HP 252: Preterm Infants: Unit 2

what is kangaroo care?

wo increasingly used interventions in the neonatal intensive care unit (NICU) are kangaroo care and massage therapy. Kangaroo care involves skin-to-skin contact in which the baby, wearing only a diaper, is held upright against the parent's bare chest, much as a baby kangaroo is carried by its mother (Raajashri & others, 2018; Stockwell, 2017). Kangaroo care is typically practiced for two to three hours per day, skin-to-skin over an extended time in early infancy.

care needs of preemies 2

§Warmth §Rest/sleep §Environmental modulation §Containment/ Comfort §Positioning §Nurturing/social interaction §Sucking

environmental causes of low birth weight

•Poor health & nutrition •Cigarette smoking •Use of drugs •Multiple births/reproductive technology •Improved technology and prenatal care

rehabs services for babies born preterm

50% of them need special education Once they hit school age, the special ed is required by law and requires and individualized education plant o geth the services they need. SPecial ed is umbrellat erms. Learning disabilities require special ed and they affect kids who are preterm. Learning disability has a high IQ bu tlow reading or verbal disability. Early interentions: EI is free, intensive rehavb services for kids age 0-3. Working on sand table to bild find motor. A kid preterm will have weak gros smotor and that will affect fine motor. Kids up to age 3 do a variety of activities in order to make sure hey have the enrichment they need to keep devleopment on track. make sur ekids are developing and learning to talk and developing sensory and integrate sense and adapta nd learn and grow. They ge thelp from SLPs. OT, PTs, kangaroo care and massage therapy can also help babies development--tehy grow faster and seem to have better outcomes. Babies born preterm can usually do fine but you just have to watch an dmake sure and get through NICU experience and get home aand get nterventiosn tehy need and usually donthave long term effects.

mother and nurse views on kangaroo care

A survey conducted in the United States found that mothers were much more likely to have a positive view of kangaroo care and to believe it should be provided daily than were neonatal intensive care nurses (Hendricks-Munoz & others, 2013). There is concern that kangaroo care is not used as often as it could be used in neonatal intensive care units (Smith & others, 2017). Increasingly, kangaroo care is recommended as standard practice for all newborns (Johnston & others, 2017).

consequences of preterm birth and low birth weight

Although most preterm and low birth weight infants are healthy, as a group they have more health problems and developmental delays than normal birth weight infants (George & others, 2018; London & others, 2017). For preterm birth, the terms extremely preterm and very preterm are increasingly used (Ohlin & others, 2015). Extremely preterm infants are those born at less than 28 weeks gestation, and very preterm infants are those born at less than 33 weeks of gestational age. Figure 8 shows the results of a Norwegian study indicating that the earlier preterm infants are born, the more likely they are to drop out of schoo

anemia 2

Anemia--not enough chromatic / low iron. Some babies need transfusions. Anemia canc reate problems with tiredness and in severe cases cardiovascular and respiratory issus. One of the at risk complications

As and Bs of prematurity

As and Bs of prematurity (apnea--stop breathing when sleeping and bradychardia--when you stop breathing, heart rate slows) Babies can't leave nICU until they have 6-8 hrs of apnea and bradychardia free time This is from immature neurological system Ally ou have to do is rub babies foot and arm and heart rate will start back up

BPD

BPD: caused bymechancial ventilators. If baby cant breathe on own because born preterm, apgar score is lower and baby is bluish since they cnat breathe on their own. They use CPAP (continued positive airway pressure) that blows air through baby'swindpie into baby's lungs. When babies needmore O2, they actually need a tiny ventilator. If you put too much oxygen into babby's lungs you can end up with BPD,

