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The High Risk Infant Flashcards

1
Q

how do you high risk defined

A

high probability of developmental delay
high rate of mortality and morbidity

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2
Q

what is high risk classified by (3)

A

birth weight
gestational age
physiological status

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3
Q

what determines the setting of care

A

medical stability
level of care needed

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4
Q

what are the 4 levels of Neonatal care

A

1 - well-baby nursery
- capacity for emergency resuscitation
- expectation that infant requires little monitoring and is on way of going home

2 - special care nursery
- more monitoring available

3 - NICU
- critically ill

4 - regional NICU
- speciality centers

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5
Q

who is a developmental follow up clinic most appropriate for

A

levels 2-4 of neonate care
- level 1 still might need

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6
Q

who is appropriate for inpatient rehab

A

if can’t go home right away

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7
Q

why can asphyxia or hypoxia-ischemia happen

A

d/t placental insufficiency or umbilical asphyxiation

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8
Q

what are risks for morbidity & mortality of an infant (8)

A

prematurity
LBW, SGA
IUGR
RDS, BPD
metabolic
- hypoglycemia -> significant risk
multiple births
genetic syndromes & dz
neonatal abstinence syndrome

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9
Q

what is IUGR

A

intrauterine growth retardation
- infant born significantly low in wt, length, and head circumference

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10
Q

why can multiple births inc risk for morbidity and mortality

A

defined amt of space
can compromise fetus and inc risk of premature delivery and mortality

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11
Q

how can disparities in health and healthcare affect risk for morbidity and mortality

A

racial inequities in pregnancy related mortality

black women 2x likely to deliver VLBW infant
preterm birth 50% higher in black women

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12
Q

what is FTG

A

38-41wks

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13
Q

what is pre-term gestational age

A

<37wks

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14
Q

what is post-term gestational age

A

> 42wks

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15
Q

what is normal birth weight at 40wks

A

~6lbs

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16
Q

what is low BW

A

~5.5lbs

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17
Q

what is very low BW

A

</= 3.3lbs

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18
Q

what is extremely LBW and when is this normal

A

<2lbs
normal BW for 24wks gestation

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19
Q

what are 4 common related complications associated w prematurity

A

pulmonary (IRDS & BPD)
CNS (IVH, PVL)
GI (NEC)
hemotological (hyperbilirubinemia)

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20
Q

what multisystem path are premature infants at risk for

A

cardiopulmonary
CNS
GI
primary sensory

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21
Q

what are 4 general characteristics of premature infants (<37wks)

A

physiological flexion
- absent or diminished
reflexes (rooting, suck swallow)
- absent or diminished
immaturity - physio & behavior
pain sensitivity

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22
Q

why is the premature infant more sensitive to pain

A

by 20-24wks gestation: pain pathways, cortical and subcortical centers of pain perception, and neurochemical system associated w pain transmission are functional

not until 36-40wks gestation that pain modulatory tracts which inhibit pain via serotonin and norepinephrine are functional

= heightened sensitivity

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23
Q

what is the risk of poor management of the premies’ heightened sensitivity to pain

