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פידס > Prematurity: growth and development > Flashcards

Prematurity: growth and development Flashcards

1
Q

conditions that indicate will present likely have CP

A

major complications of prematurityL neurologic 28-32 weeks

intraventricular hemorrhage

periventricular leukomalacia

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2
Q

Bronchopulmonary dysplasia risk factors

A

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

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3
Q

tx jaundice

A

phototherapy

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4
Q

tummy time

–when to start

A

right away

prone, football hold, on lap, roll up a towel and put it underneath their arm pits

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5
Q

Gravida Para

FAPL

A

G= Gravida: # of pregnancies

P = Para: outcomes

G6P224

F: full term births
P= pre-mature births
A: abortion spontaneous or therapeutic
L = living

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6
Q

G6P224

A

???

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7
Q

Full term: how many weeks?

A

born at 38-40 weeks

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8
Q

Post Term: how many weeks?

A

born after 40 weeks

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9
Q

Preterm: how many weeks?

A

born before 37 weeks

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10
Q

Minimum age of viability

A

23-24 weeks of gestation

—with scattered reports of survivors at 21-22 weeks estimated gestation

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11
Q

APGAR

A

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

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12
Q

APGAR

A =

A

appearance (skin color)

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13
Q

APGAR

P=

A

P = pulse (heart rate)

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14
Q

APGAR

G=

A

G = grimace (reflex irritability)

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15
Q

APGAR

A=

A

A= activity (muscle tone)

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16
Q

APGAR

R=

A

R = respiration

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17
Q

APGAR

score

what is normal score?

what is resuscitation score?

A

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

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18
Q

APGAR

score 8 or 9

A

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

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19
Q

APGAR

score 4-6

A

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
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20
Q

APGAR

score 0-3

A

resuscitation score is 0-3

–baby went into distress and delivered and resuscitated

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21
Q

low APGAR score may be related to

A
  1. prematurity
  2. medications given to the mother during labor
  3. rapid delivery
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22
Q

FPAL

F

A

full term births

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23
Q

FPAL

P

A

pre mature births

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24
Q

PFAL

A

A

abortion

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25
Q

FPAL

L

A

living

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26
Q

Para

A

outcomes

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27
Q

Gravida

A

number of pregnancies

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28
Q

AGA

A

appropriate for gestational age

birth weight between 10th and 90th percentile

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29
Q

SGA

A

small for gestational age

birth weight below 10th percentile

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30
Q

LGA

A

large for gestational age

birth weight above 90th percentile

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31
Q

*Normal Birth Weight

A

2500-3999g

5 lbs 8 oz

TO

8lbs 13 oz

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32
Q

*LBW

A

<5 lbs, 8 oz

2500g

33
Q

VLBW

A

< 3lbs 4 oz

<1500g

34
Q

ELBW

A

extremely low birth weight

< 2lbs 3 oz

35
Q

MLBW

A

1500-2500g

3lbs 5 oz

TO

5lbs 8 oz

36
Q

micro preemies

A

about 23 weeks

750g or

1lb 10oz

37
Q

Risk factors for LBW

4

A

1) born before 37 weeks
2) SES: low income, lack education
3) maternal health problems (DM, HTN)
4) multiple births, triplets…

38
Q

Low APGAR may be due to (3)

A

1) prematurity
2) medications given to mother during labor
3) rapid delivery

39
Q

Major complications of prematurity (5)

A

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

40
Q

Neurological complications of prematurity

A

1) IVH: intraventricular hemorrhage
2) PVL: periventricular leukomalacia
3) Seizures

41
Q

Neurological complications of prematurity

IVH

what is it

who gets it

outcome

how to dx

A

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

42
Q

Neurological complications of prematurity

PVL

-what is it

who gets it

outcome

how to dx

A

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

43
Q

Respiratory complications of prematurity

A

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)

44
Q

True of false: Apnea is not associated with SIDS

A

there is no association between apnea and sudden infant death syndrome = SIDS

45
Q

Respiratory complications of prematurity

Apnea

A

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

46
Q

Respiratory complications of prematurity

RDS:

A

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.]

47
Q

Respiratory complications of prematurity

BDP

  • who
  • what happens
  • consequences
  • tx
A

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

48
Q

online BPD

A

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.