care for preterms

Babies need to be covered up and kept warm so they aren't wasting calories on keeping warm With premature labor, keep gravity and activit yout of the picture. Keep them on bedrest to prevent premature labor Last 8 weeks of preganncy is growing. Preterm babies dot have great muscle tone becaus ethey didn't have chance to get increased fat and get bigger inside uterus and grow muscle tone since uterus is so small and they are squished in there They put antibiotic cream on eyes of baby because mom's cervix may be infected Tiny baby needs smaller diapers because that can cause hip dysplasia. With a baby liek this, you need to position it. Encourage good muscle tension and posture. Put the baby in support so that muscle tone can develop. Kee the baby contained and give baby diaper size it needs nad keep baby in warm an quiet enviro so baby can feed and grow. Most preterm babies spend most of their time sleeping. For preterm babies, they need to develop out of the uterus what full term babies woul dhave grown or devleoped in the uterus. Thatf rog leg position is not good at all. Preterm babies do this because of lack of muscle tone

what does NICU look like?

Because of herculean effort we hav emade to save addicted babies, we can now save all small babies A lot of times in nicu baby is in isolette and baby is covered up and there are two hotels for the arms Baby is getting oxyge, because baby's vision wehn born preterm can be compromised b y light, baby is getting nutrition, baby has test leeds on ti to make sure breathing and heart rate is going okay. Teeny weeny like pacifier is helpful for tiny baby to get selth soothing

Necrotizing enterocolitis

GI system. rare condition that affects intestinal wall of very premature babies. Diagnosed witht ypical x-ray image of bowel wall. baby on breast milk has 10x less risk of developing this. It really interferes with baby's capacity to digest food and if not treated then baby can die from this. Death of cells and tissues - necrotizing. This is why we weight the baby so much and look at what baby eats and what baby is eliminating - kept notes of how many ounces of milk and had to track when he and ho wmuch he pooped to make sure he was using what was going in.

care needs of preemies

He has a nasogastric tube. cartialge of ears were still soft. Eyelashes werent in. NG tube stays in--preemies dont have succking, swallowing, breathinga ctivities to coordinate those activities to breast feed. NG tube helps baby get that nurritionw ithout all of that

hemmorhage

Hemorrhage--brain bleed. Stage 1 - 4. Bleeding inb rain from fragile immature vessles into ventricles and can cause issues. Extremely premature babies predisposed to IVH. If they are below 1200 g then they are higher risk for this Grade 1--light bleeding gaade 2--ittle more. Grade 3 and 4--pressure build up from bleeding. Very serious wehn baby needs a shunt to take care of that and drain the blood. Grade 1 IVh can resolve on its own. THey can do a C T scan. If someone has IVh, greater risk of learning disability late ron

jaundice 2

High b bilirubin Babies look yellow Wanna clear that out of the system using UV lights

rate of preterm birth in US

In 2015, 9.6 percent of babies born in the United States werePage 95 born preterm (Martin & others, 2017). The preterm birth rate was 8.8 percent for non-Latino White infants, down from 11.4 percent in 2011 (Martin & others, 2017). In 2015, the preterm birth rate was 13.4 percent for African American infants (down from 16.7 percent in 2011) and 9.1 percent for Latino infants (down from 11.6 percent in 2011) (Martin & others, 2017).

adolescent mothers and preterm birth

In both developed and developing countries, adolescents who give birth when their bodies have not fully matured are at risk for having low birth weight babies (Bird & others, 2017; Kirbas, Gulerman, & Daglar, 2016). In the United States, the increase in the number of low birth weight infants is due to factors such as drug use, poor nutrition, multiple births, reproductive technologies, and improved technology and prenatal care that result in more high-risk babies surviving (National Center for Health Statistics, 2012; Pereira & others, 2017). Poverty also continues to be a major factor in preterm births in the United States (Huynh & others, 2017; Wallace & others, 2016). Women living in poverty are more likely to be obese, have diabetes and hypertension, and to smoke cigarettes and use illicit drugs, and less likely to receive regular prenatal care (Timmermans & others, 2011).

NICU setting disruptive?

