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PPC3 Exam 1 > Premature Infant 2 > Flashcards

Premature Infant 2 Flashcards

1
Q

Speech and Language (3)

A
  1. 20-40% premature infants have language deficits by 2 years
  2. Puts 2 words together by 2 year corrected age
  3. Speaks word that can be understood by stranger by 2.5 years
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2
Q

Developmental Screening (4)

A
  1. 9, 18, 30, 48 months of age
    * *For muscular hypotonia**
  2. MCHAT at 18 months and age 2
  3. Make referral to EIP as indicated
  4. Assess school readiness
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3
Q

Cognitive Outcomes (6)

A
  1. Deficit in visual motor and visual spatial skills
  2. Difficulty with self regulation or organization of sensory information
  3. Higher rate of attention problems
  4. Learning disabilities
  5. Hyperactivity, aggressiveness, depression and anxiety
  6. Much greater risk of seizures
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4
Q

Common medical problems (15)

A
  1. Risk of CP; CP can get better with age, around 7 years old
  2. Strabismus and amblyopia
  3. Retinopathy of prematurity
  4. Chronic Lung Disease: 17-54%; high rate of this
  5. Transient Tachypnea of the newborn
    a. Common in late pre-term; generally not a problem
  6. Acute respiratory infections
  7. Apnea of Prematurity (23%)
  8. Necrotizing enterocolitis
  9. GER
  10. IVH
  11. Anemia
  12. Patent ductus arteriosus
  13. Chronic cardiac insufficiency, cor pulmonale, or CHF
  14. Hernia
  15. Undescended testicles
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5
Q

physical assessment of the throat

A

evaluate suck-swallow, tongue thrust, oral aversion, uvula movement, hyper-hypoactive gag reflex

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6
Q

physical assessment of respiratory tract

A

a. Rate and retractions
b. Stridor
c. Monitor closely for RSV—wheezing

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7
Q

physical assessment of neck and shoulder

A

Poor head control, tight scarf sign, difficulty bringing hands to midlines

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8
Q

physical assessment of trunk

A

a. Arching
b. Decreased range of motion
c. Hypotonia

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9
Q

Physical assessment of extremities (7)

A
  1. Hypo/hypertonia
  2. Passive tone
  3. Hand to mouth coordination
  4. Hyperreflexia: how to test
  5. Clonus
    i. Watch for clonus at heel
  6. Testing for Babinski to avoid plantar, gait
  7. Stress gait by putting penny on nose
    i. Will stress trying to keep penny on nose (2-3 y/o)
    * Subtle weaknesses as they grow
    * Hemiparesis is common
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10
Q

Types of Brain Injury in the Premature Infant (3)

A
  1. Periventricular Leukomalacia (PVL)
    * #1 cause of cerebral palsy
  2. Intraventricular Hemorrhage (IVH)
    * Related to infarctions
  3. Periventricular Hemorrhagic (Infarct PVHI)
    * Related to infarctions
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11
Q

Periventricular Leukomalacia (8)

A
  1. Necrosis of white matter in the brain.
  2. It effects 4-15% of VLBW babies
  3. Most common ischemic brain injury in premature infants
  4. Watershed injury to periventricular area due to a vascular insult
  5. 4-26% of preemie with most common in infants <32 weeks or < 1500 gm
  6. Cerebral palsy with spastic diplegia
    a. Most common form
    b. With CP, can have normal mental functions/intelligence
  7. Quadriplegia associated with severe PVL
    a. Visual impairment
    b. Intellectual/developmental impairment
  8. Diagnosis: MRI of brain
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12
Q

Intraventricular Hemorrhage (3)

A
  1. Usually occurs in infants < 32 weeks
  2. Complications of grade 3 to 4 IVH
    a. Hydrocephalus
    b. Seizures
    c. Cerebral palsy
    d. Cognitive, sensory, and language delay
  3. May need VP shunt
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13
Q

Periventricular hemorrhagic infarction

A

Hemorrhagic necrosis of periventricular white matter

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14
Q

Cerebral palsy: overview

A

Chronic disability of central nervous system origin characterised by aberrant control of movement of posture, appearing early in life and not the result of progressive neurological disease.

