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USAHS Conditions Test 2 > Premature Birth > Flashcards

Premature Birth Flashcards

1
Q

Premature Birth

A

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
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2
Q

Late Preterm Births

A

Babies born between 34 and 36 weeks of gestation

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3
Q

Very Preterm Births

A

Babies born during less than 32 weeks of gestation

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4
Q

Extremely Preterm Births

A

Babies born at or before 25 weeks

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5
Q

Needs of Premature babies

A
  • 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
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6
Q

Prematurity can result in many…

A

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

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7
Q

Symptoms of Prematurity

A
  • Small size
  • Sharp-looking features
  • Lanugo covering musch of the body
  • Low body temp
  • Labored breathing
  • Lack of suck-swallow reflex
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8
Q

Risk Factors for Premature Birth

A
  • 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
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9
Q

Short-term complications of prematurity

A
  • Breathing problems
  • Heart problems
  • Brain problems
  • Temperature control problems
  • Gastrointestinal problems
  • Blood problems
  • Metabolism problems
  • Immune system problems
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10
Q

Long-term complications of prematurity

A
  • 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
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11
Q

What is the incidence rate of Prematurity?

A
  • 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
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12
Q

What are the contributing factors to preterm birth?

A
  • Maternal and Socioeconomic factors:

- Fetal Health Factors:

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13
Q

Maternal and Socioeconomic Factors (contributing factors to preterm birth)

A
  • 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
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14
Q

Fetal Health Factors (contributing factors to preterm birth)

A

Congenital anomalies or in utero injuries to the developing fetus, Rh incompatibility

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15
Q

Prevention of Preterm Low Birth Weights

A
  • Early identification of women at risk – offering education and prenatal health care
  • Early detection of pre-term labor and use of antenatal steroid therapy
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16
Q

Low-birth weight (LBW)

A

Birth weight less than 2,500 grams (5 ½ lbs)

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17
Q

Very low-birth weight (VLBW)

A

Birth weight less than 1,500 grams (3 ½ lbs)

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18
Q

Extremely low-birth weight (ELBW)

A

birth weight less than 800 grams (1 ¾ lbs)

-Also referred to as a micropreemie

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19
Q

Why is Gestational Age important?

A
  • 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.
20
Q

Physical Characteristics of the Preterm Infant

A
  • 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
21
Q

Consequences and Complications of Prematurity-Respiratory System

A
  • Respiratory Distress Syndrome (RDS)

- Bronchopulmonary Dysplasia (BDP)

22
Q

Respiratory Distress Syndrome (RDS)

A

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
23
Q

Medical Management of RDS:

A
  • 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
24
Q

Bronchopulmonary Dysplasia (BDP)

A
  • 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
25
Q

What is the Medical Management of BPD?

A
  • High frequency ventilation

- Steroid therapy and diuretics

26
Q

Consequences and Complications of Prematurity-Neurological

A
  • Neurologic System
  • Intraventricular Hemorrhage (IVH)
  • Periventriculat Leukomalacia (PVL)
27
Q

Neurologic System (Consequences and Complications of Prematurity-Neurological)

A

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.

28
Q

Intraventricular Hemorrhage (Consequences and Complications of Prematurity-Neurological)

A
  • Defined as bleeding into the ventricular space within the brain hemispheres;
  • Risk of IVH correlated to the degree of prematurity
29
Q

IVH – four levels of severity:

A

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

30
Q

Neurodevelopmental Consequences

A

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

31
Q

Periventricular Leukomalacia (PVL) (Consequences and Complications of Prematurity-Neurological)

A
  • 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
32
Q

Medical Management of IVH and PVL

A
  • 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
33
Q

Medical Management of IVH and PVL

A
  • 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
34
Q

Consequences and Complications of Prematurity- Gastrointestinal

A
  • 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)
35
Q

Necrotizing Enterocolitis (NEC)

A

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.

36
Q

Gastroesophageal reflux disease (GERD)

A

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.
37
Q

Medical Intervention: Necrotizing Enterocolitis (NEC)

A

Alternative nasal-gastric feedings. May require surgical intervention to remove damaged sections of the bowel.

38
Q

Medical Intervention: Gastroesophageal reflux disease (GERD)

A

Medication and alternative positioning techniques

39
Q

Consequences and Complications of Prematurity- Visual and Auditory Systems

A
  • Retinopathy of Prematurity (ROP)

- ELBW (auditory system)

40
Q

Retinopathy of Prematurity (ROP)

A

Abnormalities in the retinal vascular development common among preterm infants

41
Q

Medical Intervention: Retinopathy of Prematurity (ROP)

A
  • 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.
42
Q

ELBW (Auditory System)

A

-Infants at increased risk for hearing loss due to systemic illnesses and medications that may be toxic to the auditory system.

43
Q

Medical Intervention: ELBW

A

Joint Committee on Infant Hearing (2000) recommended ALL newborns undergo an auditory screening. Most common test is the brainstem auditory evoked response (BAER).

44
Q

ELBW (Auditory System)

A

-Infants at increased risk for hearing loss due to systemic illnesses and medications that may be toxic to the auditory system.

45
Q

Concept of Developmental Care in the NICU

A
  • 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.
46
Q

The Developmental Care Approach

A
  • 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
47
Q

Role of OT with Premature Infants

A
  • 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.

USAHS Conditions Test 2 (6 decks)

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