Ch. 7 Premature and Small-for-Dates Infants

Intraventricular hemorrhage

bleeding into the brain

School age

by ____ ____, the developmental status of preterm children who had birth weights above 1500g is not very different from full-term infants

Periventricular leukomalacia

death of brain tissue around fluid-filled ventricles

Bronchopulmonary dysplasia

infants require supplemental O2 and/or mechanical ventilation beyond 28 days postnatal age

Malnourished

small-for-gestational-age infants may appear ______ due to intrauterine growth restriction

Home care visits

_____ ____ ____ by nursing and/or social work staff are important for family support after infant discharge from NICU

37

a preterm or premature infant is born before the _____th week of gestation

Hyaline membrane disease

aka respiratory distress syndrome; decreased production of SURFACTANT that normally keeps the alveoli stable, permitting exchange of O2 + CO2

Small-for-gestational-age infants

birth weight in the 10TH percentile, either born full term or premature

Gestational age

calculated from projected birth dates, uterine size (measured by clinical + uterine examination), + when fetal activity first develops

1. Patent ductus arteriosus (PDA)

cardiovascular complication of prematurity

1. C-sections (increased obstetric interventions) 2. Assisted reproduction technology 3. High number of multiple pregnancies (fertility drugs) 4. Increased substance abuse in urban areas 5. Idiopathic preterm delivery rate from adverse effects of low SES factors + maternal education levels 6. Maternal infections 7. Teen pregnancies

causes of premature birth:

1500

children with birth weights below ______ grams have an increased risk for developmental disabilities

1. Feed well by mouth + consistent weight gain 2. Maintain stable body temp outside of isolette 3. No more episodes of apnea + bradycardia

clinical criteria for discharge from the NICU is based on:

Bradycardia

complication of prematurity; dangerously slow heart rate

Auditory toxicity

complication of prematurity; increased risk of hearing loss due to frequent use of medications (like antibiotics) that can harm the auditory system

Apnea

complication of prematurity; respiratory pause lasting 15-20 SEC

3, 5

early intervention programs benefit neurodevelopment of most premature infants through ____-____ years of age

1. Group meetings for parents 2. Home visits (after 24 months chronological age) 3. Attendance at multidisciplinary child development center

early intervention strategies for premature infants

Patent ductus arteriosus (PDA)

fetal vessel that diverts blood flow from lungs does not close so lungs are not oxygenated

Lanugo

fine body hair present on the premature infant

1. Necrotizing enterocolitis 2. Gastroesophageal reflux disease (GERD)

gastrointestinal complications of prematurity

Assessment of gestational age

helps distinguish appropriate-for-gestational-age infant from a small-for-gestational-age infant

1. Immature immune system 2. At risk for susceptibilities to generalized bacterial + fungal infections

immunologic complications of prematurity

1, 16

incidence has decline ____% since 2006 but overall has risen ____% since 1990

Special education

many premature children will still need _____ ____ services to maintain the benefit of EI

1. Intraventricular hemorrhage 2. Periventricular leukomalacia

neurological complications of prematurity

1. More relationship-based + developmentally supportive 2. Observation + response to infant behavior 3. Actively involves parents in infant's care

new approach to NICU care:

Sudden infant death syndrome (SIDS)

occurs more than TWICE as frequently in premature infants; use APNEA monitors; recommended infants sleep on their BACKS

Retinopathy of prematurity (ROP)

opthalmologic complication of prematurity caused by abnormalities in retinal vascular development

1. Increased risk for brain damage 2. Glucose + electrolyte instability 3. Anemia 4. Deficiency of thyroid hormone production

other physical complications of prematurity

Muscle tone, joint mobility

physical + behavioral characteristics of the premature infant include: reduced ____ _____ + activity, and increased _____ ______

Reddish, creases, ear, breast

physical characteristics of the premature infant include: lanugo; smooth, ______ skin; absence of skin _____, ______ cartilage, + ______ buds

Irritable, feedings

premature infants may be more ____, cry more often, have poorer sleep-wake cycles, + require more ______

Neonatal intensive care units (NICUs)

preterm + SGA infants are best managed + cared for in high-risk obstetrical centers with ______ ______ ______ _____

Deaths, half

preterm births are responsible for the majority of neonatal _____ and nearly _____ of all cases of neonatal-onset neurodevelopmental disabilities (like CP)

13

preterm births occur in about ____% of pregnancies worldwide

1. Hyaline membrane disease 2. Bronchopulmonary dysplasia

respiratory complications of prematurity

Executive function

school-age children both very preterm or at ELBW are at greater risk of developing _____ _____ deficits (ADHD, learning disability, ASD)

Necrotizing enterocolitis

severe injury to portion of BOWEL wall

Gastroesophageal reflux disease (GERD)

syndrome in which the contents of the stomach are regurgitated back into the esophagus

90

thanks to advances in technology of NICUs, survival of LBW infants has increased to more than _____%

Extremely low birth weight

weight < 1000g (2.2 lbs)

Very low birth weight

weight < 1500g (3.3 lbs)

Low birth weight

weight < 2500g (5.5 lbs)

Micropreemie

weight < 800g (<1 lb)