A

can lead to prolonged structural and functional changes

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24
Q

what are components for pain management

A

clustering care
sucrose
developmental supportive care

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25
what are 4 risk factors for developing IRDS
prematurity - CP system immature LBW low APGAR need for neonatal transport - from community hospital bc not able to provide care
26
what are 3 causes of IRDS
1. significant pulmonary immaturity 2. no/insufficient surfactant 3. ventilation/perfusion mismatch
27
why is it common for no/insufficient surfactant in premies
surfactant starts being produced at 26-29wks but not chemically mature -> doesn't start to function until 34wks
28
why is a ventilation/perfusion mismatch sometimes seen in premies
surfactant not doing its job -> inc surface tension -> alveolar collapse & atelectasis -> inc pulmonary artery pressure -> ventilation perfusion mismatch
29
when does uncomplicated IRDS resolve
w/i 3-4 days
30
what are interventions that may be utilized with IRDS
supplemental O2 - mechanical vent - ECMO surfactant replacement therapy
31
what are the benefits of surfactant replacement therapy for IRDS
dec morality dec air leak dec chronic lung dz in premies w IRDS
32
what is the pathophys of bronchopulmonary dysplasia (BPD) - 3
interstitial fibrosis alveolar collapse smooth ms hypertrophy
33
what is a common dx to follow a dx of BPD
chronic lung dz of infancy
34
what is the dx criteria for BPD (3)
1. mechanical vent - 1st wk of life 2. (D) on O2 >28days 3. persistent densities on chest XR
35
what are dx findings via PFTs in BPD (3)
inc airway resistance dec compliance inc work of breathing
36
what are interventions for BPD (3)
infection control* significant hydration & nutrition - critical for growth of healthy alveoli respiratory support therapy - CPT -> poor airway clearance, retention of secretions
37
what is an important factor to consider with interventions for BPD
poor activity tolerance
38
what is the overall goal/outcome of interventions for BPD
can outgrow BPD if facilitate new alveolar growth w good infection control and nutrition
39
what are 3 signs of poor activity tolerance in a baby w IRDS
change in VS poor feeding - fatigue quickly - need breaks - not gaining wt poor interaction
40
what is considered activity for infants
revolves around feeding & interaction - maybe early motor activity (ex: head control)
41
what are the 3 main goals of PT in infants
improve activity, feeding, and interaction
42
why do you commonly see CNS complications in premies
immaturity/anomalies of CVP will create inc vulnerability to altered states of HoTN or HTN, inc vulnerability to CNS damage
43
what is periventricular leukomalacia (PVL)
areas of cellular necrosis in white matter, near lateral ventricle - fluid filled cysts left behind
44
what are 2 causes of PVL
trauma hypoxia/ischemia to arterial supply to periventricular white matter
45
what is PVL a sensitive marker for and why
sensitive marker for poor neurodevelopmental outcomes - risk for CP inc bc of location, along lateral ventricle near corticospinal tract
46
what is intraventricular hemorrhage (IVH)
starts in subependymal layer (where glioblasts are formed) of germinal matrix - may extend into intraventricular space
47
what is IVH associated with (3)
1. poor vascular autoregulation 2. high metabolic activity of germinal matrix 3. fragile endothelial walls of immature vasculature
48
what does IVH have a direct relationship to
prematurity
49
grades 1/2 vs 3/4 of IVH
1/2: mild and infants have good outcomes 3/4: much more significant w more bleeding - 3: bleeding press on brain - 4: bleeding invades brain
50
what are 2 complications of IVHs
hydrocephalus - obtructed flow of CSF hypoxic/ischemic lesions
51
how is IVH dx
head US, CT
52
what is medical treatment for IVH (2)
stabilize hemodynamics limit stim (acute phase)
53
what is necrotizing enterocolitis (NEC)
acute inflammatory dz of bowel - reflects immaturity of bowel to handle minor toxins and infections
54
what are 3 factors for NEC
intestinal ischemia infection toxins
55
what are signs/red flags for NEC (4)
vomiting abdominal distention bloody stools change in respiratory status
56
what are treatments for NEC
TPN - gives gut time to rest gastric suctioning possible surgery - remove necrotic tissue via temporary colostomy and later re-anatomize ends of colon
57
what is hyperbilirubinemia
buildup of bilirubin in blood d/t immature liver - leading to jaundice
58
what are sx of hyperbilirubinemia (4)
lethargic low tone low feeding low sucking
59
what is the risk fo hyperbilirubinemia
kernicturus - buildup of bilirubin in BG d/t weakened BBB
60
what is the main treatment for hyperbilirubinemia
phototherapy - can also be used prophylactically
61
NAS vs NOWS
neonatal abstinence syndrome - result of poly substance used neonatal opioid withdrawal syndrome - result of opioid use (prescription, methadone, heroin)
62
what is NAS/NOWS caused by
prenatal exposure to opiates rapid discontinuation at delivery w cutting of cord -> significant inc in noradrenalin -> ANS, CNS, & GI s/sx of withdrawal
63
what are CNS (4), ANS (4), and GI (3) s/sx of withdrawal seen in NAS/NOWS
CNS: - inc ms tone - inconsolibility - irritability - high pitched cry ANS - sweating - sneezing - frequent yawning - inc RR GI - poor feeding - regurgitation/vomiting - loose / watery stools
64
what medical intervention is seen with NAS/NOWS
methadone/morphine - dosing determined by q4hour assessment
65
what does NAS/NOWS impacts in the infant's development outcomes
neurobehavioral language motor systems
66
what are long term outcomes in early stages of NAS/NOWS impacted by
polypharmacy exposure SES

Lifespan (20 decks)

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