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Pediatrics > NICU > Flashcards

NICU Flashcards

1
Q

What are some special considerations of PT practice in the NICU?

A
  1. Child misses out on physiologic flexion
  2. lungs are underdeveloped
  3. more sensitive neurologically
  4. less body fat, smaller
  5. difficulty regulating temp and HR
    - to be removed from NICU, must maintain core temp and gain weight
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2
Q

What are the educational requirements for a PT to work in the NICU?

A
  • Not entry-level
  • Sub-specialty area within pediatrics
  • Potential for causing harm (physiologic jeopardy); Not for the PT or OT assistant
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3
Q

What is the role of the PT in the NICU?

A
  1. Screen infants to determine need for PT based on established referral criteria
  2. develop and implement a risk management plan to prevent neurobehavioral organization and secondary complications, to max neurodevelopment function
  3. design, implement, and evaluate intervention plans and strategies in collaboration with family and team
  4. consult and collaborate with internal and external players
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4
Q

What is the role of the SPT in the NICU

A
  1. non handling observations in the NICU: Varying ages, diagnoses and acuity levels; Infant caregiver interaction; Handling and interaction by all team members; Communication with team members
  2. Handling, examination, intervention on the pediatric unit and PICU
  3. Interaction, examination, intervention in NICU follow-up clinic
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5
Q

A high-risk infant is defined as High probability of demonstrating developmental delay as a result of exposure to medical factors. What is this classified based on?

A
  1. birth weight (under 5lb 8oz)
  2. gestational age
  3. pathophysiologic problems
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6
Q

What are the differences btwn NICU babies and “normal” babies?

A
  1. Less body fat
  2. Less muscle tone
  3. Smaller
  4. Can’t regulate body states: Temperature, Rhythm of breathing, Swallowing & sucking, Remembering to breathe, Jaundice
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7
Q

What does the posture look like in premature infants?

A
  1. Hyperextended neck
  2. Elevated shoulders with adducted scapulae
  3. Decreased midline arm movements
  4. Excessively extended trunk
  5. Immobile pelvis
  6. Infrequent antigravity movement of legs
    - problems in prone, sitting, breathing, reaching
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8
Q

Neonates and premature neonates can feel pain. what are their physiologic and behavioral responses?

A
  1. increased heart reate
  2. blood pressure, and respirations
  3. decreased O2 sats
  4. pallor, flushing, diaphoresis, palmar sweating
  5. increased muscle tone
  6. dilated pupils
  7. crying, grimaces, furrowed brow, limb withdrawal, fist clenching, finger splaying
  8. changes in state
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9
Q
  • Causes: Insufficient Surfactant; Pulmonary immaturity
  • Risk factors: Prematurity, LBW, Low Apgar at 1 and 5, Maternal age over 35
  • Treatment: Steroids to Mother, Administration of surfactant to infants, Prophylactically in infants <30wga, Positive pressure ventilation
A

Respiratory distress syndrome (Hyaline membrane disease)

- 32 weeks produce surfactant, prior to 30 wks, definitely not there

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10
Q

What are the respiratory conditions that can be seen in the NICU

A
  1. Respiratory distress syndrom
  2. Apneay and bradycardia - need apnea monitor
  3. bronchopulmonary dysplasia
  4. Chronic lung disease
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11
Q
  • Damage to immature lung tissue from artificial ventilation
  • Diagnostic Criteria: 28 days (born at >/=32 wga) and require supplemental O2; Abnormal physical exam (wheezes, tacypnea, retraction); Abnormal chest X-ray
A

Bronchopulmonary dysplasia

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12
Q
  • thickened and hyperreactive airways, decreased lung compliance, increased airway resistance, impaired gas exchange with ventilation-perfusion mismatch, air trapping
  • 36 wga and requires supplemental O2; same as BPD but at 36 wks or older
A

chronic lung disease

- clinical manifestations = irritability, restlessness, postural abnormalities, fatigue

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13
Q

What is the long term sequelae from respiratory problems?

A
  1. Repeated infections
  2. Requirement of supplemental oxygen
  3. Pulmonary hypertension
  4. Cardiac hypertrophy
  5. Transient hypertonicity
  6. Asthma - Especially with BPD
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14
Q

What is the cardiac condition seen in NICU?

A

Patent ductus arteriosus

  • or persistent fetal circulation
  • rx: indomethacin or sx
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15
Q

What are the causes of intraventricular hemorrhage (IVH)?