It's loud and clutter of cords all over. Beepps and other babies' monitors are going off

kangaroo care again

Kangaroo care: bothphysical and psychological benefits. Helps keep babies warm and helps them thrive.

difference between low birth weight, preterm, small for date

Low birth weight is under 5.5 pounds preter m is before 37 weeks Happening more because women delay having babies til later life and then they have to use IVF because they aren't as fertile and there are multiple births na dthat make si thard to carry both babies in the uterus full term Low birht weight is umbrella Small for date infants are different. The baby is born at full term but the baby is low birth weight. Usually that is something going on with baby that is keeping it from thriving or developing When baby is born early, incompetent cervix or placenta so its something with the mom with preterm Substance abuse, stress, teratogens causes low birht weight and all of that is on the increase so its causing the upward trend in low birth weight babies

preemies and learning disabilities

Neurological system takes longer to develop - learning disability Most kids need some sort of special education EI - first three years o flife Enruichment program Sand table sand stuff to build fine motor skills for school Massage therapy - gentle massage of chld's skin so it snot too stimulating Moro reflex - nuerological systems are immatureadn they are stressed about something ine nviro

BPD

Lung issue.

benefits of massage therapy for preemies

Many adults will attest to the therapeutic effects of receiving a massage. In fact, many will pay a premium to receive one at a spa on a regular basis. But can massage play a role in improving the developmental outcomes for preterm infants? A study found that both kangaroo care and massage therapy were equally effective in improving body weight and reducing length of hospital stay for low birth weight infants (Rangey & Sheth, 2014). In another recent study, massage therapy improved the scores of HIV-exposed infants on both physical and mental scales, while also improving their hearing and speech (Perez & others, 201

meningitis

Meningitis - infection in cranial or spinal cord fluid. Try to keep infections down to a minimum and keep a real sterile field. Let baby be in the dark and keep them s warm as they cana nd help them feed and grow so they dont have to spend precious energy and weight fighting off these complications

exercise and preterm birth

Might exercise during pregnancy reduce the likelihood of preterm birth? One study found that compared with sedentary pregnant women, women who engaged in light leisure time physical activity had a 24 percent reduced likelihood of preterm delivery and those who participated in moderate to heavy leisure time physical activity had a 66 percent reduced risk of preterm delivery

NICU setting

NICU setting is loud and stimulating. 8-10 babies around him or her and bay hooke up to machines. YOu can bring stuffed animals as long as they are washed beforehand. Babies need hats to keep them warm containment/comfort: wrap them up so they are tucked in like the womb and develop muscle tone. Give them pacifier to suck for self soothing nurturing/social inetercation: hand on hand and leave it there but nos trokign and rubbing because they have little fat and it is too much for the nerves. Not soothing! Sucking--gives child a way to cope and deal. Kangaroo care--HELPS WITH PHYSICAL GEOWTH AND PSYCHOLOGICAL OUTCOMES> builds oxytocin and alpha waves in braint hat kind of sync up Breast milk intot est tube which is fed to baby through NG tube because baby isnt coordinated enough to suck yet. Breast milk that comes in and is high in fat so they encourage momsto pump that milk and freeze it because its just what baby needs. Breast milk involves in nutritional content to be exactly what they need Baby can sleep on back or side or stomach because baby is hooked up to so many monitors that we dont have to worry about SIDS

NG tubes

Nasogastric tube: breast milk can be put through the tubebecause preterm babies can suck and swallow and breathe at the same time

PDA

PDA--blood supply goes past thelungs. IN healthy full term babies, this vessel closes up. In rpeterm babies, this vessel doesnt close. Once baby is born and lungs begin tow ork, the lungs can fill with blood. Helthy preemies, the vessel will close by itself but some babies needs urgery for it to close

NEC

Premature baby struggling to feed and grow - NEC

why is kangaroo care important?

