Lecture 16 - Phsyio role and Management in NICU

Question 1

what is the average BW or a child

Answer 1

2500-4000g

Question 2

Explain the types of NICU

Answer 2

SCN - babies requiring more intervention than available in maternity unit nursery, 1 nurse:3-4 babies, focus on educating parents, babies are stable

HDU - high dependency unit - 1 nurse:1 baby, babies on resp support

NICU - respiratory support, high risk infants, surgical (pre/post)

Question 3

Term babies vs Pre-term babies: respiration and CV fitness

Answer 3

Respiration

• term: spontaneous
• preterm: may require resuscitation

CV

• term: masters w/o difficulty,
• preterm: brady or tachy common

Question 4

Term babies vs Pre-term babies: Arousal and Temp regulation

Answer 4

Arousal

• term: alert post birth, achieve normal sleep cycle
• preterm: affected by medical conditions

Temp reg

• term: maintain temp
• preterm: poor temp control

Question 5

Term babies vs Pre-term babies: feeding and Movement

Answer 5

Feeding

• term: sucking/rooting reflex at birth
• preterm: fed with NGT or TPN

Movement:

• term: flexor tone can move into and out of flexed pos
• preterm: ext/flex imbalance, struggles to move against gravity

Question 6

What is the Lacey Assessment of Preterm Infants

Answer 6

Assessment of CP

prognostic factors =

• asymetric tonic neck reflex - >10 secs
• UL tone >LL tone
• use of extensor postural control
• contradictory signs - head lag
• increased adductor toe

Question 7

describe Prechtyl general movement assessment

Answer 7

characterized by writhing period and fidgety period
writhing:
- measured 26 GA to 5-9w
- abnormal: cramped, choatic

fidgety:

• measured 9-20w
• golden fidgety at 12 w
• recurrent synchronized cramped movement in the writhing period + absent fidgety movement = strong predictor of CP

Question 8

For neurodevelopmental interventions for positioning what are some positions you can put the baby in

Answer 8

flex at all jts except the neck
scap protraction with arm support
support to provide boundaries - promote temp regulation
WB through hips and shoulders

Question 9

What are some other common deformities seen in CP

Answer 9

MSK conditions

• head shape deformity
• talipes - treated using ponsetti - casting - ankle inversion/PF
• developmental Hip dysplasia: identified with Barlow/Ortolani asessments, leg length discrepancy, asymmetrical skin folds
• fractures - humerus most common during birth

Genetic Conditions

• downs, prada willis, arthrogyposis, osteogenesis imperfecta
• plagio, bracio, scaphocephaly

Question 10

What percentage of babies in NICU need ventilation

Answer 10

89%