NICU, prematurity, & common diagnoses (9/22)

level I: well newborn nursery

provide postnatal care for stable FT infants

stabilize, provide care for 35-37 wks gestation infants who remain stable

stabilize infants <35 wks gestation til transferred

level II special care nursery

care for infants >32 wks and weighing >/=1500g

convalescing after intensive care

ventilation for <24 hrs or CPAP

stabilize infants brn <32 wk or 1500 g

level III NICU

provide life support for <32 wks gestation, <1500 g, critical illnesses

full range of specialists

full range of respiratory support

advanced imaging w/ urgent interpretation

level IV regional NICU

located in facility able to provide surgical repair of complex conditions

full range of subspecialists on site

facilitate transport & provide outreach edu

prematurity

infants born <37 wks gestation

combo of genetic, social, environmental factors

most are caught up on milestones by 2 y/o

prior to 2 y/o, may align better with milestones at adjusted age

LBW

<2500g

VLBW

<1500g

SGA (small for gestational age)

<10th percentile

LGA

>90th percentile

prematurity increases risk for

CNS complications

visual and hearing impairments

learning disabilities

behavioral disorders

NICU developmental care

as womb-like as possible to reduce stress on the infant: reduced light and noise, positioned comfortably in flexion, clustered cares to maximize sleep

encourage parental involvement in cares

NICU PT role

screening & exam of infants to determine need for direct services, referral to other providers, referral for services following d/c

design and implement interventions

collaborate w/ team members to support infant & family

incorporate family in providing care to support infant development

NICU team

neonatologist, neonatal NP, RNs, resp therapists, dietitians

therapeutic & developmental team (PT, OT, SLP)

lactation consultant

social workers

discharge planners

respiratory distress syndrome

pulmonary immaturity + low surfactant production

incr pulmonary artery psi and ventilation-perfusion mismatch

s/s: grunting, retractions, nasal flaring, cyanosis, incr O2 req after birth

bronchopulmonary dysplasia (BPD)

very premature birth +lung injury sec to ventilation

diagnosed based on need for O2 support for 28 days and amt of O2 needed at 36 wks gestation

chronic lung disease (CLD)

36 weeks gestation needing supplemental O2, abnormal physical exam, abnormal chest radiograph

intraventricular hemorrhage (IVH)

grade I-IV

RFs: low APGAR scores, severe RDS, seizures, infection, mech ventilation

s/s range in severity

incr risk for development delay and CP

periventricular leukomalacia (PVL)

white matter injury, leading known cause of CP

often assoc w/ IVH

incidence of white matter damage incr w/ decr gestational age

hypoxic-ischemic encephalopathy

hypoxic or ischemic event leading to decr O2 to neural tissue

damage depends on timing, severity, duration of event

causes may be maternal, uteroplacental, intrapartum, or fetal complications

neonatal abstinence syndrome (NAS)

neonatal withdrawal (from a substance ingested by mom)

may be admitted to NICU for close monitoring or pharmacologic tx

supportive therapies for calming

necrotizing enterocolitis

acute inflamm disease of bowel

most often in infants <2000g in first 6 wks of life

retinopathy of prematurity (ROP)

damage to retinas d/t prematurity

range from normal vision to total vision loss

incr incidence w/ lower gestational age, LBW, BPD

other premature diagnoses

merconium aspiration syndrome

gastroesophageal reflux

hyperbilirubinemia

genetic diagnoses

cardiac conditions diagnosed prenatally

arthrogryposis

myelodysplasia (spina bifida)

intrauterine growth restriction (IUGR)

sepsis

potential PT services in NICU

developmental care, direct interventions (positioning, facilitation & handling, infant massage, oral feedings), discharge planning