Preterm infants often have difficulty coordinating their breathing and heart rate, and the close physical contact with the parent provided by kangaroo care can help to stabilize the preterm infant's heartbeat, temperature, and breathing (Boundy & others, 2017; Furman, 2017). Preterm infants who experience kangaroo care gain more weight than their counterparts who are not given this care (Sharma, Murki, & Oleti, 2018). Recent research also revealed that kangaroo care decreased pain in newborns (Johnston & others, 2017; Mooney-Leber & Brummelte, 2017). Further, a research review concluded that kangaroo care decreased the risk of mortality in low birth weight infants (Conde-Aguedelo, Belizan, & Diaz-Rossello, 2014). Also, a research study demonstrated the positive long-term benefits of kangaroo care (Feldman, Rosenthal, & Eidelman, 2014). In this study, maternal-newborn kangaroo care with preterm infants was linked to better respiratory and cardiovascular functioning, sleep patterns, and cognitive functioning from 6 months to 10 years of age. Further, in a longitudinal study, the nurturing positive effects of kangaroo care with preterm and low birth weight infants that were initially found for intelligence and home environment at one year of age were still positive 20 years later in emerging adults' reduced school absenteeism, reduced hyperactivity, lower aggressiveness, and social skills (Charpak & others, 2017).

preerm stories

Preterm store NG tube, test leeds to monitor heart and breathing, nutrients going through IV Oximeter -put on finger tip to test oxygen Got cut on face and chest because of emergency c section Gettinglights because has jaundice Teeny weeny to help with sucking Getting IV nutrition nd breast milk still They can bathe at 3 poudns and g tube stays in What mostly happens is a lot of feeding and growing Using hand for support because core is still weak

ROP

ROP can be caused by ane ye disease that causes severe vision problems or blindness. They an do premature baby precedures or surgeries to help with this. Putting something over their eyes helps with this first.

How to decrease rate of preterm births?

Recently, considerable attention has been directed to the role that progestin (a synthetic hormone similar to progesterone) might play in reducing preterm births (Awwad & others, 2015; Iams & others, 2018). One study found that progestin treatment was associated with a decrease in preterm birth for women with a history of one or more spontaneous births (Markham & others, 2014). Increasing use of progestin and decreasing rates of smoking are among the factors that likely account for the recent decrease in preterm births (Schoen & others, 2015).

respiratory distress

Respiratory distress-insuffience surfactant in lungs - lining that enables us to breathe - immature babies doesnt have tiem to develop that. If baby is going to come earlier than we thought, we give mom steroid shots that increases surfactant in baby's lungs and decreases risk of RDS

sepsis

Sepsis - infection in the blood that can become systemic. Systemic antibiotics are tough for your system to handle because infection can be insidious and it can affect all of the organ systems

are small for date infants always born full term?

Small for date infants may be preterm or full term. One study found that small for date infants had more than a fourfold increased risk of death

rate of preterm births internationally

The incidence of low birth weight varies considerably from country to country. In some countries, such as India and Sudan, where poverty is rampant and the health and nutrition of mothers are poor, the percentage of low birth weight babies reaches as high as 31 percent (see Figure 7). In the United States, there has been an increase in low birth weight infants in the last two decades, and the U.S. low birth weight rate of 9.6 percent in 2015 is considerably higher than that of many other developed countries (Martin & others, 2017). For example, only 4 percent of the infants born in Sweden, Finland, Norway, and South Korea are low birth weight, and only 5 percent of those born in New Zealand, Australia, and France are low birth weight.

health problems in preterm babies

The number and severity of health problems increase when infants are born very early and as their birth weight decreases (Linsell & others, 2017; Pascal & others, 2018). Survival rates for infants who are born very early and very small have risen, but with this improved survival rate have come an increased rate of severe brain damage (Rogers & Hintz, 2018) and lower level of executive function, especially in working memory and planning (Burnett & others, 2018).

