Prematurity: growth and development Flashcards
conditions that indicate will present likely have CP
major complications of prematurityL neurologic 28-32 weeks
intraventricular hemorrhage
periventricular leukomalacia
Bronchopulmonary dysplasia risk factors
born premature (more than ten weeks preemie)
weigh less than two pounds
history of RDS (respiratory distress syndrome)
on supplemental oxygen
lung tissue thickened and makes O2 and CO2 exchange difficult
tx jaundice
phototherapy
tummy time
–when to start
right away
prone, football hold, on lap, roll up a towel and put it underneath their arm pits
Gravida Para
FAPL
G= Gravida: # of pregnancies
P = Para: outcomes
G6P224
F: full term births
P= pre-mature births
A: abortion spontaneous or therapeutic
L = living
G6P224
???
Full term: how many weeks?
born at 38-40 weeks
Post Term: how many weeks?
born after 40 weeks
Preterm: how many weeks?
born before 37 weeks
Minimum age of viability
23-24 weeks of gestation
—with scattered reports of survivors at 21-22 weeks estimated gestation
APGAR
newborns assessed at 1 and 5 minutes after birth to determine the physical condition of the newborn and need for immediate care
A = appearance (skin color)
P = pulse (heart rate)
G = grimace (reflex irritability)
A= activity (muscle tone)
R = respiration
APGAR
A =
appearance (skin color)
APGAR
P=
P = pulse (heart rate)
APGAR
G=
G = grimace (reflex irritability)
APGAR
A=
A= activity (muscle tone)
APGAR
R=
R = respiration
APGAR
score
what is normal score?
what is resuscitation score?
Normal: score 8 or 9 : newborn is in good condition
a score of 10 is very unusual because almost all newborns lose one point for blue hands and feet which is normal
resuscitation score is 0-3
–baby went into distress and delivered and resuscitated
APGAR
score 8 or 9
Normal: score 8 or 9 : newborn is in good condition
a score of 10 is very unusual because almost all newborns lose one point for blue hands and feet which is normal
APGAR
score 4-6
a score of 4, 5, 6, requires immediate intervention
a score of 4-6 indicates that the neonate is having difficulty adapting to life outside the uterus
Baby gets this score because required immediate intervention:
- suctioning if breathing has been obstructed by mucous
- O2 respiratory assistance
- O2 delivered–O2 placed near BUT NOT DIRECTLY over the nose and mouth
APGAR
score 0-3
resuscitation score is 0-3
–baby went into distress and delivered and resuscitated
low APGAR score may be related to
- prematurity
- medications given to the mother during labor
- rapid delivery
FPAL
F
full term births
FPAL
P
pre mature births
PFAL
A
abortion
FPAL
L
living
Para
outcomes
Gravida
number of pregnancies
AGA
appropriate for gestational age
birth weight between 10th and 90th percentile
SGA
small for gestational age
birth weight below 10th percentile
LGA
large for gestational age
birth weight above 90th percentile
*Normal Birth Weight
2500-3999g
5 lbs 8 oz
TO
8lbs 13 oz
*LBW
<5 lbs, 8 oz
2500g
VLBW
< 3lbs 4 oz
<1500g
ELBW
extremely low birth weight
< 2lbs 3 oz
MLBW
1500-2500g
3lbs 5 oz
TO
5lbs 8 oz
micro preemies
about 23 weeks
750g or
1lb 10oz
Risk factors for LBW
4
1) born before 37 weeks
2) SES: low income, lack education
3) maternal health problems (DM, HTN)
4) multiple births, triplets…
Low APGAR may be due to (3)
1) prematurity
2) medications given to mother during labor
3) rapid delivery
Major complications of prematurity (5)
1) neurologic (28-32 weeks neurologic damage): IVH, PVL, Seizures
2) respiratory: RDS, BPD, apnea
3) cardiac: patent ductus arteriosus, bradycardia
4) gastrointestinal: necrotizing enterocolitis, jaundice, kernicterus, athetoid CP
5) sensory: retinopathy of prematurity, hearing impairment
Neurological complications of prematurity
1) IVH: intraventricular hemorrhage
2) PVL: periventricular leukomalacia
3) Seizures
Neurological complications of prematurity
IVH
what is it
who gets it
outcome
how to dx
intraventricular hemorrhage: bleeding into the brain’s ventricular system
*** lateral ventricular bleed, most common
occurs in premature infants
WHO: occurs in premature infants less than 32 weeks and less than 1500g (VLBW)
OUTCOME: spastic hemiparesis, quadriparesis, cognitive deficits