49
Q

Cardiac Complications of Prematurity

A

1) patent ductus arteriosus (unclosed hole in the aorta)
- heart murmur

2) bradycardia

50
Q

GI complications of Prematurity

A

1) Necrotizing Enterocolitis (NEC)

2) Jaundice (kernicterus, athetoid CP)
- kernicterus (brain damage due to exces jaundice)
- athetoid CP (caused by excess bilirubin)

51
Q

online

Athetoid cerebral palsy

A

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.

52
Q

GI complications of Prematurity

Necrotizing Enterocolitis (NEC)

what is it

cause

A

–small intestines wall necrosis

exact cause unknown, suspect MULTIFACTORIAL causes:

  1. bacteria
  2. intestinal mucosal immaturity/dysfunction
  3. intestinal ischemia
  4. formula feeding increases the risk of NEC by 10x compared to infants breastfed alone !!!!!
53
Q

online NEC

A

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]

54
Q

Sensory complications of Prematurity

A

1) retinopathy of prematurity

2) hearing impairment

55
Q

Sensory complications of Prematurity

retinopathy of prematurity

A

-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

56
Q

Sensory complications of Prematurity

hearing impairment

A

risk!

57
Q

GI complications of Prematurity

Jaundice

  • what is it
  • complications
  • tx
A

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

58
Q

kernicterus

A

a form of brain damage caused by excessive jaundice

consequence of hyperbilirubinemia, a GI complication of prematurity

59
Q

athetoid CP

A

(bc high biliruin) consequence of hyperbilirubinemia, a GI complication of prematurity

60
Q

signs of distress in infants

A

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
61
Q

online

signs of distress in infants

A

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.

62
Q

positioning premature infants

A

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

63
Q

<32 weeks: why give them eyepatch?

A

<32 weeks: difficulty coping with light and noise, eye patches

64
Q

4 bad consequences of lack of proper NICU positioning

A

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

65
Q

Kangaroo Care:

what is it

A

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
66
Q

Kangaroo Care:

benefits (11)

A
  1. HR stabilize
  2. improve BREATHING pattern, decreased apnea
  3. improve O2 sat levels
  4. more SLEEP time
  5. more rapid WEIGHT gain
  6. decreased CRYING
  7. ANALGESIC during painful procedures such as heel stick
  8. IMPROVED THERMOREGULATION
  9. improved behavioral state-promotes CALMING behaviors
  10. decreased environmental NICU stressors
  11. more successful BREASTFEEDING episodes
67
Q

Extrinsic factors that effect motor development

A
  1. opportunity / exposure: prone positioning, stair climbing
  2. motivation to move
  3. environmental pollutants
  4. inadequate nurturing and bonding
  5. parental / cultural childrearing–lack of tummy time
68
Q

TUMMY TIME

A

lack of tummy time associated with

1) gross motor delays
2) plagiocephaly –flattening of a baby’s skull

[develop gross–>fine–>speech]

69
Q

SIDS: what is it

A

sudden infant death in infants < 1 year old

70
Q

SIDS:

cause

A

unexplained cause

possible explanation:  abnormal serotonin production and use
serotonin regulates:
1. breathing
2. BP
3. body heat
4. ability to wake
71
Q

Risk factors for SIDS

A
  1. young maternal age
  2. late or no prenatal care
  3. premature birth and/or LBW
  4. maternal smoking during pregnancy
  5. second hand smoke
  6. male
  7. prone sleeping
  8. sleeping on a soft surface
  9. overheating
72
Q

Back to sleep campaign

A
  1. SUPINE, vary head position to avoid plagiocephaly
    * ***side sleeping is NOT AS SAFE as supine and is NOT ADVISED
  2. 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)
  3. 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
  4. 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
73
Q

AAP Blanket:

A

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

74
Q

infant sleep positioner

nap nanny

canopy

drop down side rails

A

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

75
Q

AAP on SIDS

where should baby sleep

A

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

76
Q

AAP on pacifier

A

consider it for nap and bedtime

77
Q

AAP on overheating

A

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

78
Q

Back to sleep campaign

-is it working

A

started 1994 and SIDS declined more than 50%

EDUCATE PARENTS AND etc ABOUT BACK TO SLEEP CAMPAIGN AND ABOUT…

TUMMY TIME!!!!!!!!!

79
Q

Tummy time

–when to do it

–how to do it

–when to start

–how often

A

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

פידס (13 decks)

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