Premature Birth Flashcards
Premature Birth
Child born before the 37th week of prenacy
- Have complicated medical problems
- Earlier a child is born the more likely they are to develop complications
Late Preterm Births
Babies born between 34 and 36 weeks of gestation
Very Preterm Births
Babies born during less than 32 weeks of gestation
Extremely Preterm Births
Babies born at or before 25 weeks
Needs of Premature babies
- Need to stay in the hospital longer and possibly in special care unity (NICU))
- Preterm children may immediately need help with feeding and adapting to life outside of their mother
Prematurity can result in many…
Short-term and long-term complications that can be addressed by an OT in the hospital setting or after discharge in an outpatient or home setting
Symptoms of Prematurity
- Small size
- Sharp-looking features
- Lanugo covering musch of the body
- Low body temp
- Labored breathing
- Lack of suck-swallow reflex
Risk Factors for Premature Birth
- Previous preterm birth
- Being pregnant with multiples
- Short duration between pregnancies
- Tobacco and drig use
- Infections in the mother
- Mother having chronic conditions such as diabetes, high BP, and stressful life events
Short-term complications of prematurity
- Breathing problems
- Heart problems
- Brain problems
- Temperature control problems
- Gastrointestinal problems
- Blood problems
- Metabolism problems
- Immune system problems
Long-term complications of prematurity
- Cerebral palsy
- Impaired learning
- Vision problems
- Hearing problems
- Dental problems
- Behavioral and psychological problems
- Chronic health issues
- Also at a higher risk of sudden infant death syndrome
What is the incidence rate of Prematurity?
- 13% of all pregnancies globally result in premature birth, accounting for:
- The majority of all neonatal deaths
- 50% of all neonatal neurodevelopmental conditions including cerebral palsy
What are the contributing factors to preterm birth?
- Maternal and Socioeconomic factors:
- Fetal Health Factors:
Maternal and Socioeconomic Factors (contributing factors to preterm birth)
- Fertility assistance such as in vitro fertilization and multiple gestation births from fertility drugs
- Maternal age above 36 years, or below 18 years of age, maternal infections, poor prenatal care, history of previous preterm births, preeclampsia, smoking and other substance use, poverty
Fetal Health Factors (contributing factors to preterm birth)
Congenital anomalies or in utero injuries to the developing fetus, Rh incompatibility
Prevention of Preterm Low Birth Weights
- Early identification of women at risk – offering education and prenatal health care
- Early detection of pre-term labor and use of antenatal steroid therapy
Low-birth weight (LBW)
Birth weight less than 2,500 grams (5 ½ lbs)
Very low-birth weight (VLBW)
Birth weight less than 1,500 grams (3 ½ lbs)
Extremely low-birth weight (ELBW)
birth weight less than 800 grams (1 ¾ lbs)
-Also referred to as a micropreemie
Why is Gestational Age important?
- Neonates who have a birth weight below the 10th percentile based on a graph of population-specific birth weight when compared to gestational age. Infants can be either full term or premature to classify as small for gestational age, or SGA.
- Determining gestational age can determine an appropriate-for-gestational-age from a SGA age infant.
- SGA infants are typically small due to intrauterine growth restriction (IUGR). Half of SGA births are associated with maternal illness, smoking, or malnutrition
- Increased risk for long-term growth impairments and developmental disabilities
- After birth, gestational age can be assessed using a clinical scoring system called the modified Dubowitz exam.
Physical Characteristics of the Preterm Infant
- Thin, smooth reddish skin, presence of fine body hair, known as lanugo. Absence of skin creases, body fat, or ear cartilage.
- Decreased muscle tone and motor activity
- Increased joint mobility
Consequences and Complications of Prematurity-Respiratory System
- Respiratory Distress Syndrome (RDS)
- Bronchopulmonary Dysplasia (BDP)
Respiratory Distress Syndrome (RDS)
Characterized by respiratory distress in the newborn period.
- Decreased production of surfactant to keep the alveoli open
- One of the most common and most life-threatening problems for preterm infants; diagnosis is specific to a) immaturity of the lungs, and b) lack of surfactant production in the premature infant
Medical Management of RDS:
- Neonate given injection of surfactant replacement; most cases resolve within 96 hours.
- Low level of oxygen or continuous positive airway pressure (CPAP)
- Possible mechanical ventilatory support for severe cases
Bronchopulmonary Dysplasia (BDP)
- This term used to describe infants who require supplemental oxygen or mechanical ventilation beyond 28 days postnatal age and/or a corrected age of 36 weeks.
- BPD will begin as a respiratory distress syndrome that has not resolved.
- Most common chronic lung disease of children in the U.S.
- Occurs primarily in infants born less than 32 weeks gestation and require mechanical ventilation in the first week of life
- Severe BPD more commonly associated with neonatal sepsis and lung injury
- Increased risk for neurodevelopmental disorders, cerebral palsy and seizures
What is the Medical Management of BPD?
- High frequency ventilation
- Steroid therapy and diuretics
Consequences and Complications of Prematurity-Neurological
- Neurologic System
- Intraventricular Hemorrhage (IVH)
- Periventriculat Leukomalacia (PVL)
Neurologic System (Consequences and Complications of Prematurity-Neurological)
Premature infants have an increased risk for neurologic deficits that are often directly related to their respiratory issues and can present significant developmental consequences for infants born prematurely.
