NICU Overview Flashcards
Extremely Preterm
born before 25 wks
Very Preterm
born 25 to 32 weeks
Moderately Preterm
born 32-34 weeks
Late Preterm
born 34-36 weeks
Adjusted Age of Preterm Babies
correct their age until 2 yrs old
typically say their age in weeks and days
Want to get them home by 42 wks gestation if possible
NICU Numbers
preterm birth is #1 cause of death in babies
1/10 babies
380,000 babies are premature each year
premature birth rate is 9.8%
Preterm Birth Risks
higher risk for motor, sensory, cognitive, and behavioral/mental health disorders
SLP Role in NICU
- help during heel sticks/procedures, baths, etc. to minimize negative impacts
- serve as communication specialists
- read infant stress cues and respond to help them cope and provide support and positive experiences
- help enhance neuroprotective care
SLP NICU Goals
- normalize development
- conserve energy
facilitate organization
-recognize stressors
-encourage self-consoling - prevent neuronal cell death
(caused by apnea or hypoxia)
(also want to support brain development after an injury that decreases cell death) - assist in integration of input in a positive manner
- support family integrated care
Preventative Care
Want to consult before problems arise
Preterm babies are at a high risk of having feeding difficulties, want to set them up for success
Why Neuroprotective Care?
Time period between 35-40 wks is when neurons in brain become more specialized
Proliferation occurs during last trimester and is when there’s lot of neuronal growth
- Want to avoid interrupting this
Neonatal Sensory Development
Tactile - 7-18 wks
- warm and cozy in womb. In NICU, they could be intubated, wearing a diaper, etc. Feeling is different
Vestibular - 14-16 wks
- in womb, they float. In NICU, they are held, turned around, etc.
Olfactory/gustatory - 12-14 wks
- in womb, they smell mom and taste what she eats. In NICU, different tastes and smells
auditory - 18-35 wks
- in womb, sounds are muffled
- in NICU, carts rolling, beeps, etc.
visual - 38-term
- In womb, its dark
- In NICU, lots to see and lights
Summary: Very different environments, so want to support then to be able to interpret information and tolerate it
Synactive Theory - What is it?
Helps us understand infant’s behavior and that their body is constantly interacting with the environment
All systems are interdependent
Autonomic, Motor, State, Attention, and Self regulation
- Systems are not fully developed so we see stress in at least one subsystem
Autonomic System
Basic Foundation. Basic physiologic function of infants that is necessary for survival
Color:
- Good: pink over entire body
- Bad: pale, red, dusky, mottled color changes on part or whole body
RR:
- Good: 40-60 bpm, regular
- Bad - uneven intervals (more than 60 or less than 40), breathing pauses for 2 secs or more, gasping, yawning, or coughing
Visceral Signs:
- Good: stable digestion with appropriate burping, regular elimination of abdominal wastes
- Bad: regurgitation, hiccups, gagging, excessive drooling, diarrhea, gassy
Motor System
Tone and Posture:
- Good: arms, legs and body well rounded and softly flexed
- Bad: flat limbs, face or body, extended limbs or fingers, arching of neck or back, excessive tucking of body
Movement:
- Good: smooth movement of arms, trunk and face
- Bad: movements jerky, frantic flailing movements, repetitive behaviors that interrupt organization and stability
Self-regulatory behaviors
- Good: holding hands to face, mouthing/sucking on hands, adjusting posture
- Bad: not successful at
State System
- Good: sleep or fully awake is clearly defined, smooth transitions, appropriate state for situtation, stable and predictable cycles, contol and not overwhelmed by stimuli
- Bad: states not easily defined, rapid changes, inappropriate state to time, unpredicatble cycles, overwhelmed by stimuli
EX: crying over a shot is fine, but want to see them calm down. Deep sleep to fully awake fast is not good.
Attention/Interaction System
- Want to see them engaging with caregiver
- Bad: will display stress cues from autonomic, state, and motor systems
- inability to integrate with other sensory input (can’t look at caregiver, suck on bottle and listen to talking att he same time)
Self-Regulatory Behaviors
want to see:
- change in position
- hand-to-mouth
- grasping
- sucking
- visual locking
- hand clasping
State Considerations
Deep sleep - when brain growth occurs, dont want to wake them (no interest in feeding, difficult to arouse, not receptive to social interaction)
Quiet Alert - optimal for interaction, NNS, and Feeding (best state for learning since infant focuses on visual, auditory, tactile, and sucking stimuli)
Crying - stressed, overstimulated, needs external support to calm (want to avoid this stage)
Neonatal Integrative Developmental Care Model
6 petals and a center that outline NICU care
supports:
- reducing negative effects of stay
- neurological protection
- developmental skills development
Includes:
1) partnering with families
2) postioning and handling
3) safeguarding sleep
4) minimizing stress and pain
5) protecting skin
6) optimizing nutrition
7) healing environment
Healing environment
Cycled lighting - on day and off at night, eye covers vs room light, helps to improve weight gain, shorter stay, oxygen levels, growth
Sound reduction - often exceeds 45dB acceptable level, HL is increased in infants, incorporate quiet time, decrease alarms, use carpets/rubber wheels, use incubators to filter noise
Smell/Taste - give taste of breast milk/colostrum, limit smells, limit lotions, aftershave, etc., give infant clothes that smell like parents
Supporting Families
Essential for optimizing developmental outcomes
NICU is stressful, can negatively impact infant/caregiver bonding, can result in caregiver stress with impacts the child
Reunification and zero separation are ultimate goal
- want to create secure attachment and emotional connections
- STS/kangaroo care improves maternal responsiveness and infant attachment, leads to improved development
- limited parental care results in negative changes in brain structure and function
Family is part of IPP and want them to be competent in caring for infant
Proper Positioning
neutral head positioning
rounded shoulders
hips and knees flexed
toes pointed straight
hands to mouth
boundaries provided appropriately
eyes, knees, and toes all in same direction
(want to mimic position in utero, teaches them to be aware of their bodies)
Proper Handling
Quick turning aka “premie flip” can cause disorganization for 20 mins
Want smooth and slow movements
light touch or gental stroke can be over-stimulating
Want a gentle but firm “static containment”, like hand hugs
Touch
Good Touch:
STS/Kangaroo Care: creates better mood for parents, better developmental outcomes for infant, helps baby spend more time in deep sleep, regulates baby heart rate, body temp, breathing, improves baby weight gain, increases mother’s milk production, better bonds (Want to do before feeding/swallowing issues arise)
Hand hugs, infant massage
Negative Touch/Procedural Touch results in :
- hypoxia
- bradycardia
- sleep disruptions
- increased intracranial pressure
- puts them at an increased risk of intraventricular hemmhorage and developmental delays
Protect Sleep
deep sleep - energy restoration, bodily homeostasis
light sleep - sensory input processing, memory encoding, learning
Sleep patterns emerge around 28 wks (important for brain plasticity, learning, memory, neurosensory development)
Stess and Pain
cortical production results in:
- decreased synapses and affects attachment
- increased arousal puts infants on high alert
- may lead to long term hyperactivity, anxiety, and impulse behavior
- can lead to attention and self-control problems later
Two person Care helps relieve pain/stress, hellps coping
- want to help parents learn to calm/soothe infants and read cues
Optimizing Nutrition
Support families in feeding goals
EBM is best tolerated
- decreased sepsis, helps gray matter volume, better IQ, better developmental outcomes
Infant Response Feeding:
- Address feeding readiness cues and family support
