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