Chapter 7- Premature and Small for Date Infants
Grade I IVH
bleeding into the germinal matrix, the blood vessels in the roof of the lateral ventricles
Intraventricular Hemorrhage (IVH)
bleeding into the ventricular space between hemispheres of brain; significant neurological complication of prematurity; correlates directly to the degree of prematurity; divided into 4 levels based on severity of bleed 50% first day of life 90% third day of life
Grade IV IVH
bleeding invades the substance of the brain
Grade III IVH
bleeding is significant enough to dilate the ventricle
Grade II IVH
bleeding that extends beyond the germinal matrix into the ventricular system
School Age Kid- Preterm >1500g
by school age, should catch up with "normal" kids; not very different from full term infants
Relationship Based Care
get parents there and involved as much as possible so they can feel comfortable taking their baby home
Patent Ductus Arteriosis
instead of closing at birth, duct remains open and continues diverting blood away from the lungs, leading to a decrease in O2 to he body and brain
Result of Periventricular Laukomalacia
spastic diplegia
Preemie Nutritional Needs
specialty formulas are often used (although breast milk is better)
Incidence of Preterm Births
13% of all pregnancies worldwide
Executive Function Defecits
ADHD learning disabilities autism
Test for Hearing Impairments
BAER OAE
Apnea
a respiratory pause lasting 10-20 seconds associated with a decrease in heart rate to below 80-100 bpm
Spastic Diplegia
a type of cerebral palsy with two limbs affected
Ophthalmologic Problems
abnormalities in retinal vascular development lead to retinopathy of prematurity (ROP)
Hyaline Membrane Disease
aka: respiratory distress syndrome (RDS); disorder characterized by respiratory distress in the newborn period- can not process O2 well
Suck/Swallow Reflex
before 32 weeks, not developed- makes feeding very difficult for preemies
Premature
before 38th week (resources vary- our book says 36th week or before- most say 37-38 week)
Small for Gestational Age
birth weight below 10th percentile- weight is compared to infants of same gestational age at risk for multiple gestational age
Apnea Treatment
caffeine and theophylline are used to stimulate breating
Causes of Hearing Impairment
could be genetic; result of systemic illness or toxic medications; likelihood increases with lower birth weight
Periventricular Leukomalacia (PVL)
damage to the white matter closes to the ventricles
Traditional Medical Care
docs take care of baby then send it home with a mom who hasnt taken care of it and has no idea what to do
Gastroesophageal Reflux Disease
due to immaturity in the gastroesophageal sphincter
Preemie Care Post Hospital
expensive
GERD
gastroesophageal reflux disease
Levels of Intraventricular Hemorrhage
grade 1, grade 2, grade 3, grade 4
Lanugo
hair that covers body and limbs of fetus/newborn
Respiratory Problems
hyaline membrane disease (HMD) bronchopulmonary dysplasia (BPD)
Adjust Age for Prematurity
if born 2 months premature, and the child is 20 months old-- must subtract the 2 months and compare to an 18 month old
Survival of Low Birth Weight Infants
increased from 50% to 90+% since 1960
Optimal School Outcome
increased parental education two parents stability in family composition and residence
School Age Kid- Preterm <1500g
increased risk for developmental disabilities
IUGR
intra uterine growth restriction
Neurological Problems
intraventricular hemorrhage periventricular laukomalacia
Characteristics of Premature Infant
lanugo smooth, reddish skin absence of skin creases, ear cartilage, and breast buds reduced muscle tone behaviorally passive and disorganized
Individualized Developmental Care
leads to best outcomes for children and families
Extremely Low Birth Weight
less than 1000 grams or 2.25 pounds
Very Low Birth Weight
less than 1500 grams or 3.5 pounds
Low Birth Weight
less than 2500 grams or 5.5 pounds
Micropreemie
less than 800 grams or 1.75 pounds
Causes of Preterm Births
lots of OB interventions assisted reproduction multiple pregnancies substance abuse/smoking low socioeconomic status maternal infections adolescent pregnancies inadequate prenatal care history of premature pregnancies intrauterine infections
