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114 Cards in this Set

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What is the Heidi Als theory for developmental care in the NICU?
Synactive theory, naturalistic observation of newborn behavior, each premature baby is different, givve them individualized treatment/care, family focused, comprehensive, developmentally supportive
What type of external environmental things are appropriate for the NICU?
-cycled lighting
-pacing of care
-quiet time
-interventions as needed instead of as scheduled
What is kangaroo care?
Baby in diaper against Mom/Dad's bare chest, skin to skin.
What is kangaroo care and co-bedding associated with?
-Increased weight gain
-Decreased time on the ventilator
-Increased O2 sats
-Decreased hospital stay
-Improved infant states and neuromuscular behaviors
What percentage of babies born are premature?
7-10%
What is considered premature?
Less than 37 weeks
What is within the normal time frames for gestation?
38-42 weeks
What is the cut of time for viable babies?
24 weeks is generally considered viable.
What are the weight ranges for:
1. LBW
2. VLBW
3. ELBW
4. Micropremie
1. 1501-2500g/36 weeks g.a.
2. below 1500g/32 weeks g.a.
3. below 1000g/28 weeks g.a.
4. below 800g/about 500g/24 weeks g.a.
What are the standards for small for gestational age (SGA) or large for gestational age (LGA)?
SGA - birth wt. is below the 10th % of norms. Can be full term, fully developed.

LGA - birth weight is above the 90% for norms.
What is IUGR?
Intrauterine growth retardation, stunted growth
What types of disorders are associated with VLBW?
Neurologic sequelae, developmental delay, decreased intellectual and language skills. The smaller the baby, the greater the risk for delays and developmental problems.
What do Apgar scores look at? How is it scored?
HR, RR, ms tone, response to stimuli, color. Refers to how baby is doing after birth. 0 = no response, 2 = best response. Max score is 10. Taken at 1 min., 5 min., 10 min. and every 10 min thereafter. The lower the Apgar score, the worse off the babies diagnosis will be.
Name and describe three causes of premature birth.
Social - teenage preg., little family support, drugs, alcholol.
Maternal - infection/disease, increased BP.
Fetal - toxemia due to mother being sick. Risk to Mom's organs and baby. Baby may be too big for mom.
Name four respiratory complications with premature babies.
1. Apnea
2. Bradycardia
3. Respiratory Distress Syndrome (RDS)
4. Hyaline Membrane Disease (HMD)
What is the most common respiratory problem in neonates?
Hyaline Membrane Disease
What is HMD?
Pulmonary immaturity, decreased surfactant production which leads to an increase in surface tension of alveoli. This leads to alveolar collapse, diffuse atelectasis and decreased lung compliance.
At what week do the alveoli develop?
24 weeks
What week does the brain control respirations?
30 weeks
At what weeek does the baby start to make surfactant?
22 weeks
What are some treatments for HMD/RDS?
surfactant, oxygen assisted ventilation via High Frequency Oscillatory Ventilation. (Little puffs, most premature babies). ECMO - extracorporeal membrane oxygenation.
Complications with RDS/HMD.
-Prognosis
-Mortality Rate
-Risks
Prognosis varies w/ severity, mortality rate is 10%, Increased risk for neurodevelopmental delay and URTI
What is Broncho-Pulmonary Dysplasia? (BPD)
A chronic lung disease characterized by interstitial fibrosis, alveolar collapse, scarring w/ increased airway resistance, increased work of breathing caused by prematurity, increase ventilator pressure, O2 toxicity. Lungs have lots of scarring
How do premies get BPD?
Greatest risk if O2 dependent for more than 28 days, or after mechanical ventilation for more than a week.
What percentage of premies get BPD?
5% of premies, 12-69% of those less than 1500g (VLBW)
How can BPD be detected?
Increased density areas on x-ray
What risks are associated with BPD?
Neurodevelopmental delay, poor weight gain, decreased fat deposits. Risks - CHF, cor pulmonale, increased right ventricle hypertrophy, pulmonary edema, trouble with bone healing.
