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Pediatrics > Pre, Peri, and Post Natal Issues and Prematurity > Flashcards

Pre, Peri, and Post Natal Issues and Prematurity Flashcards

1
Q

Prematurity

A
  • Preterm- infant born before 38 weeks of gestation or less
  • low birthweight= 2500 grams
  • Very low birthweight= 1500 grams

Post conceptual age (PCA) survival rate

  • 23 weeks PCA= 5-25%
  • 27 weeks PCA= >90%

High percentage of infants and children seen later in therapy have spent time in NICU.

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2
Q

Pre-Natal Concerns

A
  • Pre-natal care of mother
  • length of gestation
  • Complications during pregnancy
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3
Q

Autosomal Dominant

A

abnormal gene passed on from one of the non-sex chromosomes.

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4
Q

Autosomal Recessive

A

Gene must be carried from both parents (1/4 chance of getting disease)

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5
Q

Sex linked

A

Sex linked abnormal gene is passed on sex linked chromosome by the mother.

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6
Q

Polygenetic or multifactorial

A

Many genes passed from both parents.

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7
Q

Pre-natal concerns- STORCH

A

Syphilis- Caused by hepatitus, can lead to death, feeding problems, and neurological deficits
Toxoplasmosis- Can get it from changing cat litter and sand boxes or eating raw meat- fecal matter from cats can cause death, hydrocephaly, liver damage, and chorioretinits (blindness)
Rubella (Measles)- used to be more common prior to vaccination, although may become more of an issue because parents aren’t vaccinating their children due to the autism scare. Can cause deaf/blindness, MR, heart defects
Cytomegalovirus (CMV)- type of herpes spread through the body fluids, multiple system involvement passed onto baby- Can cause multiple neurological conditions and deafness, very severe for: organ transplants, AIDs patients, and developing fetuses
AIDS- can result in neurological deficits and motor impairment.

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8
Q

Peri-Natal Complication

A
  • Diabetes
  • Structural abnormalities of the pelvis
  • Placenta Previa
  • Present birth defects
  • Multiple Births
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9
Q

Post natal complications

A

Accidents- Anoxia, Exposure to lead (older low income houses risk), shaken baby syndrome (non-accidental TBI), Infection

Acquired Childhood illness disease

  • Cancer
  • Juvenile disease
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10
Q

Prematurity problems

A 
Respiratory
Cardiovascular
Neurological
Metabolic
Gastrointestinal
Vision
-General medical problems due to prematurity
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11
Q 
Respiratory- 
Bronchopulmonary Disease (BPD)
A

acute respiratory problem that requires prolonged use of ventilator.
Extracorporeal Membrane Oxygenation (ECMO): life support using a cardiopulmonary bypass. (wear and tear on the lungs)

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12
Q

Respiratory-

Meconium Aspiration Syndrome (MAS)

A

aspiration of meconium into trachea and bronchi. (baby swallows stool during birthing process)

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13
Q

Respiratory-

Apnea

A

prolonged pause in respiration, accompanied by slowing of heart rate.

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14
Q

Respiratory-

Respiratory distress syndrome (RDS)

A

air sacs of term babies kept open by a chemical coating called surfactant for gas exchange to occur. In premature infant doesn’t produce surfactant the lungs will collapse.

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15
Q

Cardiovascular prematurity-

Patent Ductus Arteriosis

A

While in utero, fetal circulation by passes the lungs via ductus arteriosus and normally closes at birth. In some preterm infants it may remain open, leading to enlargement of heart and back-up of blood in lungs.

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16
Q

Neurological-

Hypoxic-ischemic encephalopathy

A

lack of oxygen due to many factors (perinatal), seizures are associated.

17
Q

Neurological-

Intraventricular or intracranial hemorrhage (IVH)

A

bleeding into cerebral ventricles and surrounding brain tissue.
Grade 1 &2 brain bleeds- can be reversible
Grade 3- Can cause motor problems, can cause cerebral palsy. If half the tracts are affected it can cause spastic diplegia.
Grade 4 - Most severe, involves bleeding into ventricles, can cause more severe cerebral palsy

18
Q 
Neurological-
Preventricular leukomalacia (PVL)
A

necrosis of white matter below the cortex around the ventricles.

