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S7- Special Populations > Week 3- Development of Infant Born Prematurely > Flashcards

Week 3- Development of Infant Born Prematurely Flashcards

1
Q

PART 1

A

PART 1

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2
Q

How many NICU levels are there?

A
  • Level 1 = Well-baby nursery
  • Level 2 = Special Care nursery
  • Level 3 = NICU
  • Level 4 = Regional NICU
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3
Q

What are each of these abbreviations?

  • CP
  • RDS
  • BPD
  • ROP
  • NEC
  • ID
  • HI
  • DCD
A
  • CP – cerebral palsy
  • RDS – respiratory distress syndrome
  • BPD – bronchopulmonary dysplasia
  • ROP – retinopathy of prematurity
  • NEC – necrotizing enterocolitis
  • ID – intellectual deficit
  • HI – hearing impairment
  • DCD – developmental coordination disorder
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4
Q

Children born at less than ___ weeks’ gestational age and with VLBW (very low BW) are 30% more likely to develop CP, ID, RDS, BPD, ROP, HI.

A

37 weeks

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5
Q

The prevalence of perceptual motor problems is reported as high ass 48%. What are 2 tests recommended to assess motor development?

A
  • MABC

- VMI

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6
Q

What are some characteristics of preemies? (4)

A
  • Hypotonia
  • Decreased ratio of T1:T2 muscle fibers (results in muscular fatigue, particularly respiratory muscles)
  • Incomplete ossification and ligament laxity (results in greater effects of positioning and gravity)
  • Increased reactivity to sensory stimuli
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7
Q

Describe the evolution of the 5 sensory responses in order from first to last.

A
  1. ) Touch
  2. ) Movement
  3. ) Smell/Taste
  4. ) Hearing
  5. ) Sight
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8
Q

Vestibular System Development:

  • Is mature in the ____-_____ newborn.
  • Modifications with development due to synapses and dendrites. This is dependent of what?
  • Vestibular stimulation is known to enhance _______ states.
A
  • full-term newborn
  • Dependent on what child is exposed to.
  • behavioral states
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9
Q

Olfactory/Gustatory Development:

  • Olfactory development begins at __ weeks’ gestation.
  • The ability to smell begins at ___ weeks.
  • Taste buds begin to mature at approximately ___ weeks.
  • The fetus experiences a variety of taste and smells in utero.
A
  • 5 weeks
  • 28 weeks
  • 13 weeks
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10
Q

Auditory System Development:
-By ___ weeks’ gestation, cochlea and peripheral sensory end organs are developed but the pathways continue to mature.
The preemie is exposed to NICU noise that may cause cochlear damage, sleep disturbances, and disturbed growth and development.

A

-24 weeks

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11
Q

Visual System Development:

  • Vision is the least mature at term birth.
  • From ___ weeks to term, the retina and visual cortex undergo extensive maturation and differentiation.
  • By ___ weeks, pupillary reflex present, may see brief eye opening and fixation on a high contrast form under low illumination.
  • By ___ weeks, saccadic visual following horizontally and vertically.
  • At term, vision is 20/400. What does this mean?
A
  • 24 weeks
  • 34 weeks
  • 36 weeks
  • Babies are near sighted.
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12
Q
  • Describe the difference between flexor tone of a preterm infant at 40 weeks and a infant born at term.
  • Preterm infants have less predictable __________ and _________ patterns.
  • Preterm infants have less flexor hypertonicity resulting in ________ ROM.
A
  • The flexor tone of a preterm infant who has reached full-term is never as great as the flexor tone of an infant born at term.
  • sleep-wake cycles and feeding patterns
  • greater ROM
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13
Q

Describe the difference between gestational age, post conceptual age, and corrected age/adjusted age/post-term corrected age.

A

-Gestational Age (GA): Age of infant based on mom’s last menstrual period. (weeks in womb)
-Post Conceptual Age: GA plus the number of weeks since the infants birth.
Corrected age/adjusted age/post term corrected age: gestational age plus weeks since birth minus 40 weeks.

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14
Q
  • Full-term = _______
  • Post-term = ________
  • Pre-term = ________
A
  • Full-term = 37-41 weeks
  • Post-term = >42 weeks
  • Pre-term = <37 weeks
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15
Q
  • Extremely low birth weight (ELBW) = ________
  • Very low birth weight (VLBW): _______
  • Low birth weight (LBW): _________
A
  • ELBW: <1000g
  • VLBW: <1501g
  • LBW: 1501g-2500g

**The lower the birth weight the higher the chance of neurological problems.

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16
Q
  • The size of an infant at birth is based on what 3 things?

- What does AGA, SGA, LGA, and IUGR stand for?

A

-length, head circumference, and weight

  • AGA: appropriate for gestational age
  • SGA: small for gestational age (<10th percentile)
  • LGA: large for gestational age (>90th percentile)
  • IUGR: intrauterine growth retardation
17
Q
  • What does APGAR stand for?

- What is it?

A
  • A: Activity
  • P: Pulse (HR)
  • G: Grimace to stim
  • A: Appearance
  • R: Respiratory Rate

-APGAR scores the 5 things listed above from a scale of 0-2 to help determine the condition of the newborn infant immediately after birth. (10 = good, 0 = bad)

18
Q

What is Respiratory Distress Syndrome (RDS)?