What is Meconium aspiration?
Aspiration of meconium prior to or during birth, airway obstruction, tissue damage. 1st attempt at metabolizing amniotic fluid, meconium gets into lungs
What is the frequency of Meconium aspiration? What babies get this?
5-10% of all live births, infants born at term or post term.
What is hyperbilirubinemia?
Excessive accumulation of bilirubin in the blood.
What are the causes of hyperbilirubinemia?
-Immature liver function
-Increased hemolysis due to increased concentration of RBC's
-Rh factor/ABO incompatibility
-Physiologic jaundice due to limited ability to excrete bilirubin
Hyperbilirubin can result in what condition of the brain?
Kernicterus
What is Kernicterus?
Yellow staining of the brain caused by unconjugated bilirubin deposits. Bilirubin acccumulates around the brain.
What two structures of the brain are affected with Kernicterus?
Basal ganglia and hippocampus
What are some long term neurological problems that develop as a result of Kernicterus?
Athetosis, rigidity, hypotonia, hi-fequency hearing loss, MR
What is the treatment used for Hyperbilirubin?
Phototherapy via UV lights, exchange transfusions
What is the most common brain lesion in infants less than 32 weeks g.a.? How common is it?
Intraventricular Hemorrhage, 40% of pre-terms
When do IVH occur?
Within the first 2 days and generally within the first week of birth.
What exactly is a IVH?
Bleeding into the subependymal germinal matrix.
When is the subependymal germinal matrix prominent? What is it?
Prominent from 26-34 weeks gestation and then gone by term.
Single layer vessels at the roof of the brain.
What are three causes of intraventricular hemorrhage?
1. Fluctuating cerebral blood flow
2. Increased cerebral venous pressure
3. Disturbance of platelets/coagulation
What is the onset of IVH like?
Can occur suddenly or evolve over 2-3 days. Baby will hemorrhage one time, but not repeatedly.
What is a grade I IVH?
Grade I: isolated within the germinal matrix, low risk. Minimal risk for long-term neurological deficit.
What is a grade II IVH?
Grade II: IVH into the lateral ventricles with normal sized ventricles. No damage to surrounding tissues. Minimal risk for long-term neurological deficit.
What is a grade III IVH?
Grade III: IVH with ventricular dilation. Increased risk for hydrocephalus, CP, MR.
What is a grade IV IVH?
Grade IV: IVH into the periventricular white matter, can be unilateral or asymmetric. Ventricle dilates w/ irritation around the tissues. Increased risk for hydrocephalus, CP, MR.
Why is it important to measure a babies head?
To ensure brain growth, watch for hydrocephalus.
What is PVL?
Periventricular Leukomalacia. Leuko (white), malacia (softening). Softening of the white matter around the ventricles.
How is PVL caused?
Caused by decreased blood flow in the periventricular region (systemic hypotension) where the end zones of the middle, posterior and anterior cerebral arteries meet. "Water shed effect" - decrease in blood flow from middle cerebral artery causing tissue necrosis. Also caused by apnea, bradycardia.
With PVL, what areas are affected?
Descending motor tracts due to the close proximity of the ventricles.
How is PVL diagnosed?
Serial cranial U/S
What is the difference between cystic PVL and PVL?
Cystic PVL has cysts or holes in the area. Causes destruction of tissue. More likely to see loss of vision and spasticity in LE and possibly UE.
What is PVL associated w/?
CP, MR, visual impairment
What type of management do you do for PVL?
Maintain adequate ventilation and blood pressure.
What is HIE?
Hypoxic-Ischemic Encephalopathy aka perinatal asphyxia. Hypoxia is decreased O2 in blood and ischemia is O2 deprivation. Extended amount of time of O2 deprivation.
What are some major signs of HIE?
Seizures, abnormalities in consciousness, ms tone, posture, reflexes,repiratory patterns, autonomic function, quality of movement, feeding difficulties.
What are some causes of HIE?
