NICU Infants

Question 1

9% of newborns go to NICU
2% (25%) will have increased risk of disability /death
Who is at risk of disability /death

Answer 1

1 <32weeks or <1500gm
2 need major surgery
3 ventilated >4hours
4 neonatal encephalopathy
5 major birth defect
Premature babies are those born <37weeks

Question 2

If born 23/52 should you go to NICU

Answer 2

No discouraged about 1/3 of these babies survive but lots of problems in those that survive
>26weeks NICU offered to most
By 27weeks 90% of babies survive and at 28/52 10% of these children will have mod-severe disability

Question 3

What are the complications of NICU

Answer 3

1 parental psychological problems  ( 80% of mums psychological impact compared with 15% other new mums  fathers also problems 
2 feeding problems 
3 growth problems 
4 chronic lung disease 
5 CP
6 Intellectual disability
7 blindness 
8 deafness 
9 learning problems

Question 4

Effects of PND maternal

Answer 4

1 decreased maternal sensitivity to the infants needs
2 behavior problems in children
3 decrease cognitive ability/emotional development
4 poor attachment/ more -ve maternal responses
5 increased risk of child abuse and neglect

Question 5

Feeding problems in infants

Answer 5

Immature feeding skills eg poor coordination with swallow and sucking
Immature gut
Breast milk protective for gut/eyes/ID/ and may reduce atop
Breast milk alone is not enough caloric supplementation

Question 6

Growth

Answer 6

Preterm infants grow slower
Plot on age adjusted charts
90% will reach their full growth potential
Anemia prophylaxis for prem infants ( twins and blood transfusion)
Osteopenia need extra phosphate

Question 7

Hernias / hydrococeles

Answer 7

Preterm infants increased risk of hernias
15-20% will have hernia in <32weeks
Males :females 9:1

Question 8

Chronic lung disease

Answer 8

1/10 kids in NICU will get this 
Common esp the younger you are 
Lung development poor need surfactant 
By one year very few babies need oxygen 
Immunizations RSV and Influenza

Question 9

Immunizations in preterm infant

Answer 9

Need the full dose chronological age

Don’t respond as well to Hep B vaccination

Question 10

Predictors of morbidity

Answer 10

Low birth weight

Male

Question 11

Poor outcomes in NICU

Answer 11

Chronic lung disease
Intracranial haem leading to Hydrocephalus
3 necrotising enteroclogitis
4 needing steroids for Chronic lung disease
5 infections
6 retinopathy

Question 12

All children NICU need NEURODEVELOPMENT follow up

Answer 12

Gross motor skills ( hypo/hyper tone need physio) CP 20% <27/52. 10% 27-29 weeks. Range of effects
Fine motor skills most have this
Vision most eye problems mild ( 1-2% <30weeks blind need ophthalmology)
Hearing 2-3% <30weeks need hearing aids
Speech /language common area of difficulty in NICU
Social /behavioral social skills developed at age adjusted
Many easily distracted
Learning and cognition. Learning problems are a major problems in premature infants
Need extra help/ special school

Question 13

Major surgery and newborn encephalopathy

Answer 13

Major effects often
Monitor for problems
Need multidisciplinary team follow up