EI rehab and prenatal care

Through EI and rehab and prenatal care, we can address deficits that might happen with genetic disorders and preemies, etc Goal is to support a healthy early childhood

jaundice

excess bilirubin common in preemies because immature babies livers cant metabolize bilirubin. Baby si brain is at higher risk because blood brain barrier cant protect ig rom getting in. Light therapy.

newborns weigh less than 2 pounds.

extremely low birth weight

Retinopathy of prematurity

eyes. Abnormal proliferation of blood vessels around retina around eye. Sever when gien too high level sof oxygen. Have to give babies the amount of oxygen it needs to reduce risk of issues with retina. Blood vessels of babies re tiny and can be affected by too much oxygen.

what are all these conditions so scary in preemise?

babies dont have a lot of resources to fight these infections and stuff.

sucking is important

babies who can suck can self soothe. Oftentimes babies in NICU get poked and prodded and it is uncomfortable especially with not a lot of subcutaneous fat tissue.

shortened/incomplete intrauterine development

baby appears to be about 30 weeks. They are very little. Very littele subcutaneous fat tissue. Baby is not positioned well. Make sure arms and legs are tucked in. Critical for preterms - this baby will have issues with hips. They put full term diaper on the baby. Their is gonna be issues later on when they learn to wak. The legs should nto be in a frog like position.

apnea and bradycardia

baby's respiratory system and hart rate. Number 1 reason why baby needs to be in NICU and hooked up tomonitors. Neurologial system is immature and breathing stops and heart rate stops and baby needs foot rubbed and breathing will resume. Baby needs to go 24 hours free of apnea and bradycardia to be released from NICU

anemia

beocmes apparent in a few weeeks of age. Delay n producing red blood cells if bone marrow is immature. Baby needs iron in its milk. Add iron in to make sure baby is getting enough. Anemia can create other issues if not treated

Sucking reflex

usually there at birth.

why is kangaroo care important? 2

developed ins oth america as a necessity. but it helps developp growth develop and attachment. Babies with this grow faster and have better outcomes than babies who do not. In south america didnt have enough siolettes to keep baby warm. A preemie can be easily stimulated. Dnt liek to be patted becaus ethey don't have a lot of fat tissue. Sensory system is still development and pretty raw. Holding the baby is very comforting. Dnt do a lot of patting

why baby needs warmth?

dont want babies to spend calories onkeeping warm. Want them to spend calories on feedign and growing

Complete Intrauterine development

hat to keep body warm. Umbilical cord clamped. Shiny antibiotic oitnemnt on the eye to protect any infect that was transmitted coming through the cervix or birth canal. Good flesh, all parts are their (eyebrows nipples

long term negative effects of steroid injections used to prevent RDS and IVH

icnrease inr ish of ADHD for babies who have steroid treatment. Babies used to die from respiratory distress. They didn't used to have a way oto treat this so this used to be fatal

patent ductus arteriosis

issue with heart. Not that common but it is something that we look for. When there is a persitent opening between two major blood vessels leading from the heart. Normal part of circulatory system before birth that closes shortly after birth but in preemies may remain open. Doesnt always need to be treated and can close up on its own. Left untreated it may allow poorly oxygenated blood to flow in wrong direction. Weaken hear tmuscle and cause complications. Medication, monitorting, surgery to close that up.

weigh less than 5 pounds 8 ounces at birth.

low birth weight

•infants less than 5 ½ lbs. at birth

low birth weight

Covers for isolette

make these covers. Helps keep the baby warm and positioned. Bring hoem to the baby. Keeps it warm and ddark and a little bit mroe quiet

Respiratory distress syndrome

most babies born before 32 weeks are at risk for this. Surfactant in ungs is missing so lungs dont expand the way they need to and ungs are lacking in eelasticity. Give mom a shot of steroid to buff the lungs and gives the baby's lungs a chance to develp a bit more quickly. Buys some tiem and buffs the lngs. The steroid treatment prevents ivh too.