-Mom could be anemic
-Decreased blood flow to the placenta
-Maternal hypoventilation
-Cardiopulmonary disease
-Hypotension
-Traumatic delivery, prolonged labor, placental or cord problems.
How can HIE be confirmed?
-Neurologic consultation, Cranial U/S, MRI, EEG, Monitor closely
How can HIE be prevented?
Identify high risk pregnancies, fetal monitoring, C-section, mantain BP on infants, monitor blood glucose levels, control seizures/brain swelling.
What is the most frequent overt sign of neurologic disorders?
Neonatal seizures
When do most neonatal seizures occur?
Usually within the first 2-5 days of life with 85% in the first 15 days of life.
What causes neonatal seizures?
Hypoxic-Ischemic Encephalopathy, Intraventricular Hemorrhage, hypoglycemia, Mom with infection or a diabetic, developmental defects, drug withdrawal.
What are some clinical signs of seizures?
Facial, tongue, oral, eye movements, apnea, changes in BP, HR, pupil size, tonal changes. Rhythmic movements in teh extremities and face.
How do you treats neonatal seizures?
Anti-convulsants and glucos if hypoglycemic to regulate blood sugar.
What are some secondary results of seizures?
15-20% have mental retardation, motor impairment, or both if seizures are in the first days of life.
What is Necrotizing Entercolitis? (NEC)
Acute inflammatory disease of the bowel. Necrosis of the intestines. Associated with sepsis.
When does NEC usually happen?
Within the 1st 6 weeks of life in infants less than 2000g, tiny babies.
What are some signs of Necrotizing Entercolitis?
Abdominal distension, bloody stools, change in respiratory status.
What is a secondary risk with NEC?
25-35% form stricutres leading to failure to thrive (FTT), feeding difficulties, diarrhea, bowel obstruction. Difficulty growing, because they burn all the calories that they are ingesting.
What is Retinopathy of Prematurity (ROP)?
A vascular disturbance in the retina of the premature infant. Abnormal growth of blood vessels in the developing eye.
What causes ROP?
It's multifactorial, but supplemental O2 is indicated, along with shock, hypothermia, Vit E deficiency, light exposure.
How is ROP caused?
By severe vasoconstriction of the retinal vessels leading to hypoxia of the vasculature of the retina with subsequent vascular proliferation of the retinal capillaries ino the hypoxic area. The retina become edematous and begins to detach. There is too much blood, vessels become filled and start to pull away and retina becomes detached.
ROP incidence is proportional to what?
a decreased birth weight
ROP outcomes are...
range from normal vision to total loss of vision
What are the prevention strategies with ROP?
Close monitoring of O2 delivery, surgery to prevent detaching of the retina.
What is stage I of ROP?
Stage I: normal eye w/ incomplete vascularization of the peripheral retina
What is stage II of ROP?
Active stage, early vascularization with engorged arterioles and venules.
What is stage III of ROP?
Advanced active stage, all of stage 3 with retinal traction.
What is stage IV of ROP?
Retinal traction with partial detachment
What is stage V of ROP?
Retinal detachment
What is screened prior to discharge on all infants in NE?
Hearing
What is Ototoxicity?
Toxicity due to drugs, antibiotics that can damage nerves.
Describe Brachial Plexus Injuries. Trauma to?
-Usually unilateral
-Paralysis of weakness of UE after trauma to spinal nerve roots C5-T1
Where is the damage for Erb's Palsy?
C5-C6, "waiters tip"
Where is the damage for Klumpke's palsy?
C8-T1
Where is the damaage for Erb-Klumpke?
Entire UE
How does a baby get a Brachail Plexus injury?
1. Prolonged difficult labor
2. High birth weight
3. Sedated patient
4. Hypotonic infant
5. Traction on the shoulder during delivery in breech or traction of the head or neck during vertex delivery.
Other injuries that you could see as a result of a brachial plexus injury?
-Facial N. involvement
-Frx of clavicle/humerus
-Sublux of shoulder
-Torticollis
-Hemi-paralysis of diaphragm by injury to phrenic nerve C4
What are some treatment options for brachial plexus injury?
