NICU considerations Flashcards by Claire Freeman

Signs of stress in an infant

Skin: pale, cyanotic, gray, flushed
Eyes: glassy, gaze aversion, staring
Gasping for air
Grimacing, fussing, irregular breathing
fluctuating muscle tone (flaccidity or hyper-tonicity)
Frantic movements
*table 4.3, pg 112 in book*

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Minimizing stress in NICU

Decrease noise/light
Minimize handling
Protect sleep states
Help parents understand behavioral cues
Promote relationship-based care giving

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Provide family-centered care by:

Facilitate bonding process
Reflect family’s and child’s strengths
Use baby’s name
Provide info that is consistent and sensitive

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Preterm is classified as:

37 weeks or before

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Characteristics of preterm infant compared to full term

Hypotonia
Decreased flexor tone
Decreased extension and head control
Increased ROM
Increased reactivity and startle response
Former pre-terms may also demonstrate toe walking

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Evolution of Tone, Reflexes, and Musculoskeletal development

Proceeds in orderly, sequential pattern: LE to UE, distal to proximal
20-26 wks: many changes quickly
By 32 wks: development slows, looks more like term infant

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4 sensory components of tactile system:

Touch
Temperature
Pain
Proprioception

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Tactile System at 7 wks

pain receptors first appear around mouth

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Tactile System at 22 wks

pain pathways are myelinated

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Pain reduction strategies

*mimic environment of uterus*
Dim lights/shade eyes
Reduce noise
Reduce frequency of handling
Swaddle
Non-nutritive sucking
Kangaroo Care
Facilitated tucking

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Common Neonatal Pain Assessment Scales

CRIES
Premature Infant Pain Profile (PIPP)
Neonatal Facial Coding Scale (NFCS)
Neonatal Infant Pain Scale (NIPS)

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CRIES : characteristics assessed

C*rying
R*equires additional O2
I*ncreased vital signs
E*xpression
S*leeplessness

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Premature Infant Pain Profile (PIPP) : characteristics assessed

Gestational age
Behavioral state
HR
O2 sat
Brow bulge
Eye squeeze
Nasolabial furrow

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Neonatal Facial Coding Scale (NFCS) : characteristics assessed

Brow bulge
Eye squeeze
Nasolabial furrow
Open lips
Stretched mouth
Lip purse
Taut tongue
Chin quiver
Tongue protrusion

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Neonatal Infant Pain Scale (NIPS) : characteristics assessed

Facial expression
Cry
Breathing patterns
Arms
Legs
State of arousal

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Vestibular nerve is full-size and tracts are myelinating at ___ weeks

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Vestibular stimulation enhances ______ __ _______

States of arousal

slow and rhythmic = calming, fast and erratic = stimulating

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Olfactory and gustatory development: Smell at ___ ; Taste buds begin to mature at ___

28 weeks

13 weeks

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Olfactory and gustatory development: Preterm infant lacks practice in _______

Swallowing (makes coordination of SSB difficult)

*from 24 weeks until term, fetus swallows 1L of amniotic fluid daily

Auditory: ____ wks GA able to hear ___ dB consistently. Normal conversation = ___ dB

28 wks
40 dB
60 dB
*AAP recommends NICU should not exceed 45dB

Visual: major eye structure and visual pathways are in place by ____ wks

23-24 GA

Visual: retina and visual cortex undergo extensive maturation from _____ wks to _____

24 wks to term

Visual: eyelids separate between ___-___ wks

24-28 wks

Visual: pupillary reflex is present at ___ wks

34 wks

bright light causes lid closure without fatigue

Brazelton- Neonatal behavioral assessment scale: State 1

Deep sleep, without movements, breathing regularly

Brazelton- State 2

Light sleep, eyes closed, some corporal movement

Brazelton- State 3

Sleepy, eyes opening and closing

Brazelton- State 4

Awake, eyes open, minimal corporal movement

Brazelton- State 5

Completely awake, strong corporal movement

Requirements for COMPLETE neonatal neuromotor assessment: (3)

Able to tolerate gentle handling Be in a calm alert state On room air and in open crib

Gestational age

length of time baby was in the womb

AGA, LGA, or SGA

appropriate, large or small for gestational age

APGAR

``` A*ppearance (color) P*ulse (HR) G*rimace (reflex irritability) A*ctivity (muscle tone) R*espiration (respiratory effort) recorded at first and fifth minute of life ```

Respiratory Distress Syndrome (RDS)

Insufficient surfactant production and structural lung immaturity Symptoms: increased respiratory rate, interconstal retractions, nasal flaring, cyanosis

Patent Ductus Arteriosus

Ductus arteriosus usually closes 10-15 hours after birth, when it does not close it is termed PDA. Symptoms: murmur, increased HR, respiratory distress, failure to gain weight

Hyperbilirubinemia (jaundice)

Immature liver function causes build up of bilirubin in the blood Symptoms: decreased level of arousal and activity, lethargy, hypotonia, poor sucking ability, can also alter visual, social-interactive and neuromotor abilities

Gastroesophageal Reflux

Movement of gastric contents into esophagus and above | Symptoms: irritability, extension and arching of trunk to the right (trying to get away from it)

Necrotizing Enterocolitis

Acute inflammation of immature intestines causing necrosis (risk doubles in babies with prenatal cocaine exposure) Symptoms: abdominal distension and vomiting

Germinal Matrix-Intraventricular Hemorrhage (GM-IVH)

*most common type of brain lesion in premature infants* Damage can extend to periventricular white matter, resulting in significant neurological issues (CP, mental retardation, seizures)

Periventricular Leukomalacia (PVL)

Death of small areas of brain tissue around ventricles, damage creates 'holes' in the brain High risk for developing problems with motor, busual, and cognitive functions

Retinopathy of Prematurity

Abnormal blood vessel development in retina of the eye | Symptoms: abnormal eye movements, crossed eyes, severe nearsightedness, white-looking pupils

Prenatal drug exposure

Symptoms: gongenital anomalies, abnormal sleep patterns, tremors, poor organized response, irritability and inability to be consoled

Chorioamnionitis

Inflammatory response that occurs when cervicovaginal bacteria invades the amniotic cavity

Bone disease of prematurity/osteopenia

Third trimester very important for bone development, 80% of bone is produced between 24-40 wks, Preterm infants are missing mechanical stimulation of cramped uterus

Bronchopulmonary Dysplasia (BPD)

Most common chronic lung disease associated with prematurity Greatest factor is under-developed lungs Symptoms: bluish skin, rapid breathing, shortness of breath