This diseases are static and may in fact get better

Not a disease that gets worse over time

Inborn errors of metabolism manifestations get worse over time though

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15
Q

Cerebral palsy: etiology (4)

A
  1. Prenatal (70%): Infection, anoxia, toxic, vascular, Rh disease, genetic, congenital malformation of brain
  2. Natal (5-10%): Anoxia, traumatic delivery, metabolic
  3. Post natal: Trauma, infection, toxic
  4. Most of these are in utero insults not related to poor delivery
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16
Q

Cerebral palsy: spastic rigidity

A

Upper motor neuron lesions; increase tone throughout range of movement

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17
Q

Cerebral palsy: hemiplegia, diplegia, paraplegia, quadriplegia, monoplegia

A

hemiplegia: one side of the body
diplegia: UMNL of all four limbs but legs more than arms. May be symmetric or asymmetric
paraplegia: one leg involement
quadriplegia: equal involvement of arms and legs
monoplegia: one limb

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18
Q

Cerebral palsy: dyskinesia

A

involuntary movements and changes in muscle tone. Damage to basal ganglia and extrapyramidal pathways

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19
Q

Cerebral palsy: athetosis

A

Slow writhing movements of limbs. Extension and fanning of fingers and extension of wrist

20
Q

Cerebral palsy: chorea

A

Quick jerky movements of trunk and proximal limb muscles

21
Q

Early sings of CP: Birth History (5)

A

a. Prematurity.
b. Seizures.
c. Low Apgar
d. Intracranial haemorrhage.
e. Periventricular leukomalacia.

22
Q

Early signs of CP: other (6)

A
  1. Delayed Milestones

2 Abnormal Motor Performance

a. Handedness
i. Preferring one hand over another before age 2 **
b. Reptilian crawl.
i. If mother says baby isn’t crawling normally then it’s a sign of CP

  1. Toe waking.
  2. Altered Tone
    a. Hypertonia – will feel like “sack of potatoes”
    b. Can also be hypotonia
    i. But all hypotonics will become hypertonic
  3. Persistence of primitive reflexes.
  4. Abnormal posturing-Cortical Thumb
23
Q

Landau Reflex (2)

A
  1. Infant will lift head and extend the neck and trunk

2. Present by 6 months

24
Q

Parachute reflex (2)

A
  1. Present by 6-8 months

2. Look for symmetric response

25
Q

Propping reflex (2)

A
  1. Anterior propping when sitting up
    * Should proper forward as they first learn to prop
  2. Lateral propping to maintain balance
26
Q

Cerebral palsy complications (12)

A
  1. Spasticity
  2. Weakness
  3. Visual compromise
  4. Deformation
  5. Increase reflexes
  6. Hip dislocation*
  7. Clonus
  8. Seizures
  9. Articulation & Swallowing
  10. Kyphoscoliosis
  11. Constipation
  12. Urinary tract infection difficulty
27
Q

Vision: Retinopathy of prematurity (8)

A
  1. Proliferation of abnormal retinal blood vessels
  2. May regress or worsen to retinal detachment
  3. Risk factor: >32 weeks and supplemental oxygen
  4. Eye exam: 4-6 weeks post birth if oxygen exposed
  5. Premature infants are at increased risk
    a. Visual impairment from myopia and strabismus
    b. Visual impairment as a result of cortical injury.
  6. Early detection and treatment are key
  7. Classed by location of the disease in the retina (zone), vascular abnormality (stage), and extent of developing vasculature (clock hour)
  8. Treated with laser surgery
28
Q

Nasal deformities (2)

A
  1. May have pressure necrosis from NP CPAP prongs or cross bars
  2. Problems with purulent secretions and infections should be referred to pediatric ENT
29
Q

Oral tracheal intubation (6)

A
  1. Speech irregularities
  2. Deformities of teeth and arches
  3. Palatal grooving
  4. High shaped V palate
  5. Missing teeth
  6. Posterior cross bite
30
Q

Dental vs Dentition

A

Dental: If birth weight is less than 1500 gram, refer to pediatric dentist after first tooth eruption

Dentition: Onset of tooth eruption is related to corrected age
*Preemies: 20-30 % of enamel defects—enamel hypoplasia or opacities of primary teeth

31
Q

Chronic and Cardiac Insufficiencies (2)

A
  1. Cor pulmonale: Heart is enlarged and less efficient pump, total body fluid overload, compromises pulmonary function
  2. Recovery of normal cardiac function parallels recovery of pulmonary system
32
Q

Respiratory System: CLD/BPD (4)

A
  1. Incidence is inversely proportional to birth weight and gestational age
  2. Characterized by increase airway resistance from inflammation of the airway and bronchial hyperresponsiveness
  3. May have tracheomalacia and/or bronchomalacia
  4. Many with neurodevelopmental deficits Growth failure
33
Q

CLD (3)

A
  1. Iatrogenic disease: Oxygen toxicity and Barotraumas from pressure ventilation
  2. Excessive bronchial secretions, narrowed airways, ineffective O2 and CO2 exchange
  3. Severe forms: oxygen dependence, increased work of breathing, vulnerable to infections
34
Q

