Chapter 7: Premature and Small-for-Date Infants

Intraventricular hemorrhage (IVH)

bleeding in the brain

AGA

10th-90th percentile

Legislation related to EI

1986 Education of the Handicapped Act (EHA): incentivized states to provide family-centered care for infants with disabilities 1990 Individuals with Disabilities Act (IDEA), Part C: states must make available services for infants & toddlers w/ DD 1997, 2004 Individuals with Disabilities Education Improvement Act (IDEIA)

SGA

<10th percentile

LGA

>90th percentile

Pre-term

A preterm or premature infant is one born before the 37th week of gestation

Ophthalmologic problems

Abnormalities in retinal vascular development lead to retinopathy of prematurity (ROP) ROP: abnormal tissue growth causes detached retina, blindness

Survival of LBW infants

Advances in technology of NICUs and their application to the premature infant have helped to reduce mortality Since 1960, survival of LBW infants has increased from 50% to more than 90%

Apnea and bradycardia

Apnea pause lasting 15-20 seconds Disorder of respiratory control and related to immaturity of central nervous system

Neurodevelopmental Outcome

By school age, the developmental status of preterm children who had birth weights above 1,500 grams is not very different from full-term infants Children with birth weights below 1,500 grams have an increased risk for developmental disabilities School-age children born very preterm or ELBW are at greater risk of developing executive function deficits (attention-deficit/hyperactivity disorder, learning disabilities, autism)

Hyaline membrane disease

Decreased surfactant i.e. Respiratory Distress Syndrome (RDS)

Individualized Family Service Plan

Developed by the team (coordinated by service coordinator) after the initial evaluation Defines environments where services will be provided, frequency/duration of services Includes current status and team-written outcome statements No jargon Discipline-free Real-life settings

New approach to NICU care

Differs from traditional care based on medical protocol and procedures More relationship based, individualized, developmentally supportive Involves observation of and response to infant behavior Actively involves parents in infant's care

Auditory toxicity

Increased risk for hearing loss due to frequent use of medications that can be toxic to the auditory system

Early Intervention Programs

Focus on family strengths Families are treated respectfully Families have control, make choices Families work with the provider Focus is on the child within the family unit

Immunologic problems

Immature immune system premature infant at risk for generalized bacterial and fungal infections

Causes of premature birth

Increased obstetric intervention (C-sections) Use of assisted reproduction techniques (in vitro fertilizations) High number of multiple pregnancies (fertility drugs) Increased substance abuse in urban areas Rise in idiopathic preterm delivery rates due to adverse effect of low socioeconomic factors and maternal education level Maternal infections Adolescent pregnancies

Other physiologic abnormalities

Increased risk for brain damage Glucose and electrolyte instability Anemia of prematurity Transient deficiency of thyroid hormone production

Clinical criteria for discharge based on

Infant able to feed well by mouth/consistent weight gain Infant maintaining a stable body temperature outside of an isolette Infant no longer experiencing episodes of apnea and bradycardia

Gastrointestinal problems

NEC (Necrotizing enterocolitis )severe injury to a portion of the bowel wall Gastroesophageal reflux disease (GERD) contents of the stomach are regurgitated back into the esophagus

Key Points about Part C

Non-categorical eligibility Entitlement program vs. mandated (Part B) OT is a primary service Family centered Treatment occurs in natural environment State funding is payment of last resort

Incidence of preterm births

Occurs in about 13% of all pregnancies worldwide Preterm births responsible for majority of neonatal deaths and nearly one half of all cases of neonatal-onset neurodevelopmental disabilities (including cerebral palsy) Incidence of preterm births has declined 1% since 2006, but overall has risen 16% since 1990

SIDS

Occurs more than twice as frequently in premature infants Apnea monitors used for premature infants with significant apneic spells Recommended that infants sleep on their backs

Cardiovascular problems

Patent ductus arteriosus (PDA) fetal vessel that diverts blood flow from the lungs; vessel does not close, so the lungs are not oxygenated

Clinical criteria for discharge based on

Premature infants may be more irritable, cry more often, and have poorer sleep-wake cycles; require more frequent feedings Home care visits by nursing and/or social work staff important for family support after infant discharge

Physical and behavioral characteristics of the premature infant

Presence of fine body hair (lanugo) and smooth, reddish skin, along with the absence of skin creases, ear cartilage, and breast buds Reduced muscle tone and activity; increased joint mobility Appears passive, more likely to be disorganized than a full-term infant

Medical and Developmental Care of Low Birth Weight Infants

Preterm and SGA infants are best managed and cared for in high-risk obstetrical centers with neonatal intensive care units (NICUs)

Bronchopulonary dysplasia (BPD)

Require oxygen supplementation &/or ventilation

Eligibility Determination

Some specific diagnoses, or confirmed developmental delay identified by multi-disciplinary team Criterion-referenced assessments frequently used Informed clinical opinion

Chronologic age

actual age since birth

Neurological problems

auditory toxicity, intraventricular hemorrhage (IVH), and periventricular leukomalacia

Periventricular leukomalacia

damage to hearing from antibiotic use

Corrected age

how old the baby would be if born at full term CA minus number of weeks early

Respiratory problems

hyaline membrane disease, apnea and bradycardia, and bronchopulmonary dysplasia (BPD)

Complications of prematurity

neurological system, cardiovascular system, respiratory system, gastrointestinal system, ophthalmologic system

Gestational age

time elapsed between 1st day of last period to day of birth completed weeks full term: 38-42 weeks