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Paediatric Interventions > Premature Baby & Predicting Outcomes > Flashcards

Premature Baby & Predicting Outcomes Flashcards

1
Q

What is prematurity?

A
  • More than 24 weeks but less than 37 weeks gestation

- 5-9% of births

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2
Q

How are premature babies classified?

A

By gestation & weight

  • Low birth weight = <2500g
  • Very low birth weight = <1500g
  • Extremely low birth weight= <1000g
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3
Q

What are the causes of pre-term labour & delivery?

A
  • Infection or inflammation
  • Utero placental ischaemia or haemorrhage
  • Uterine overdistension
  • Stress
  • Other immunologically mediated processes
  • Precise mechanism cannot be established in most cases
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4
Q

What are the pregnancy-related risk factors for pre-term labour & delivery?

A
  • Pre-eclampsia: high BP & protein in urine after 20th week of pregnancy
  • Premature rupture of amniotic membranes
  • Infection: UTI, infection of amniotic membrane, placenta
  • Weakened cervix that begins to dilate early
  • Birth defects of uterus
  • Poor nutrition
  • History of preterm delivery
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5
Q

What are the other factors that increase risk of pre-term labour & delivery?

A
  • Age of the mother (<16 or >35)
  • Use of tobacco, cocaine, or amphetamines
  • Lack of prenatal care
  • Low SES
  • Diabetes
  • Renal disease
  • Cardiorespiratory disease
  • Polyhydramnios
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6
Q

What are the baby-related risk factors for pre-term labour & delivery?

A
  • Multiple pregnancy: 15% preterm infants are multiple births
  • Anomalies
  • Intrauterine foetal death
  • Infection
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7
Q

What can organ immaturity in premature babies result in?

A
  • Food intolerance
  • Poor immunity
  • Poor thermoregulation
  • Heart and lung problems
  • Neurological insults
  • Ophthalmic lesions
  • Kidney immaturity
  • Metabolic disturbances
  • Lack of survival reflexes (suck, swallow, cough, gag)
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8
Q

What are some of the lung-related complications of prematurity?

A
  • Surfactant
  • Respiratory distress syndrome (RDS)
  • Chronic lung disease
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9
Q

What is surfactant?

A
  • A slippery substance (phospholipid) in the lungs
  • Helps the lungs fill with air & keeps the alveoli from
    deflating at low volumes
  • Protects lung surface from epithelial injury, infection &
    capillary leakage
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10
Q

Why is surfactant a complication of prematurity?

A
  • Present from 24 weeks but not in large enough quantity
  • 28-30 weeks with assistance
  • 34 weeks for spontaneous first breath
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11
Q

What is respiratory distress syndrome (RDS)?

A
  • Aka hyaline membrane disease (HMD)
  • Stiff lungs difficult to inflate and ventilate
  • Pulmonary interstitial emphysema (PIE): Alveolar air leak
  • Pneumothorax (alveolar rupture)
  • Pneumonia (collapse +/- consolidation)
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12
Q

What is chronic lung disease?

A
  • AKA bronchopulmonary dysplasia (BPD)

- O2 required at 28 days old

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13
Q

What are some of the treatments for lung-related complications?

A
  • Maternal corticosteroids & artificial surfactant: Benefit to baby lungs & possibly gut maturity
  • Magnesium sulphate: treats maternal preeclampsia
    & reduces rate of CP in early childhood
  • Improving ventilation
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14
Q

What are some of the strategies for improving ventilation in premature babies?

A
  • Quick intubation for artificial surfactant & then extubation & Bubble CPAP asap
  • Gentler ventilation modes, HFOV, targeted O2
  • Careful positioning plans, V/Q matching
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15
Q

What are some of the brain-related complications of prematurity?

A
  • Periventricular leukomalacia (PVL)

- Peri/intra ventricular haemorrhage

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16
Q

What is periventricular leukomalacia (PVL)?

A
  • White matter lesion
  • Injury to oligodendrocytes in periventricular area
  • Site of injury affects the descending corticospinal tracts, visual radiations & acoustic radiations.
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17
Q

What is the cause of PVL?

A

Hypotension, ischemia & coagulation necrosis at watershed zones of MCA

18
Q

What are some of the initial symptoms of PVL?

A
  • Decreased tone in lower extremities
  • Increased tone in neck extensors
  • Apnea and bradycardia events
  • Irritability
  • Pseudobulbar palsy with poor feeding
  • Clinical seizures
19
Q

What are the longer term outcomes for PVL?

A
  • Mild PVL: Spastic diplegia CP most common

- Severe PVL: Quadriplegic CP most common, varying degrees of intellectual & developmental impairment

20
Q

What is a peri/intra ventricular haemorrhage?

A

Haemorrhage in the fragile capillary network supplying the germinal matrix

21
Q

What are the grades of peri/intra ventricular haemorrhages?

A
  • Grade I: Subependymal region &/or germinal matrix
  • Grade II: Subependymal hemorrhage with extension into lateral ventricles without ventricular enlargement
  • Grade III: Subependymal hemorrhage with extension into lateral ventricles with ventricular enlargement
  • Grade IV: Intraparenchymal haemorrhage
22
Q

What is necrotising enterocolitis?