19
Q

Neurological-

Hydrocephalus

A

-inflammation from blood in ventricles impedes circulation and re-absorption of CSF. Build-up of CSF in the ventricles of the brain.

extra fluid in ventricles. Enlarged head due to CSF in the ventricles of the brain. Need a shunt to help manage the extra CSF fluid. Even with shunt there tends to be a larger head (dressing can be tricky.

20
Q

Metabolic-

Hyperbilirubemia

A

excess of bilirubin, referred to as jaundice (yellow color) resolves a couple of days after birth)

21
Q

Metabolic-

Hypo and Hyperglycemia

A

blood sugar imbalance

Can lead to problems with controlling temperature and regulation of breathing (highly monitored, NICU/incubators)

22
Q 
GI and nutritional problems-
Necrotizing Entercolitis (NEC)
A

necrosis of the mucosa of the small intestine and colon

23
Q

GI and nutritional problems-

Malnutrition

A

referred to as failure to thrive if not maintaining adequate calories or inadequate absorption of nutrients

24
Q

Medical problems- prematurity

A

Temperature Regulation (incubator may be necessary)

Sepsis (decreased immunity leads to increased susceptibility of infection.

25
Q

Opthomalogical problems-

Retinopathy of prematurity (ROP)

A

Grades 1 and 2 = Minor, no long term effects
Grade 3 = Results in high levels of nearsightedness (big cute glasses)
Grade 4 = Involves the retina being partly attached, causes significant vision problems
Grade 5 = _Completely detached retina, leads to blindness

26
Q

Sensory and Behavioral problems

A
  • Vision problems (myopia, high risk for cortical visual impairment, greater risk of strabismus)
  • Cortical visual impairment- everything in the eye orbit and optic track is typical but the visual association areas (not recognizing what the eyes are seeing)
  • Hearing loss
  • 30% higher chance of ADHD
27
Q

Stages of Preemie

A

Early Preemie- less than 30 wks gestation

Developing Preemie- 30-35 wks gestation

Older Preemie- 35 wks+ gestation

28
Q

Early Preemie

A
  • Remains more or less in drowsy state
  • Shows unstable physiologic signs
  • Coloring changes, cardiorespiratory problems
  • Demonstrates flaccid muscle tone, few elicited responses and jitteriness
  • Weak palmar grasp, weak suction reaction
  • Shows little capacity to remain alert
29
Q

Developing Preemie

A
  • Shows longer periods of alertness and some fuzziness
  • Physiologically more stable
  • Motor systems include disorganized movements and some self-comforting movements
  • Flaccid muscle tone, beginning to flex knees, frog-like posture
  • Stronger suck and grasp
  • Lifting of legs, swiping of arms, attempts to reach mouth or kick
  • Attends briefly to caregiver
30
Q

Older Preemie

A
  • Physiologically stable,
  • Well-differentiated states with longer alert periods
  • Movements are smoother and more coordinated
  • Greater muscle tone, better suck swallow reflex, palmar grasp, better motor control
  • Beginnings to respond to social interaction
  • May pus away a stimulus, more directed self-comfort, much longer alert periods
31
Q

Physical state of pre-term infants

A
  • low muscle tone
  • Arms and legs very flexible
  • very weak
  • sleeps almost all the time
  • Very sensitive to sensory input
  • Visual alertness around 30 wks
  • Very tiny lacking in body fat *bad temp reg)
32
Q

Potential development problems

A
  • Feeding difficulties
  • Learning problems and general delays
  • Cerebral palsy
  • Vision and hearing deficits
  • Speech and language delays
  • Cognitive Disability
  • Attention deficits and behavior problems.
33
Q

Role of OT working with Pre-term infants

A

Assessment
-Collaboration with medical team and parents

Consultation
-Feeding team

Referral

  • Early Intervention services
  • Follow-up NICU clinic or medically-based OT
  • Community resources
34
Q

OT Goals

A
  • Enhance parent-infant interaction
  • Facilitate infants own adjustment to environment
  • Facilitate infant’s acquisition of motor skills
  • Facilitate infant’s development of appropriate feeding.
35
Q

Frames of reference with Premature infants

A

Coping

Sensory integration

Sensory Processing

Motor Skills Acquisition/ Dynamic Systems

Pediatrics (11 decks)

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