation
Discharge planning from the NICU
Premature infants are at risk for developmental delay and other health complications.
- Most discharge criteria include that they baby can: breath independently or that caregiver be independent with vent care, Feed well by bottle/ breast or be independent with tube placement and feedings, maintain adequate temperature and weight.
Frames of Reference used in NICU
Biomechanical Sensory processing Sensory Integration Coping NDT
