Premature and Small for Date Infants
Feeding in NICU
breastfeeding bottle feeding non-nutritive sucking nutritive sucking-when does the suck-swollow emerge? cue-based feeding
Very low birth weight
1000-1500 grams (3 1/3 pounds)
Low birth weight
1500-2500 grams (5 1/2 pounds)
Families in NICU
Inclusion, skin-to-skin holding, discharge planning, family centered care
Goals fo OT in NICU continued
Oral motor visual and auditory musculoskeletal orthopedic consultation collaboration to home
Cardiovascular problems
Patent Ductus Arteriosus (PDA) vessel diverting blood flow from lungs does not close which causes decreased oxygenation leads to hypoxia, decreased blood flow, and heart failure closure is possible through medical intervention or medications
Neurologic problems-intraventricular hemmorrhage (IVH)
Ultrasound of head for diagnosis described based on bleeding location Grade IV can lead to PVL Indomethacin given soon after birth significantly reduces risk of incidence
Feeding skills
affected by decreased flexor and proximal muscle tone decreased buccal fat pads limited tongue mobility limited endurance low state of arousal
Causes of prematurity
assisted reproduction techniques High number of multiple pregnancies substance abuse unknown preterm delivery related to SES Maternal infections in adolescents intrauterine infection
Appropriate for gestational age
birth weight between 10th and 90th percentile
Large for gestational age
birth weight greater than 90th percentile
Small for gestational age
birth weight less than 10th percentile
signs of stress-autonomic
color vital signs tremors startle
Neurologic problems-Periventricular Luekomalacia
damage in the white matter of the brain closest to ventricles Damage due to low O2 or low blood flow Leads to conditions such as CP
Classification for Age
gestational age postconceptual age chronologic age corrected age
Respiratory Problems-Hyaline Membrane Disease (Respiratory Distress Syndrome)
decreased production of surfactant peak severity 24-48 hours after birth most resolve 72-96 hours after birth supplemental OT is treatment
signs of stress-Motor
finger splaying change in muscle tone
signs of stress-State
gaze aversion panic look
Other impairments
hearing impariments: medications can negatively impact the auditory system Apnea and Bradycardia SIDS (2-5 months; those with apnea go home with monitor, back to sleep) Retinopathy of prematurity: retinal detachment Immature immune system
Neuromotor Development
hypotonia to flexion random to purposeful reflexes become consistent flexor tone (caudalcephalic) posture and movement patterns therapeutic positioning range of motion
Gastroesophageal reflex
immaturity of gastric sphincter may cause aspiration
Premature infant characteristics
lanugo-fine body hair reddish skin color decreased muscle tone lack of skin creases lack of ear cartilage lack of breast buds
Extremely low birth weight
less than 1000 grams (2 1/4 pounds)
Ultra low birth weight
less than 750 grams (1 1/4 pounds)
sensory stimulation versus stimulation in NICU
minimal stimulation sensory deprivation therapy sensory stimulation programs sensory overload environmental neonatology individualized, relationship-based, family-centered developmental care
Gastrointestinal Problems
necrotizing enterocolitis life threatening severe injury to portion of bowel wall Treatment=withholding feedings and suction to decrease pressure on bowel wall, antibiotics, IV fluids and nutrition More than 1/2 require surgery to remove portion of bowel
Preterm Infant Behavior
physiological or autonomic responses motor responses state control attention and interaction behaviors self-regulation
Assessing oral feedings
reflexes muscle tone tongue configuration coordination of suck, swallow, and breathing, jaw
OT and NICU
require specialized training the environment can affect preterm neonate neurobehavioral systems OT services emphasize developmental supportive care, developmentally appropriate interactions, and interventions to facilitate neonate's neurobehavioral organization Work with parents as primary caregivers after the neonate is discharged from the hospital
Respiratory Problems- Bronchopulmonary Dysplasia
require supplemental O2 after 36 weeks corrected gestational age abnormal chest x-ray due to lung injury corticosteroid therapy for prevention
NICU Enivronment
sensory components: lighting, sound, environmental modifications caregiving
OT Goals in the NICU
state organization parent-infant interaction self-regulatory postural alignment: midline, symmetrical, flexion, body awareness
Positioning and Therapeutic handling continued
support calming parent infant bond nesting least intrusive swaddling, flexion positioning sensory stimulation
Positioning and Therapeutic Handling
support occupations calming slow, gentle movements hands near mouth downward gaze facilitate flexion baby with splint video