Cause of Periventricular Laukomalacia
low oxygen due to decreased blood flow
Treatment of Gastroesophageal Reflux Disease
medicines- even though it's pretty much always been there and usually disappears on its own as GI system matures
ADHD
more common issue
Males vs. Females
more males will exhibit some sort of developmental delay
Neurodevelopmental Outcomes
motor skills delayed and should be monitored sleep disturbances, feeding difficulties, learning problems
Release of Preemie From Hospital
must be between 1800 and 2000 grams must be able to feed by mouth must maintain body temperature no apnea or bradycardia family training
NG
nasogastric
NJ
nasojejunal
NEC
necrotizing enterocolitis
Gastrointestinal Disorders
necrotizing enterocolitis gastroesophageal reflux disease
Grade I and II Bleeds
often resolve themselves
Patent
open
Cardiovascular Problems
patent ductus arteriosis (PDA) is most common
Suck/Swallow Response
poorly coordinated until 32-34 weeks gestation
Immunologic Problems
preemies are way more likely to get sick; immature immune system; at risk for generalized bacterial and fungal infections
Middle School Delays
problems with executive function when organization of assignments and homework are required
Breast Milk
provides immunity to baby easier for baby to digest gives less reflux
Complications of Prematurity
respiratory problems neurological problems hearing impairment apnea and bradycardia sudden infant death syndrome cardiovascular problems gastrointestinal problems ophthalmologic problems immunologic problems other physiologic abnormalities
Preterm Births and Death
responsible for majority of neonatal deaths
Preterm Births and Disabilities
responsible for nearly 50% of neonatal-onset developmental disabilities (including CP)
Other Physiologic Abnormalities of Preemies
risk for brain damage glucose/electrolyte instability anemia of prematurity transient deficiency of thyroid hormone production
School Age Kid- Very Preterm/ELBW
risk of developing executive function deficits
Early Intervention
services should begin in NICU any preemie qualifies to be evaluated most LBW and preemies are followed through specialized outpatient clinics until 2-3 years many will qualify for in home services some will require school services
Kangaroo Care
skin to skin contact with baby- mother's core body temperature will change based on child's temperature in order to warm up child if it is too cold
Gastrointestinal Problems
suck/swallow response most preemies require nasogastric or nosojejunal tube feedings nutritional needs differ
Treatment of Patent Ductus Arteriosis
supportive management, then indomethecin or ibuprofen, then surgery (as a last resort)
Ductus Arteriosis
supposed to close at birth so blood can go to lungs (before birth it is used to direct blood away from lungs)
Treatment of Necrotizing Enterocolitis
surgery to have part of the intestine taken out
Necrotizing Enterocolitis
the most common acquired life threatening disease in preemies involves injury/death to parts of bowel wall
Premature Babies in Flexion
they would usually be curled up (in flexion) in uterus
NG/NJ Tubes
tubes go in nose to stomach/jejunum; formula gets straight to it target, bypassing the mouth/esophagus until the nervous system is developed enough to swallow
Sudden Infant Death Syndrome
twice as frequent in preemies, so they are sent home with an apnea monitor and parents are trained in CPR (rate of SIDS hasn't changed since starting to send home apnea monitor)
Diagnosis of Intraventricular Hemorrhage
ultrasound
Bronchopulmonary Dysplasia
used to describe infants who require supplemental oxygen and/or mechanical ventilation beyond 28 days postnatal care
Cause of Intra Uterine Growth Restriction
usually related to maternal illness, smoking, or malnutrition
Kindergarten/1st Grade Delays
visual and fine motor delays
Premature Babies Weighed in NICU
weighed by grams to be more specific and to compare day to day growth
Morrow Reflex
when babies come out, they push their head back and outstretch their hands
Normal Child Elbows
you can see small fat layer, which helps keep the baby warm; preemies do not have this