***CP
DX: cranial sonogram
Neurological complications of prematurity
PVL
-what is it
who gets it
outcome
how to dx
periventricular leukomalacia:
white matter necrosis surrounding ventricles secondary to decreased oxygenation and blood flow to brain
WHO: premature before 32 weeks
OUTCOMES: spastic diplegia or spastic quadriparesis, cognitive deficits
***CP
DX: CT
wiki: form of white-matter brain injury, characterized by the necrosis (more often coagulation) of white matter near the lateral ventricles.[1][2] It can affect n
Respiratory complications of prematurity
1) RDS: respiratory distress syndrome
2) BPD: bronchopulmonary dysplasia
3) apnea (lack of breathing for 20 or more seconds bc system immaturity, in 90% ELBW that weigh <1000g birth, may indicate systemic medical issue)
True of false: Apnea is not associated with SIDS
there is no association between apnea and sudden infant death syndrome = SIDS
Respiratory complications of prematurity
Apnea
apnea
lack of breathing for 20 or more seconds bc system immaturity
in 90% ELBW that weigh <1000g birth
may indicate systemic medical issue
there is no association between apnea and sudden infant death syndrome = SIDS
caffeine to minimize frequency
Respiratory complications of prematurity
RDS:
Respiratory Distress Syndrome = hyaline membrane disease
WHEN: age < 34 weeks (60% at 29 weeks)
PROBLEM: surfactant deficit: surfactant decreases surface tension of smaller airways so that the alveoli do not collapse
TX:
1) surfactant replacement
2) O2
3) mechanical ventilation in some cases
[online: Respiratory distress syndrome (hyaline membrane disease) is a breathing disorder of premature newborns in which the air sacs (alveoli) in a newborn’s lungs do not remain open because the production of a substance that coats the alveoli (surfactant) is absent or insufficient.]
Respiratory complications of prematurity
BDP
- who
- what happens
- consequences
- tx
Bronchopulmonary Dysplasia
WHO:
1) born more than 10 weeks premature
2) weigh less than 2lbs or 1,000g (ELBW)
3) Hx of RDS
CAUSE: walls of lung thicken, making O2/CO2 exchange difficult
CONSEQUENCES
1–limited physical activity tolerance leads to developmental delays
2–chronic upper respiratory problems-chronic lung disease
Tx: REQUIRED SUPPLEMENTAL O2 AND/OR MECHANICAL VENTILATION
online BPD
Bronchopulmonary dysplasia (BPD) is a lung disease that occurs most often in babies who were born severely premature—more than 10 weeks before their due date. Babies with BPD have inflammation and scarring in the lungs.
BPD usually is a complication in premature infants being treated for respiratory distress syndrome (RDS). RDS is a condition in which the baby’s lungs are not developed enough to take in the air they need.
Babies with RDS must have oxygen and often need to be on a breathing machine to prevent brain damage and to save their lives. But the oxygen premature babies need can damage their lungs. When it must be delivered into the babies’ lungs by a machine, it may be even more damaging. The infants whose lungs require this treatment are at risk for developing BPD.
Many infants with BPD recover and improve with time, achieving normal or near normal function.
Cardiac Complications of Prematurity
1) patent ductus arteriosus (unclosed hole in the aorta)
- heart murmur
2) bradycardia
GI complications of Prematurity
1) Necrotizing Enterocolitis (NEC)
2) Jaundice (kernicterus, athetoid CP)
- kernicterus (brain damage due to exces jaundice)
- athetoid CP (caused by excess bilirubin)
online
Athetoid cerebral palsy
Athetoid cerebral palsy or dyskinetic cerebral palsy (sometimes abbreviated ADCP) is a type of cerebral palsy primarily associated with damage, like other forms of CP, to the basal ganglia in the form of lesions that occur during brain development due to BILIRUBIN encephalopathy and hypoxic-ischemic brain injury.[1]
Unlike spastic or ataxic cerebral palsies, ADCP is characterized by both hypertonia and hypotonia, due to the affected individual’s inability to control muscle tone.[2]
Clinical diagnosis of ADCP typically occurs within 18 months of birth and is primarily based upon motor function and neuroimaging techniques.