A
  • Common GI complication
  • Death of intestine tissue
  • Causes abdominal bloating, blood in stool, diarrhoea, vomiting etc
23
Q

What is the treatment for necrotising enterocolitis?

A
  • Halting regular feedings
  • Relieving gas in the bowel by inserting a tube in the stomach
  • Giving IV fluids & antibiotic
    medicines
  • Monitoring
24
Q

When is surgery required for necrotising enterocolitis?

A
  • If there is a hole in the intestines
  • Inflammation of the abdominal wall
  • Remove dead bowel tissue
  • Perform a colostomy or ileostomy
  • The bowel is reconnected after several weeks or months when the infection has healed
25
Q

What environmental complications are associated with prematurity?

A
  • Noxious sensory inputs for preterm infant can contribute to neuronal disorganisation
  • Physiological stability required for social interaction & functional motor patterns
  • Favour for extensor muscles
  • Muscular & osteo-articular deformities & acquired muscle shortening
  • Midline foot/leg posture also affected
26
Q

How are flexor muscles affected by the environment in prematurity?

A
  • < 31 weeks: immature mm fibres & NMJs, diminished flexor tone
  • Uterine wall limits arcs of limb movements & encourages flexed resting postures
  • Once born, environment favours extensor muscles (gravity, equipment)
27
Q

Which muscles are commonly affected by deformities and acquired muscle shortening in prematurity?

A
  • SCM, shoulder girdle, biceps trapezoid muscle (acquired torticollis)
  • Abduction & ER muscles of shoulder
  • Blocks active movements, allowing ungainly & non-functional movements to develop
  • Passive & active muscle insufficiencies
28
Q

How is the midline foot/leg posture affected in prematurity?

A
  • ER/wide abduction of hips
  • Lack of pelvic elevation
  • May affect developmental milestones up to 6 years
29
Q

How is motor development affected by prematurity?

A
  • Infants born <32 weeks have delayed motor development during the 1st year of life
  • Slower to attain motor skills e.g. rolling, sitting, standing, walking
  • Prevalence of CP increases with decreased gestational age
30
Q

What other impairments are associated with prematurity?

A
  • Reduced gross/fine motor control
  • Reduced balance/coordination
  • Fine motor
  • Learning difficulties: concentration, behavioural problems, abstract reasoning, processing multiple tasks
31
Q

What techniques can be used by physio to help an infant find a calm, quiet & organised state?

A
  • Positioning to foster flexion
  • Midline placement of the infants limbs
  • Using slow transitional movements
  • Sucking
  • Contained & supportive touch
32
Q

What strategies can physio used to treat premature babies?

A
  • Assessment
  • Positioning and Nesting
  • Swaddling
  • Handling Advice
  • Neurodevelopmental Physio Exercises
33
Q

What are the aims of developmentally supportive positioning?

A
  • Place in positions that mimic the joint position & limb alignment in utero
  • Introduced as early as possible
  • 3/4 prone +/- postural support role
  • Sidelying with hands/knees midline
  • Prone with pelvic elevation for midline hip flexion & nil hip ER
  • Supine with nesting deep enough to support knees into midline & hip flexion
34
Q

What are the benefits of positioning?

A
  • Facilitate contained exploratory movements & maintain joint integrity
  • Increased coordinated spontaneous midline movements
  • May be beneficial for self-regulatory abilities & stress behaviours
  • Maintaining skin integrity
  • Assisting with head shaping
  • Prevention of acquired torticollis
35
Q

What is a developmental nest?

A
  • Knees & hips flexed facing same direction
  • Shoulders supported into flexion with hands in midline
  • May contribute to better coordinated midline-oriented movements
  • Gives resistance to early movement to assist fibre type differentiation
36
Q

What are the benefits of swaddling?

A
  • Fosters self-regulation
  • Gentle flexion of legs & arms without eliminating small arcs of spontaneous movement
  • Facilitates neuromuscular development
37
Q

What are some of the neurodevelopmental physio exercises?

A
  • Pick up from sidelying
  • Sidelying: chin tuck, head control arm and hand movements
  • Hand to hand
  • Foot to foot
  • Pelvic rocking
  • Cycling with resistance
  • Head positioning
  • Prone time over a roll, on lap
  • Supported upright sitting
  • Handling positions
  • Symmetry
38
Q

What are some of the problems for families post-discharge?

A
  • Poor growth
  • Pneumonia wheezing asthma
  • Bronchiolitis
  • Chronic lung disease
  • GORD
  • Complex nutritional & gastro disorders
  • Inguinal hernias
  • Re-admission to hospital in first year increased 4 times
39
Q

What are the aims of assessment at 34 weeks?

A
  • To compare infant performance with age expectations to indicate need for intervention
  • Educate parents re: infant’s motor development
  • Plan intervention prepare for referral
40
Q

What is the Lacey Assessment of the Preterm Infant (LAPI)?

A
  • Monitors developing motor skills & postures

- Predicts normal motor development or CP at 3 years

41
Q

What does assessment after discharge involve?

A
  • Growth & development follow-up clinic
  • Screening for developmental delay at periodic intervals
  • Assessment of movement, speech, language, feeding, growth
  • Prediction of motor development
  • Ensuring intervention is targeted

Paediatric Interventions (27 decks)

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