Premature and Small for date infants
Periventricular leukomalacia (PVL)
damage to the white matter of the brain closest to the ventricles due to low O2 or blood flow
feeding skills are affected by (5 things)
decreased flexor and proximal muscle tone, decreased buccal fat pads, limited tongue mobility, limited endurance and low state of arousal
brachycardia
decreased heart rate 80-100 BPM
very low birth weight
1000-1500 g or 3 1/3 lbs
low birth weight
1500-2500 g or 5.5 lbs
PVL can lead to conditions such as
CP
grade IV can lead to PVL
IVH
indomethacin soon after birth significantly reduces risk of
IVH incidence
infection around time of delivery may play a role in
PVL
state signs of stress
gaze aversion and panic look
Bronchopulmonary Dysplasia
abnormal chest x-ray due to lung injury
postconceptual age
age in relation to conception, count until about 40 weeks
chronological age
age since birth
signs of stress
autonomic, motor, state and attention/interaction
Level 1
basic nursery for normal deliveries and expected normal development/can provide resuscitation
therapeutic handling supports (6 things)
calming, slow gentle movements, downward gaze, flexion, occupations and hands near mouth
autonomic signs of stress
color, tremors, vital signs and startled
Bronchopulmonary dysplasia prevention/treatment
corticosteriod therapy/supplemental O2 after 36 weeks corrected gestational age
Hyaline membrane disease (respiratory distress syndrome)
decreased production of surfactant, peak severity 24-48 hours after birth
motor signs of stress
finger splaying and change in muscle tone
PDA can lead to
hypoxia and heart failure
gastroesophageal reflux
immaturity of gastric sphincter, may cause aspriation
6 premature infant characteristics
lanugo (fine body hair), reddish skin color, decreased muscle tone, lack of skin creases, ear cartilage and breast buds
extremely low birth weight
less than 1000 g or 2 1/4 lbs
ultra low birth weight
less than 750 g or 1 1/4 lbs
necrotizing enterocolitis
life threatening injury to portion of bowel wall due to lack of blood supply
PDA treatment
medication or surgery
feeding (look at 7 things)
non-nutritive and nutritive sucking, cue based feeding, reflexes, muscle tone, tongue configuration, coordination of suck, swallow, breath and jaw
Level 4 (NICU)
offer rescue technologies, on-site surgical repair for congenital or acquired malformations, transport systems and outreach education
PVL is more common in _____ than _____ infants
preterm infants than full term infants
apnea
respiratory pause for 15-20 seconds
Level 2 (immature babies, ie. jaundice, tube feedings)
specialty nursery for 32 weeks gestation or less and weights less than 1500 g/provide continuous airway pressure and mechanical ventilation for brief periods
9 goals of OT with premature infants
state organization, parent-infant interaction, self-regulation, oral motor, visual and auditory, orthopedic, postural alignment, musculoskeletal and consultation
Level 3 (NICU)
sub-specialty nursery able to provide continuous life support to high risk and critically ill infants/can provide surgical care
5 commom causes of premature birth
substance abuse, maternal infections, high number of pregnancies, low SES and assisted reproductive techniques
treatment for Hyaline membrane disease
supplemental O2
gestational age
total number of weeks in uteru
Intraventricular hemorrhage (IVH) diagnosed by
ultrasound of head, description based on bleeding location
sudden infant death syndrome (SIDS)
usually between 2-5 months, place on back to sleep, may need monitor for apnea
patent ductlus arteriosus (PDA)
vessel diverting blood flow from lungs doesn't close which causes decreased oxygenation
large for gestational age
weight is above the 90th percentile
small for gestational age
weight is less than 10th percentile
appropriate for gestational age
weight within the 10-90th percentile
corrected age
where they should be at developmentally, calculated till age 2
necrotizing enterocolitis treatment
withhold feedings, suction to decrease pressure on wall, antibiotics, IV fluid and nutrition or surgery