GI complications of Prematurity
Necrotizing Enterocolitis (NEC)
what is it
cause
–small intestines wall necrosis
exact cause unknown, suspect MULTIFACTORIAL causes:
- bacteria
- intestinal mucosal immaturity/dysfunction
- intestinal ischemia
- formula feeding increases the risk of NEC by 10x compared to infants breastfed alone !!!!!
online NEC
Necrotizing enterocolitis (NEC) is a medical condition primarily seen in premature infants,[1] where portions of the bowel undergo necrosis (tissue death). It occurs postnatally (i.e., is not seen in stillborn infants)[2] and is the second most common cause of mortality in premature infants,[3] causing 386 deaths in the United States in 2011, down from 472 in 2010.[4]
Sensory complications of Prematurity
1) retinopathy of prematurity
2) hearing impairment
Sensory complications of Prematurity
retinopathy of prematurity
-retinal vasculariztion is not complete until near term!!
preterm delivery may interfere with this process, resulting in abnormal blood vessel development and cause retinal detachment
can lead to blindness
HIGHEST RISK: (risk increase with lower birth weight )
<1800g (MLBW)
also increased risk if supplemental O2 for RDS
Sensory complications of Prematurity
hearing impairment
risk!
GI complications of Prematurity
Jaundice
- what is it
- complications
- tx
hyperbilirubinemia
- bilirubin accumulates in blood because immature liver cannot process it
- —bilirubin is the end product of Hgb breakdown
COMPLICATIONS
***prevent KERNICTERUS: a form of brain damage caused by excessive jaundice
–can develop athetoid CP (bc high biliruin)
TX phototherapy
kernicterus
a form of brain damage caused by excessive jaundice
consequence of hyperbilirubinemia, a GI complication of prematurity
athetoid CP
(bc high biliruin) consequence of hyperbilirubinemia, a GI complication of prematurity
signs of distress in infants
infant does not want to be held
- -physiologic
- -skin color change
- -hiccups
- -finger splaying
- -LE stiffness and extension
- -frowning
- -turning away from face or sound
online
signs of distress in infants
The baby will salute you – essentially this looks like a baby stretching out their hand toward you, (usually the back of the hand toward you) and up towards their face. Parents will say, “How cute! He is waving at me!” Nope, nope and nope.
The baby will extend the arm and splay the fingers apart.
The baby will frown, grimace, grunt.
The baby will all of the sudden start yawning, hiccupping, or sneezing multiple times. (Yes, babies do yawn, hiccup, or sneeze but this is more like 10 times in a row or more all of the sudden).
The baby will arch the back and neck and push away (and yes, some babies with gastroesophageal reflux disease will also arch and push away).
The baby will look away suddenly and for a long period after having a period of wonderful eye contact on a caregiver’s face – think about this one carefully. We ourselves do not maintain focused eye contact on others when we are in conversation, but often our eyes are scanning and resting, scanning and resting. The looking away is a sign the baby needs a break and less focus.
The baby will cry. This is usually a last sign when all other signs have been ignored.
The baby will become frantic and move all extremities wildly.
Or, conversely, the baby will just shut down, shut his or eyes and tune everything out.
positioning premature infants
position in flexion in all positions
34 weeks and older infants can lift and turn their head in prone
<32 weeks: difficulty coping with light and noise, eye patches
Sidelying: promotes hands together and hand to mouth exploration
<32 weeks: why give them eyepatch?