Intraventricular Hemorrhage (Consequences and Complications of Prematurity-Neurological)
- Defined as bleeding into the ventricular space within the brain hemispheres;
- Risk of IVH correlated to the degree of prematurity
IVH – four levels of severity:
Grade I: Bleeding into the germinal matrix
Grade II: Bleeding beyond germinal matrix, into the ventricular system
Grade III: Bleeding invades the brain’s white matter
Grade IV: Also known as periventricular hemorrhagic infarction (PVL) causing severe damage of the brain matter surrounding the ventricles
Neurodevelopmental Consequences
Grade I: Accounts for the majority of IVH with less significant neurological impairments
Grade II: Accounts for the majority of IVH with less significant neurological impairments
Grade III: Accounts for approx. 20% of IVH cases – CP noted in 30% of these cases
Grade IV: Accounts for more than 75% of these cases
Periventricular Leukomalacia (PVL) (Consequences and Complications of Prematurity-Neurological)
- Consequence of either low oxygen or low blood flow leading to damage to periventricular white matter in a vulnerable and immature brain.
- Infants diagnosed with PVL are at higher risk for neurodevelopmental conditions, such as spastic quadriplegia and hemiplegia
Medical Management of IVH and PVL
- Head ultrasound in first days of life – safe and accurate diagnosis
- Follow up MRI
- Advances in NICU medical and neurodevelopmental interventions to decrease onset of hypoxic-ischemic events in neonatal period
Medical Management of IVH and PVL
- Head ultrasound in first days of life – safe and accurate diagnosis
- Follow up MRI
- Advances in NICU medical and neurodevelopmental interventions to decrease onset of hypoxic-ischemic events in neonatal period
Consequences and Complications of Prematurity- Gastrointestinal
- More consequences of an immature system
- Immature suck and swallow until approx. 32-34 weeks’ gestation often requiring nasogastric or nasojejunal tube feeding until safe to eat orally
- Necrotizing Enterocolitis (NEC)
- Gastroesophageal reflux disease (GERD)
Necrotizing Enterocolitis (NEC)
Commonly acquired GI disease among preterm infants causing severe damage to the intestinal wall and can be life threatening.
-Incidence: 80% of infants with NEC born less than 38 weeks’ gestation and weigh less than 2,500 grams.
Gastroesophageal reflux disease (GERD)
An immature gastric sphincter muscular control and delayed stomach emptying in premature infant may result in GERD.
- Contents of the stomach are regurgitated back into the esophagus. Infants with GERD at an increased risk for aspiration pneumonia – a lung infection caused by food entering the lung.
- Developmental consequences of GERD include, a) refusing oral feeding, b) prolonged tube feedings (non-oral), discomfort and irritability.
Medical Intervention: Necrotizing Enterocolitis (NEC)
Alternative nasal-gastric feedings. May require surgical intervention to remove damaged sections of the bowel.
Medical Intervention: Gastroesophageal reflux disease (GERD)
Medication and alternative positioning techniques
Consequences and Complications of Prematurity- Visual and Auditory Systems
- Retinopathy of Prematurity (ROP)
- ELBW (auditory system)
Retinopathy of Prematurity (ROP)
Abnormalities in the retinal vascular development common among preterm infants
Medical Intervention: Retinopathy of Prematurity (ROP)
- Pediatric ophthalmologist exam performed at 32-33 weeks’ gestation.
- Preventive measures include early human milk feedings with vitamin A and E supplements to decrease severity.
- Severe ROP treated by laser to prevent permanent retinal detachment.
ELBW (Auditory System)
-Infants at increased risk for hearing loss due to systemic illnesses and medications that may be toxic to the auditory system.
Medical Intervention: ELBW
Joint Committee on Infant Hearing (2000) recommended ALL newborns undergo an auditory screening. Most common test is the brainstem auditory evoked response (BAER).
ELBW (Auditory System)
-Infants at increased risk for hearing loss due to systemic illnesses and medications that may be toxic to the auditory system.
Concept of Developmental Care in the NICU
- Providing an optimal environment within the intensive care medical model to support premature infant development.
- Preterm and SGA infants are best served in high-risk centers with neonatal intensive care units (NICU).
- This Developmental Care approach differs from the more traditional medical care.
The Developmental Care Approach
- Client-centered, developmentally supportive care model
- Recognize behavioral cues and respond appropriately by providing individualized neurodevelopmental care plans. Care plans are family-centered
- Actively engage family caregivers in the infant’s care, to include teaching behavioral observation techniques
- Promote environmental modifications within the NICU environment to support infants sleep and rest, feeding and social interaction with family and caregivers
- Refer families to early intervention services prior to NICU discharge
- Support clients with a multi-disciplinary team
Role of OT with Premature Infants
- Activities of Daily Living: Feeding
- Sleep and Rest: State regulation
- Social Interaction: Promote meaningful interaction and bonding for parents and infant.
- Neurodevelopmental Performance: Muscle tone and motor development
EI referrals can be made as a part of NICU discharge plan. A multi/ interdisciplinary team approach will include OT, PT, SLP, and early childhood educators.
