The High Risk Infant Flashcards
how do you high risk defined
high probability of developmental delay
high rate of mortality and morbidity
what is high risk classified by (3)
birth weight
gestational age
physiological status
what determines the setting of care
medical stability
level of care needed
what are the 4 levels of Neonatal care
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
who is a developmental follow up clinic most appropriate for
levels 2-4 of neonate care
- level 1 still might need
who is appropriate for inpatient rehab
if can’t go home right away
why can asphyxia or hypoxia-ischemia happen
d/t placental insufficiency or umbilical asphyxiation
what are risks for morbidity & mortality of an infant (8)
prematurity
LBW, SGA
IUGR
RDS, BPD
metabolic
- hypoglycemia -> significant risk
multiple births
genetic syndromes & dz
neonatal abstinence syndrome
what is IUGR
intrauterine growth retardation
- infant born significantly low in wt, length, and head circumference
why can multiple births inc risk for morbidity and mortality
defined amt of space
can compromise fetus and inc risk of premature delivery and mortality
how can disparities in health and healthcare affect risk for morbidity and mortality
racial inequities in pregnancy related mortality
black women 2x likely to deliver VLBW infant
preterm birth 50% higher in black women
what is FTG
38-41wks
what is pre-term gestational age
<37wks
what is post-term gestational age
> 42wks
what is normal birth weight at 40wks
~6lbs
what is low BW
~5.5lbs
what is very low BW
</= 3.3lbs
what is extremely LBW and when is this normal
<2lbs
normal BW for 24wks gestation
what are 4 common related complications associated w prematurity
pulmonary (IRDS & BPD)
CNS (IVH, PVL)
GI (NEC)
hemotological (hyperbilirubinemia)
what multisystem path are premature infants at risk for
cardiopulmonary
CNS
GI
primary sensory
what are 4 general characteristics of premature infants (<37wks)
physiological flexion
- absent or diminished
reflexes (rooting, suck swallow)
- absent or diminished
immaturity - physio & behavior
pain sensitivity
why is the premature infant more sensitive to pain
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
what is the risk of poor management of the premies’ heightened sensitivity to pain
can lead to prolonged structural and functional changes
what are components for pain management
clustering care
sucrose
developmental supportive care
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
what are 3 causes of IRDS
- significant pulmonary immaturity
- no/insufficient surfactant
- ventilation/perfusion mismatch
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
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
when does uncomplicated IRDS resolve
w/i 3-4 days
what are interventions that may be utilized with IRDS
supplemental O2
- mechanical vent
- ECMO
surfactant replacement therapy
what are the benefits of surfactant replacement therapy for IRDS
dec morality
dec air leak
dec chronic lung dz in premies w IRDS
what is the pathophys of bronchopulmonary dysplasia (BPD) - 3
interstitial fibrosis
alveolar collapse
smooth ms hypertrophy
what is a common dx to follow a dx of BPD
chronic lung dz of infancy
what is the dx criteria for BPD (3)
- mechanical vent - 1st wk of life
- (D) on O2 >28days
- persistent densities on chest XR
what are dx findings via PFTs in BPD (3)
inc airway resistance
dec compliance
inc work of breathing
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
what is an important factor to consider with interventions for BPD
poor activity tolerance
what is the overall goal/outcome of interventions for BPD
can outgrow BPD if facilitate new alveolar growth w good infection control and nutrition
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
what is considered activity for infants
revolves around feeding & interaction
- maybe early motor activity (ex: head control)
what are the 3 main goals of PT in infants
improve activity, feeding, and interaction
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
what is periventricular leukomalacia (PVL)
areas of cellular necrosis in white matter, near lateral ventricle
- fluid filled cysts left behind
what are 2 causes of PVL
trauma
hypoxia/ischemia to arterial supply to periventricular white matter
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
what is intraventricular hemorrhage (IVH)
starts in subependymal layer (where glioblasts are formed) of germinal matrix
- may extend into intraventricular space
what is IVH associated with (3)
- poor vascular autoregulation
- high metabolic activity of germinal matrix
- fragile endothelial walls of immature vasculature
what does IVH have a direct relationship to
prematurity
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
what are 2 complications of IVHs
hydrocephalus
- obtructed flow of CSF
hypoxic/ischemic lesions
how is IVH dx
head US, CT
what is medical treatment for IVH (2)
stabilize hemodynamics
limit stim (acute phase)
what is necrotizing enterocolitis (NEC)
acute inflammatory dz of bowel
- reflects immaturity of bowel to handle minor toxins and infections
what are 3 factors for NEC
intestinal ischemia
infection
toxins
what are signs/red flags for NEC (4)
vomiting
abdominal distention
bloody stools
change in respiratory status
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
what is hyperbilirubinemia
buildup of bilirubin in blood d/t immature liver
- leading to jaundice
what are sx of hyperbilirubinemia (4)
lethargic
low tone
low feeding
low sucking
what is the risk fo hyperbilirubinemia
kernicturus
- buildup of bilirubin in BG d/t weakened BBB
what is the main treatment for hyperbilirubinemia
phototherapy
- can also be used prophylactically
NAS vs NOWS
neonatal abstinence syndrome
- result of poly substance used
neonatal opioid withdrawal syndrome
- result of opioid use (prescription, methadone, heroin)
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
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
what medical intervention is seen with NAS/NOWS
methadone/morphine
- dosing determined by q4hour assessment
what does NAS/NOWS impacts in the infant’s development outcomes
neurobehavioral
language
motor systems
what are long term outcomes in early stages of NAS/NOWS impacted by
polypharmacy exposure
SES