<32 weeks: difficulty coping with light and noise, eye patches
4 bad consequences of lack of proper NICU positioning
1) skull deformities
2) preferential head turning to 1 side
3) fine motor delays:
- shoulder girdle tightness “W” arm positioning
- scapula retracted and humerus ER
4) gross motor delays
- LE tightness “M” positioning –frog legged
- hips abducted and ER
Kangaroo Care:
what is it
a method of holding a baby that involves skin to skin contact
naked infant except for diaper and a peice of clothing covering their back (either a receiving blanket or parents clothing)
the infant is placed in an upright position against the parents bare chest
- -NICU
- -MEdical team
Kangaroo Care:
benefits (11)
- HR stabilize
- improve BREATHING pattern, decreased apnea
- improve O2 sat levels
- more SLEEP time
- more rapid WEIGHT gain
- decreased CRYING
- ANALGESIC during painful procedures such as heel stick
- IMPROVED THERMOREGULATION
- improved behavioral state-promotes CALMING behaviors
- decreased environmental NICU stressors
- more successful BREASTFEEDING episodes
Extrinsic factors that effect motor development
- opportunity / exposure: prone positioning, stair climbing
- motivation to move
- environmental pollutants
- inadequate nurturing and bonding
- parental / cultural childrearing–lack of tummy time
TUMMY TIME
lack of tummy time associated with
1) gross motor delays
2) plagiocephaly –flattening of a baby’s skull
[develop gross–>fine–>speech]
SIDS: what is it
sudden infant death in infants < 1 year old
SIDS:
cause
unexplained cause
possible explanation: abnormal serotonin production and use serotonin regulates: 1. breathing 2. BP 3. body heat 4. ability to wake
Risk factors for SIDS
- young maternal age
- late or no prenatal care
- premature birth and/or LBW
- maternal smoking during pregnancy
- second hand smoke
- male
- prone sleeping
- sleeping on a soft surface
- overheating
Back to sleep campaign
- SUPINE, vary head position to avoid plagiocephaly
* ***side sleeping is NOT AS SAFE as supine and is NOT ADVISED - FIRM sleep SURFACE: do not place any soft object or material under the sleeping infant
- —no pillows, quilts, comforters, sheepskins, wedges: keep out of crib
- —no bumper pads (suffocate/strangle sleeping infant) - use FITTED SHEETS designed for mattress
never use crib sheets unless it fits securely on the crib mattress
—loose bedding ie blankets and sheets can be hazardous - Blanket: make up bedding so feet reach the foot of the crib (FEET TO FOOT) with the blankets TUCKED in around the crib mattress and reach only to the level of the infants CHEST
* ****Sleep clothing such as sleepers, sleep sacks, and wearable blankets are better alternatives to blankets
AAP Blanket:
make up bedding so feet reach the foot of the crib (feet to foot) with the blankets tucked in around the crib matress and reach only to the level of the infants chest
*sleep clothing such as sleepers, sleep sacks, and wearable blankets are better alternatives to blankets
infant sleep positioner
nap nanny
canopy
drop down side rails
products:
—infant sleep positioner device: BAD: risk of suffocation, AAP doesnt recommend any sleep positionor device to prevent SIDS
–nap nanny: injury and death associated, infant fell out despite restraint
cribs:
- –canopy: BAD: used to prevent crawling out and animals in but risk death and injury
—drop down side rails: BAD: safety risk–hardware break or fall allowing the drop side to detach from the crib –this newly created space allows the head/body to get caught between the mattress and side railing
AAP on SIDS
where should baby sleep
place crib or bassinet in parents room close to the bed
infants should not share the bed with parents during sleep
no one should sleep with infant on a couch or armchair
AAP on pacifier
consider it for nap and bedtime
AAP on overheating
avoid overheating
infant should be lightly clothed
bedroom temp kept comfortable for a lightly clothed adult
baby should not sleep next to a radiator or heater or in direct sunshine
Back to sleep campaign
-is it working
started 1994 and SIDS declined more than 50%
EDUCATE PARENTS AND etc ABOUT BACK TO SLEEP CAMPAIGN AND ABOUT…
TUMMY TIME!!!!!!!!!
Tummy time
–when to do it
–how to do it
–when to start
–how often
when awake play in prone
roll up a towel and place the infant prone over the towel
begin placing the infant in prone when they are a few days old and awake (post birth asap)
start with a few minutes a few times a day, work up to an hour a day by the end of three months
place them prone after each diaper change and each bath