-Rest for 7-10 days w/ partial immobilization of UE across abdomen.
-Then AROM and PROM
-Avoid over-stretching of joints
-Parent education and prevention
BPI treatment from infancy thru childhood includes...
-ROM/developmental activities
-Splinting
-Neurosurgery
-Orthopedic surgery
-E-stim
What are some other birth injuries that could occur?
-Fracture to skull, humerus, clavicle
-Multiple frxs could indicate osteogenesis imperfecta
How does alcohol affect the baby?
Alcohol readily crosses the placental and blood brain barrier. The babies liver and kidney's are immature and cannot process the alcohol.
What determines if the baby will be affected by alcohol intake by the mother?
It's dose dependent btwn maternal intake in the first few weeks of pregnancy and hte occurrance of FAS features.
What is the leading cause of mental retardation that is preventable?
Alcohol related birth defects, FAS
What is the triad of symptoms that a baby with FAS would have?
1. Growth deficiency (LBW, poor suck)
2. Cardiac defects
3. CNS disturbance (microcephaly, MR, dysmorphic features, ongenital hip dysplasia)
What types of behaviors would you expect to see in the NICU from a baby with FAS?
Irritability
Tremors
Apnea
Seizures
W/drawal
Poor feeding
What is the current treatment for babies w/ FAS?
Drugs, morphine to calm them.
What types of drugs will severely affect the baby in gestation?
Cocain, meth, heroine, opiates
What would you expect to see from a baby that was exposed to drugs?
Irritability
Tremors
Apnea
Seizures
Withdrawal
Poor feeders
Long term - poor judgement
What percentage of babies born to HIV+ mothers develop HIV?
10-40%
80% of children w/ HIV....
Contract the virus inutero via tansplacental transfer.
What is the major risk factor for contracting HIV?
IV drug use
Issues with maternal antibodies and HIV?
Maternal antibodies to HIV cross the placenta; infants of infected mothers will have antibodies whether infected or not.
What do infants with AIDS present with?
-Opportunistic infections (HSV, CMV, viral, fungal, protozoal)
-Spinal cord myelin loss
-Pneumonitis w/ respiratory distress
-Microcephaly
-Recurrent bacterial infections
-90% w/ encephalopathy
-Asymptomatic at birth
How can Herpes Simplex Virus hurt the baby?
Because the developing brain of the baby is susceptible to injury as a result of viral infection acquired intrauterine or early in neonatal life. Infection during organization or myelination can cause malformations or impeded brain growth.
What is the primary concern with Herpes?
Active lesions and a vaginal birth. 1 = No contract, 2 = Contract and skin lesions, 3 = contract and encephalitis
What does TORCH infections stand for?
Toxoplasmosis via cat feces
Other infections such as
Rubella
Cytomegalovirus
Herpes Simplex Virus
What types of problems does TORCH cause?
Various neurologic problems, psychomotor, retardation, microcephaly, LD, seizures. Can also cause blindness, senorineural hearing loss and hydrocephalus. The earlier in the pregnancy the worst for the baby.
Other medical complications for babies include...
Congenital Heart Disease (in 1st 8 weeks) and Myelodysplasia (Spina Bifida). These both can be corrected via surgery.
What are some things you would look for via observation in your NICU assessment?
-Behavioral states
-State regulation
-Active movements against gravity
-Muscle tone
-Muscle strength - symmmetry
-Feeding
What are the behavorial states every baby should go through? (6)
-Deep sleep
-Light sleep
-Drowsy
-Quiet awake
-Active awake
-Crying
What types of "hands on" things would you do during an assessment in the NICU?
-PROM
-Muscle tone
-Reflexes (present, symmetrical, strength)
-Standardized Tests such as the TIMP (Test of Infant Motor Performance)
What ages are appropriate for the TIMP?
32 weeks to 4 months
What types of NICU treatments could you do?
-Positioning/handling
-Environmental modifications
-Feeding
-Parent education (no infant walkers or jumpers)
-ROM as indicated
-Developmental activities as indicated/tolerated