A
  1. perinatal asphyxia in premature brain with fragile vasculature (germinal matrix 26-34 weeks)
  2. Resuscitating infants (sudden inc in BP)
  3. Respiratory Distress Syndrome
    - 28-32wga key time for neurologic damage due to vulnerability of the brain and developing glial cells
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16
Q

What are the 4 stage classifications of IVH?

A
  1. Grade I: hemorrhage in the germinal matrix only
  2. Grade II: bleeding within ventricles without distention
  3. Grade III: bleeding with ventricular distension
  4. Grade IV: bleeding extends into brain parenchyma with hydrocephalus (blood seeps into gray or wh matter)
17
Q

What are the risk factors for the different stage classifications of IVH?

A

I and II are low risk for neuro impairments

III and IV have 25-60% chance of neuro complications

18
Q

What are the key points of IVH?

A
  1. Incidence increased as Gestational Age decreases
  2. Multiple risk factors
  3. Occurs early postnatally (75% by 72 hours)
  4. Caused by hypoperfusion
  5. Corticosteroids antenatally decrease IVH
19
Q

What are the neurological complications seen in the NICU?

A
  1. Intraventricular hemorrhage - bleed
  2. Hypoxic ischemic encephalopathy (HIE) - inadequate O2 in events surrounding birth
  3. Periventricular Leukomalacia - ischemia
20
Q
  • Occurs antepartum, intrapartum, or postnatal
  • Mild to severe sequelae: normal neuro exam at 1 week=+ prognosis; Abnormal neuro exam at 3 weeks indicates risk for major sequelae (CP, intellectual disability, seizures, cortical blindness, hearing impairment, microcephaly)
A

Hypoxic ischemic encephalopathy (HIE)

  • older infants - late preterm/ full term
  • general, not focal
21
Q

Ischemia in white matter around the ventricles; main sites of focal necrosis = trigone of lateral ventricles and border zones btwn the cerebral arteries

A

Periventricular leukomalacia

  • motor tracts control leg movements closest to ventricles, resulting in spastic diplegia CP
  • strongest and most independent risk factor for the development of CP
  • can occur due to IVH
22
Q

GI complication: acute inflammatory disease of the bowel; most frequently occurs in 1st 6 weeks of life in infants weighing less than 200 g

A

Necrotizing enterocolitis

23
Q

Abnormal vascularization of the retina; Incidence is less than 1000 cases per year; Increases with lower gestational age, lower birth weight, and BPDF; Classification = 5 stages; Outcomes = Normal vision to blindness

A

Retinopathy of prematurity

- actually affects the eye, not cortical blindness

24
Q

liver complication: Can’t secrete bilirubin due to immature liver; Can cause - Kernicterus (athetoid CP)-deposition of bilirubin in the brain, especially basal ganglia and hippocampus
RX: Phototherapy/blood transfusions

A

Hyperbilirubinemia

  • AKA jaundice
  • if undiagnosed, can causes damage to the brain
25
Q

When infants are exposed to drugs in utero; manifests as withdrawal; Can cause temporary and permanent neurological issues

A

Neonatal abstinence syndrome

26
Q

What are the discharge criteria for the NICU?

A
  1. Sustained pattern of weight gain
  2. Maintenance of normal body temperature in an open environment
  3. Successful mode of feeding
  4. No episodes of apnea and bradycardia for 3 days
  5. Car Seat Test – 2 hrs
27
Q

What babies should have a follow up?

A
  1. anyone who has a diagnosed condition
  2. other clinic established criteria (i.e., clinic may require follow ups for anyone born under 32 weeks or under 4 lbs)
    - 4 mos adjusted age
    - infants d/c with tech supports (ventilator, apnea monitor, etc)
    - 10-30% of VLBW have major neuro impairments
    - 40% of VLBW have minor
28
Q

What is the developmental follow up schedule?

A
  • Every 3 months the 1st year
  • Every 6 months in the 2nd year
  • Yearly until school age
29
Q

What are the early manifestations of CP?

A
  1. Hypertonia in LE*
  2. Hypotonia in trunk** - Nothing in the head or trunk
  3. Poor feeding
  4. Neck hyperextension (predictive but majority of infants who exhibit this are okay)
  5. Primitive reflexes are LEAST predictive
  6. Fisting of hands [prolonged]
30
Q

What is the difference btwn healthy premature and full term infants in terms of neuromotor behavior?

A
  1. Greater joint mobility
  2. Less antigravity movements in supine
  3. Primitive reflexes persist longer
  4. Balance reactions are immature
  5. Flexion control less mature

Pediatrics (19 decks)

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