Week 10 - Physiotherapy Mx in NICU Flashcards
What are risk factors associated with NICU or SCN admission?
- moms <20 or >40, indegenous
- Babies with decreased gestational age, birth weight, and plurality
- babies born in more remote locations
What is considered extremely low birth weight and very low BW?
<1000g and <1500g
Define the gestational age
age of foetus from first day of last menstrual period/conception to birth
Define chronological age
age from birth to assessment
Corrected age
age from expected date of delivery to the date of assessment
Define and describe the NCIU
Neonatal intensive care unit if infant requires respiratory support, high risk infants and surgical (pre or post)
Define and describe special care nursery (SCN)
where babies requiring more intervention than available in maternity unit nursery
What are important differences and problems found in pre-term infants? (6)
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
What does the outcome for preterm infants correlate with?
mortality/morbididty inversely proportional to gestation age and birth weight
What risks is associated with pre term birth?
- cerebral palsy (5-15% ELBW infants)
2. brain development
How early can CP be detected based on new assessment tools?
3 months
List prognostic features of the Lacey assessment of preterm infants (LAPI) (8)
- ATNR > 10 sec and dominating mov’t
- UL tone > LL tone
- Spontaneous movements/coarse jitters
- use of extension for postural control
- oromotor control
- contradictories signs - head lag on pull to sit but rigid head control in supported sitting
- increased adductor tone
- thumb flexion
Define general movements
whole body movements. normally fluid, varied, elegant, complex and take up the 3 dimensions of space
what are the 2 periods of the Prechtls’s general movement assessment
- Writhing period
- 26 GA to 5-9 weeks
- normal
- Abnormal - cramped synchonized, poor repertoire, chaotic - Fidgety period
- 9-20 weeks
- “golden fidgety” at 12 weeks - present n, normal,
abnormal - absent
What is a strong predictor of CP according to Prechtl’s general movement assessment?
recurrent cramped synchronized movements in the writhing period + absent fidgety movements
What are general guidelines for all assessments? (5)
- consider state
- consider recent Hx
- exclude common confounding factors
- concerning features fleeting vs. dominant?
- comparison of subsequent longitudinal assessments
List the neurodevelopment interventions for positioning (4)
- flexion at all joints except the neck
- scapular protraction with arm support to encourage hands toward mouth
- support to provide boundaries promote temperature regulation and conserve energy
- Weight bearing through hips and shoulders
List the MS conditions for referral (4)
- head shape deformities
- Talipes
- Developmental hip dysplasia
- fractures
List 4 genetic syndromes (4)
- down syndrome
- prada willis
- arthrogyposis
- osteogenesis imperfecta
List the 3 types of head shape deformities
- Plagiocephaly
- Brachiocephaly
- Scaphocephaly
What protocol are used for structural Talipes (club foot deformity)
- Score using Pirani scale
- Manipulate and cast as per poinsettia guidelines
- Change at least once a week
- may have to delay application of first cast if infant very unstable
What is the protocol for Developmental hip dysplasia?
- Identify with Barlow and Ortolani ax
- Check for clinical signs (leg length discrepancy with knee flex/ext, asymmetrical skin folds, asymmetry in hip abduction)
- Soft signs only, diagnosis confirmed on hip US at 6/52 chronological age
- In ELBW can be a delay in diagnosis
- Treat if hip dysplasia or coverage % <40%
What is the most common fracture NICU
of humerus
What percentage of babies in NICU require assisted ventilation?
89%
What are the chest physiotherapy guidelines in NICU? (6)
H,I,M/P, P, P/E, V>P
- Improve impairments O2 and increase removal of secretions
- modified positioning without head down tip
- head support throughout tx
- techniques - vibration>percussion in small babies
- RCT - post extubation chest physio not routinely indicated
- Positioning in prone to improve O2 especially in ventilated infants
List 3 development issues preterm infants are at risk for
- CP
- Developmental Coordination Disorder
- Developmental delay
What does evidence say about intervention for preterm infants?
support for early intervention - translation to clinical practice rapidly occurring (plasticity, task related coordination)