interventriculr hemorrhage

most commonf orm of brain injury in preemies. Occurs in first 5 days after birth. It occurs in first few days after birth in 1/5 babies under 2000 grams (grams are more sensitive than pounds). The IVH is linked to severity of RDS and hypotension. Preemies can have otehr brain injuries connected with lack of oxygen. IVH level 1--resolves on its own after a few weeks, least sever.e Stage 4--pronounced bleeding in brain and they need a shunt to get out extra blood. IVH stage 1 and 2 doesnt appear to have long effects (possible ADHD or psychiatric or cognitive disorders).

eigh less than 3 pounds 4 ounces

very low birth weight

brains of preemies

ne study revealed that very preterm, low birth weight infants had abnormal axon development in their brains and impaired cognitive development at 9 years of age (Iwata & others, 2012). Children born low in birth weight are more likely than their normal birth weight counterparts to develop a learning disability, attention deficit hyperactivity disorder, autism spectrum disorders, or breathing problems such as asthma (Brinskma & others, 2017; Ng & others, 2017). Approximately 50 percent of all low birth weight children are enrolled in special education programs. Page 96 Nurturing Low Birt

Intrauterine development

optimal place for babies to grow. 16 weeks--baby has a lot of rooms. By 18 to 19 weeks, baby gets more cramped because arms and legs are growing. The last couple of months are all about feeding and growing and really fleshing out neurological development and getting mature systemse to make sure everything is ddeveloping the way it is supposed to be. By 30 weeks, baby born at muscle development is at risk of beig between 2.5 and 3.5 pounds, half the size of what we owuld expect. Would have some issues and need to spend time in the NICU.

potential consequences of prematurity

preemies have higher incidence of learning disability, brain injuries from IVH. Astham a consequence of RDS. Lower levels of reading and math achievement. Not al lpreemies have these thigns but they are at higher risk for them ADHD also. You want to track them and make sure they get the interventiont hey need to stay ona god developmental trajectory

•born three weeks or more before full term

preterm

those born three weeks or more before the pregnancy has reached its full term—in other words, before the completion of 37 weeks of gestation (the time between fertilization and birth).

preterm infants

•birth weight below normal for gestation

small for date

are those whose birth weight is below normal when the length of the pregnancy is considered. They weigh less than 90 percent of all babies of the same gestational age.

small for date infants

extrauterine development

they are developing in NICU rather than in mother's NICU. Frog legs--can develop hip dysplasia. You want to develop isometric tension by wrapping. The baby with support -- give skeletal and mucular system the chance to develop the way it was intended to

developmentally supportive care

tucked, cover, and warm also positioning and evnvironemntal modulation nesting and support we liek to promote self soothing with the hand and the mouth,. Teenie weenie fors ucking. Those things help with self soothing

prevalence of preterm infants

•400,000 births/yr in US...on the rise

maternal medical issues that can cause low birth weight

•Age •Pre-clampsia •Placenta previa •Cervical "incompetence" •Premature labor

other at risk complications for preemies

•Anemia •Jaundice •Bronchopulmonary dysplasia (BPD) •Infections •pneumonia (lung infection) •sepsis (a blood infection) •meningitis (an infection in cranial/spinal cord fluid)

potential medical risks for preterm babies

•Apnea & Bradychardia •Respiratory distress syndrome (RDS) •Intraventricular hemorrhage (IVH). •Patent ductus arteriosis (PDA). •Necrotizing enterocolitis (NEC). •Retinopathy of prematurity (ROP).

other care needs of preemies

•Containment/comfort/positioning •Secure, but not "straight jacket"! •Nurturing/social interaction: the best way to do this is to be present with the child. kangaroo care helps. •Based on baby's maturity: touch before visual •Sucking: helps them self console. •Helps them self-console/organize--its soothinga nd helps baby gather itself together and remain calm

why has number of preterm births increased?

•Number of births to mothers 35 years and older •Rates of multiple births •Management of maternal and fetal conditions •Substance abuse •Stress