Chapter 22: NICU

Question 1

Based on the Dynamic Systems Theory, what is interacting and how is it impacting the child’s performance?

Answer 1

Child and environment are all interacting to positively impact child’s performance

Question 2

Neurodevelopmental Theory: In-turning

Answer 2

Easily stressed from movement, touch, or stimuli
- Go into visible stress response

Question 3

Neurodevelopmental Theory: Coming out

Answer 3

Medical maturity and more stable
- Can be handled more without as much negative stress responses

Question 4

What is anticipatory guidance?

Answer 4

Anticipatory needs of the infant, NICU has protocols for infants and provides guidance for parents and staff

Question 5

Based on the Synactive Theory, what is the infant always interacting with?

Answer 5

The environment
- Can be too stimulating
- Make sure parents are involved as much as possible
- Monitor infant in environment to encourage development

Question 6

How does the brain develop differently in the NICU vs. in the womb?

Answer 6

Exposed to stress, increased cortisol levels which affects development

Question 7

IDC Model

Answer 7

Model of developmentally supportive care

Question 8

IDC Model components

Answer 8

Healing environment- dim lights, minimal noise
Partnering with families- skin to skin contact to create a bond
Positioning and handling- swaddling during painful procedures
Safeguarding sleep
Minimizing stress and pain
Protecting skin- layers of skin are underdeveloped
Optimizing nutrition

Question 9

Interdisciplinary care in the NICU

Answer 9

OT- sensory experiences, family and infant support
SLP- feeding and swallowing
PT- positioning

Question 10

Level I

Answer 10

Support for healthy newborns who may require additional assessment and intervention

Question 11

Level II

Answer 11

Staff are equipped to provide close observation with continuous monitoring of heart rate, respiration, oxygen saturation levels, and basic respiratory support (nasal cannula and IV)

Question 12

Level III

Answer 12

More intensive services including higher levels of respiratory support

Question 13

Level IV

Answer 13

Cares for infants undergoing highly complex, life-saving interventions

Question 14

What levels of NICU care are provided at specialized hospitals?

Answer 14

Levels III and IV

Question 15

What levels of NICU care are provided at local hospitals?

Answer 15

Levels I and II

Question 16

Basics of NICU care practice

Answer 16

Evidence-based, cost-effective, and provide only necessary intervention

Question 17

Insurance reimbursement is contingent upon…

Answer 17

• Cost containment
• Reduction of length of stay
• Avoid readmissions

Question 18

Do many NICUs allow parents to visit around the clock?

Answer 18

Yes

Question 19

Single family rooms

Answer 19

Instead of having baby in large nursery, they are in a room with their parents

Question 20

Pros of single family rooms

Answer 20

Private and intimate setting, easier to control stimuli, less germs

Question 21

Cons of single family rooms

Answer 21

Parents may be unable to be there, isolation, can be overwhelming for parents who are not prepared for their role

Question 22

What is the average birth weight for a baby in the U.S?

Answer 22

7 lbs. 7 oz.

Question 23

What weight is considered normal for a baby in the U.S?

Answer 23

5 lbs. 5 oz. - 11 lbs.

Question 24

Low birth weight (LBW)

Answer 24

3.3-5.5 lbs

Question 25

Very low birth weight (VLBW)

Answer 25

2.2-3.3 lbs

Question 26

Extremely low birth weight

Answer 26

Less than 2.2 lbs

Question 27

Incredibly low birth weight/micropreemie (ILBW)

Answer 27

1.6 lbs or less

Question 28

Appropriate gestational age BW (AGA)

Answer 28

90%-10%

Question 29

Small for gestational age BW (SGA)

Answer 29

10% or less

Question 30

Large for gestational age BW (LGA)

Answer 30

90% or more

Question 31

What types of health challenges can be a result of a NICU stay?

Answer 31

Cardiopulmonary issues Underdeveloped lungs→ chronic lung disease Stress Low stamina Suck/swallow/breathe issue→ NG tube does not help Retinopathy of prematurity→ babies are given supplemental oxygen for extended period of time→ stops retinas from developing Corrective surgery can help this Necrotizing enterocolitis→ tissue and cell damage in the colon, enflamed or ripped colon Hemorrhaging or bleeding in the brain Long term issues→ developmental disabilities or delays, learning challenges (ex. ADD), behavior challenges etc.

Question 32

Neonatal abstinence syndrome

Answer 32

Challenges a baby has due to their mother using drugs during pregnancy (usually opioids)

Question 33

Persistent pulmonary hypotension

Answer 33

The blood vessels to the lungs don’t fully open, causing too much blood to bypass into the lung, brain and body don’t get enough oxygen, high BP in the lungs hurt the baby’s heart and lungs

Question 34

Tracheo-esophageal fistula

Answer 34

Abnormal connection between esophagus and trachea, diagnosed by inability to insert NG tube

Question 35

Hypoxic ischemic encephalopathy

Answer 35

Type of brain injury that occurs when the brain experiences a decrease in oxygen or blood flow Neurological signs→ severe respiratory difficulty, atypical posturing, seizures, dysregulation states of arousal

Question 36

Congenital diaphragmatic hernia

Answer 36

Hole in the diaphragm which forms during development, another organ moves into chest cavity interfering with lung development

Question 37

Prader-Willi syndrome

Answer 37

Genetic disorder with low muscle tone Deletion in a chromosome from father

Question 38

Arthrogryposis

Answer 38

Associated with multiple joint contractures and stiffness, no muscle around the joint causes joint to build other tissues to hold in place

Question 39

Outcomes of NICU survivors

Answer 39

Survival improves with each week of gestation 24 weeks: 35%-84% chance of survival

Question 40

Any baby that spends time in the NICU is at an increased risk of...

Answer 40

Having a developmental delay

Question 41

It is important to provide consistent ______ in the NICU

Answer 41

Support and occupation based care

Question 42

What should the child be receiving after their NICU stay?

Answer 42

Early intervention

Question 43

Sensory habitat of a typical fetus

Answer 43

Unrestricted access to mother Flexible boundaries that offer containment and support Opportunities for movement against fluid resistance without the pull of gravity Limited exposure to external stimuli

Question 44

Sensory based interventions in the NICU consider what?

Answer 44

Type of sensory stimuli and the amount of exposure Conditions under which these interventions are being implemented Timing of intervention with regard to the infant’s gestational age and ability to process the intervention

Question 45

OT assessment in the NICU

Answer 45

Safety, collaboration, observation, checklists, and interview (nurse and parents)

Question 46

Specific therapeutic interventions in the NICU

Answer 46

Address sensory needs Promote therapeutic handling and positioning Breast and bottle feeding Being close with the family Modifying the environment

Question 47

Partnering with families in the NICU

Answer 47

Family has greatest influence over infant's health and well-being Parents should be included as partners in care planning

Question 48

How do we support parental participation in the NICU?

Answer 48

Explaining procedures Encouragement to participate and practice skin to skin contact Giving ideas of what is to come