A
  • Respiratory distress syndrome (RDS) occurs in premature babies whose lungs are not fully developed. The earlier the infant is born, the more likely it is for the baby to have RDS and to need extra oxygen and help breathing.
  • RDS is caused by the baby not having enough surfactant in the lungs. Surfactant coats the tiny air sacs in the lungs and helps to keep them from collapsing.
19
Q

What are the (3) factors that increase risk for RDS?

A
  • Degree of prematurity (<34 weeks)
  • Maternal diabetes (insulin interferes with surfactant production)
  • Thoracic malformations
20
Q
  • What is used to prevent RDS?

- Why is this controversial?

A
  • Antenatal steroids to accelerate lung maturity.

- Controversial because it may lead to poor neurobehavioral problems.

21
Q

RDS S/Sx. (8)

A
  • Increased RR
  • Expiratory grunting
  • Sternal and intercostal retractions
  • Nasal flaring
  • Cyanosis
  • Decreased air entry on auscultation
  • Hypoxia
  • Hypercarbia
22
Q

RDS Interventions. (6)

A
  • Oxygen supplementation
  • ECMO – extracorporeal membrane oxygenation
  • CPAP – continuous positive airway pressure
  • PEEP – positive end expiratory pressure
  • Mechanical Ventilation
  • Surfactant administration prophylactically
23
Q

What are (4) complications of RDS treatment?

A
  • Barotrauma = increased airway pressure
  • Volutrauma = large gas volume
  • Atelectotrauma = alveolar collapse
  • Biotrauma = increased inflammation
24
Q

What is Bronchopulmonary Dysplasia (BPD)? This is a complication of what?

A
  • In BPD the lungs and the airways (bronchi) are damaged, causing tissue destruction (dysplasia) in the tiny air sacs of the lung (alveoli).
  • Complication of immature lungs along with prolonged mechanical ventilation.
25
Q

What is Hyperbilirubinemia?

A

Accumulation of excessive bilirubin in the blood. Common in preemies due to liver function not being matured.

26
Q

How is Hyperbilirubinemia treated?

A

bili lights

27
Q

What is Retinopathy of Prematurity (ROP)?

A

ROP is an eye disorder caused by abnormal blood vessel growth in the light sensitive part of the eyes (retina) of premature infants. May lead to scarring and detached retina, and may result in blindness.

28
Q
  • ROP peaks at ___-___ weeks and requires regular monitoring by ophthalmologist.
  • How many levels are there, and which is the worst?
  • Is it the leading cause of visual impairment in preemies?
A
  • 34-40 weeks
  • levels 1-5 (5 being the worst)
  • Yes
29
Q

What is Necrotizing Enterocolitis (NEC)?

A

The intestinal tissue becomes damaged (typically due to infection) and begins to die. Symptoms include bloating or swelling in the abdomen.

30
Q

What are the abdominal S/Sx of NEC? (7)

A
  • Distention
  • Gastric retention (residual milk in stomach before a feeding)
  • Tenderness
  • Vomiting
  • Diarrhea
  • Rectal bleeding (hematochezia)
  • Bilious drainage from enteral feeding tubes
31
Q

What is the most common cause of preterm labor?

A

Chorioamnionitis (infection in membrane surrounding fetus)

32
Q

What is Meconium Aspiration Syndrome?

A

Early onset respiratory distress in term or near term infants born through meconium stained amniotic fluid.

33
Q

Osteopenia:

  • Approximately 80% of bone is produced between ___-___ weeks’ gestation.
  • Mechanical loading occurs due to increasing muscle mass and decreased uterine space.
  • Risk increases with decreasing ____________ and ____________.
  • Other contributing factors: chronic illness, prolonged hyperalimentation, BPD, NEC, use of steroids, diuretics
  • Increased risk for fractures and positional deformities such as dolichocephaly.
A
  • 24-40 weeks

- gestational age and birth weight

34
Q

PT in the NICU:

  • ___ ___ _____
  • Addresses functional and structural integrity of body parts and systems.
  • Promotes the development of postural and motor activities.
  • Promotes appropriate interaction between the infant and the environment.
  • Promotes interaction with family, NICU staff, and consultants.
A

DO NO HARM

35
Q

During our examination, what do we want to minimize? How do we do this?

A
  • MINIMIZE EXCESSIVE HANDLING AND OVERSTIMULATION

- Do this by providing cluster care (performing multiple things at once to allow rest)

36
Q

Taping:

  • Allows easy inspection of the skin and vascular integrity.
  • Risk for intolerance requires careful monitoring.
  • Not recommended for infant less than ___-___ weeks’ gestation.
  • Assess integumentary status and perform a patch test to determine any sensitivity to the tape.
  • Provide the nursing staff and family careful instructions in terms of signs of intolerance and how to safely remove the tape.
A

-30-32 weeks

37
Q

Splinting:

  • Indicated for some infants in the NICU with documented or potential ________ and _____________ limitation concerns.
  • Risk of fracture, dislocation, joint effusion, and skin breakdown.
  • Traction on joints and nerves can be a concern because of the weight of the splinting material.
  • Instructions and pictures posted bedside.
  • Post discharge monitoring.
  • Casting may be done by orthopedics.
A

-alignment and joint motion

S7- Special Populations (18 decks)

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