Week 10 - Physiotherapy Mx in NICU

Question 1

What are risk factors associated with NICU or SCN admission?

Answer 1

1. moms <20 or >40, indegenous
2. Babies with decreased gestational age, birth weight, and plurality
3. babies born in more remote locations

Question 2

What is considered extremely low birth weight and very low BW?

Answer 2

<1000g and <1500g

Question 3

Define the gestational age

Answer 3

age of foetus from first day of last menstrual period/conception to birth

Question 4

Define chronological age

Answer 4

age from birth to assessment

Question 5

Corrected age

Answer 5

age from expected date of delivery to the date of assessment

Question 6

Define and describe the NCIU

Answer 6

Neonatal intensive care unit if infant requires respiratory support, high risk infants and surgical (pre or post)

Question 7

Define and describe special care nursery (SCN)

Answer 7

where babies requiring more intervention than available in maternity unit nursery

Question 8

What are important differences and problems found in pre-term infants? (6)

Answer 8

RCATFM
Respiration - variable/not spontaneous, may require resuscitation, support

Cardiovascular - variable such as bradycardia/tachycardia

Arousal - likely affected by medical complications and interventions

Temperature - poor control, expend energy attempting to maintain

feeding - mature suck not present until 32-34 weeks, intolerance

movement - extensor/flex imbalance , lower active and passive tone, struggles against gravity, jerky, startles

Question 9

What does the outcome for preterm infants correlate with?

Answer 9

mortality/morbididty inversely proportional to gestation age and birth weight

Question 10

What risks is associated with pre term birth?

Answer 10

1. cerebral palsy (5-15% ELBW infants)

2. brain development

Question 11

How early can CP be detected based on new assessment tools?

Answer 11

3 months

Question 12

List prognostic features of the Lacey assessment of preterm infants (LAPI) (8)

Answer 12

1. ATNR > 10 sec and dominating mov’t
2. UL tone > LL tone
3. Spontaneous movements/coarse jitters
4. use of extension for postural control
5. oromotor control
6. contradictories signs - head lag on pull to sit but rigid head control in supported sitting
7. increased adductor tone
8. thumb flexion

Question 13

Define general movements

Answer 13

whole body movements. normally fluid, varied, elegant, complex and take up the 3 dimensions of space

Question 14

what are the 2 periods of the Prechtls’s general movement assessment

Answer 14

1. Writhing period
   - 26 GA to 5-9 weeks
   - normal
   - Abnormal - cramped synchonized, poor repertoire, chaotic
2. Fidgety period
   - 9-20 weeks
   - “golden fidgety” at 12 weeks - present n, normal,
   abnormal - absent

Question 15

What is a strong predictor of CP according to Prechtl’s general movement assessment?

Answer 15

recurrent cramped synchronized movements in the writhing period + absent fidgety movements

Question 16

What are general guidelines for all assessments? (5)

Answer 16

1. consider state
2. consider recent Hx
3. exclude common confounding factors
4. concerning features fleeting vs. dominant?
5. comparison of subsequent longitudinal assessments

Question 17

List the neurodevelopment interventions for positioning (4)

Answer 17

1. flexion at all joints except the neck
2. scapular protraction with arm support to encourage hands toward mouth
3. support to provide boundaries promote temperature regulation and conserve energy
4. Weight bearing through hips and shoulders

Question 18

List the MS conditions for referral (4)

Answer 18

1. head shape deformities
2. Talipes
3. Developmental hip dysplasia
4. fractures

Question 19

List 4 genetic syndromes (4)

Answer 19

1. down syndrome
2. prada willis
3. arthrogyposis
4. osteogenesis imperfecta

Question 20

List the 3 types of head shape deformities

Answer 20

1. Plagiocephaly
2. Brachiocephaly
3. Scaphocephaly

Question 21

What protocol are used for structural Talipes (club foot deformity)

Answer 21

1. Score using Pirani scale
2. Manipulate and cast as per poinsettia guidelines
3. Change at least once a week
4. may have to delay application of first cast if infant very unstable

Question 22

What is the protocol for Developmental hip dysplasia?

Answer 22

1. Identify with Barlow and Ortolani ax
2. Check for clinical signs (leg length discrepancy with knee flex/ext, asymmetrical skin folds, asymmetry in hip abduction)
3. Soft signs only, diagnosis confirmed on hip US at 6/52 chronological age
4. In ELBW can be a delay in diagnosis
5. Treat if hip dysplasia or coverage % <40%

Question 23

What is the most common fracture NICU

Answer 23

of humerus

Question 24

What percentage of babies in NICU require assisted ventilation?

Answer 24

89%

Question 25

What are the chest physiotherapy guidelines in NICU? (6)

Answer 25

H,I,M/P, P, P/E, V>P

1. Improve impairments O2 and increase removal of secretions
2. modified positioning without head down tip
3. head support throughout tx
4. techniques - vibration>percussion in small babies
5. RCT - post extubation chest physio not routinely indicated
6. Positioning in prone to improve O2 especially in ventilated infants

Question 26

List 3 development issues preterm infants are at risk for

Answer 26

1. CP
2. Developmental Coordination Disorder
3. Developmental delay

Question 27

What does evidence say about intervention for preterm infants?

Answer 27

support for early intervention - translation to clinical practice rapidly occurring (plasticity, task related coordination)