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