Transient Tachypnea (5)

A
  1. Most common respiratory disorder seen in late preterm
    a. Delayed reabsorption of fetal alveolar fluid
    i. Used to be thought squeeze through birth canal did it
    ii. Now recognize that fluid production decreases before vaginal delivery
    iii. Large premature, term or late preterm infant born via C/s section with no history of labor or infant of diabetic mother.
  2. Usually within 2-3 hours of birth
  3. Can be as late as 12 to 24 hours
  4. Slight tachypnea with RR 60-80
  5. Mild labored with nasal flaring and grunting
35
Q

Acute respiratory infections (2)

A
  1. Preemies are more susceptible to pneumonia
    * Do not let any children with colds/sick be around premies
  2. Catastrophic outcomes in CLD with RSV
36
Q

Respiratory Complications: Bronchopulmonary Dysplasia (4)

A
  1. “Chronic lung disease following respiratory failure”
  2. Etiology: barotrauma, inflammation and oxygen exposure
  3. Increased susceptibility to pulmonary infections
  4. Persists until adolescence
37
Q

Respiratory Complications: Bronchopulmonary Dysplasia – What could you have done? (3)

A
  1. Provided higher caloric diet
  2. Bronchodilators, Lasix, oxygen and treat infections
  3. Palivizumab – RSV monoclonal antibody
38
Q

Management of CLD/BPD (7)

A
  1. Bronchodilators
  2. Diuretic
  3. Oxygen
  4. Antibiotics when needed
  5. Immunize with Synagis/flu vaccine
  6. Excellent nutrition with high calories and nutrients
  7. MCT oil .25 to 1 gm per ounce of formula  Consult dietician, OT, speech therapy
    a. Speech therapy//make sure they are not aspirating
39
Q

Management of Apnea with Prematurity (5)

A
  1. Periodic breathing with pathologic apnea in premature infants
  2. 40% are central, 50% are mixed, 10% are obstructive
  3. Usually ceases by 37 weeks
  4. Pharmacological management with caffeine
  5. Preemies may be discharged on meds
40
Q

Persistent Pulmonary Hypertension of Newborn (PPNH) (3)

A
  1. Syndrome of acute respiratory failure
  2. Failure to achieve a normal decrease in PVR that occurs at birth with a variable degree of right to left shunting of venous blood across the fetal chambers (PDA, PFO)
  3. Characterized by systemic hypoxemia and elevated pulmonary arterial pressure in the absence of congenital defects.
41
Q

Gastroesophageal Reflux: Overview (6)

A
  1. Manifests as regurgitation, apnea, aspiration pneumonia, worsening BPD/CLD
  2. Increased incidence in premature
  3. Theophylline and caffeine exacerbate GER symptoms
  4. Regurgitation, apnea, irritability, bradycardia, or Respiratory Distress syndrome (RDS)
  5. Potential morbidity
    a. Pneumonia
    b. Respiratory distress
    c. Esophagitis
  6. Use of PPI not recommended
42
Q

Gastroesophageal Reflux: Manifestations (3)

A
  1. Premature infants: hypotonic LES, delayed emptying and decreased compliance of stomach
  2. Vomiting after feeds, spells, cough
  3. Sandifer syndrome: arching of back, rigid neck, opisthotonus
43
Q

Gastroesophageal Reflux: Conservative Treatment (2)

A
  1. Thickened feeds, frequent small feeds, positioning the infant
  2. Medical Treatment: Ranitidine, PPI’s and prokinetic are used without approval for use
44
Q

Premature and GER (3)

A
  1. Infants with very low birth weight (VLBW)
  2. H2RAs often given for GER or to prevent stress-induced gastritis
  3. H2RA use in significant association with necrotizing enterocolitis
45
Q

NEC (6)

A
  1. Destructive process of small bowel
  2. Occur in 5 of 100 VLBW live births
  3. 1 of 1000 live births
  4. Ileocecal region is most commonly involved*
  5. Up to 15% necrosis of bowel
  6. Risk of short bowel syndrome due to resection
46
Q

Inguinal Hernia (5)

A
  1. Appear as bulge in the groin, scrotum or labia
    a. Parent should immediately go to ED if they see this
  2. Greater risk of strangulating with premature infants
  3. Surgical repair to prevent incarceration (within the first six months)
  4. Prompt referral
  5. Educate about when to go to the ED
47
Q

Car seat safety (3)

A
  1. Observe child in care seat if child is at risk for respiratory problems
  2. Air travel should be delayed until 6-8 weeks past due date
  3. All infants with cardiac and apnea monitor should make sure that equipment has adequate battery life

PPC3 Exam 1 (13 decks)

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