NICU Graduates

Who are NICU Graduates?

- very low birth weight
- small gestational age
- BPD
- CNS infections

What are some risk factors for premature delivery?

- Multiple gestation
- Amniotic fluid (too much or little)
- Diabetes
- High Blood Pressure
- Maternal malnutrition or bad habits

What is Respiratory Distress Syndrome?

Condition that causes breathing difficulties when the lungs do not produce enough surfactant to keep the airways open

How is Respiratory Distress Syndrome diagnosis confirmed?

Lung x-ray and blood gas levels

What are some management techniques for Respiratory Distress Syndrome?

- CPAP
- Nitric Oxide

What is Apnea?

An episode in which an infant stops breathing for a period of 20 seconds or more

True or False: Apnea is not associated or linked to any pathology

True

What is Intraventricular Hemorrhage?

Condition where bleeding occurs within the ventricles of the brain

Which infants are at greatest risk for intraventricular hemorrhage?

very low birth weight

In Intraventricular Hemorrhage, where are bleeds generally seen?

Germinal matrix near the caudate nucleus

What is a Grade 1 Intraventricular Hemorrhage?

Isolated to the germinal matrix

What is a Grade 2 Intraventricular Hemorrhage?

IVH with normal ventricular size

What is a Grade 3 Intraventricular Hemorrhage?

IVH with ventricular enlargement

What is Grade 4 Intraventricular Hemorrhage?

IVH with parenchymal hemorrhage

True or False: Neurological outcomes often correlate with IVH grade

True

What is Periventricular Leukomalacia?

Decreased blood flow that damages the white tissue matter surrounding the ventricles

What does Periventricular Leukomalacia often result in?

Spastic diplegia 

What is Osteopenia of Prematurity?

Decreased bone mineralization and increases the risk of fractures

What is the primary indicator of Osteopenia of Prematurity?

Elevated alkaline phosphatase levels

What is used to prevent and treat Osteopenia of Prematurity?

Minimal fortified formula

What is Jaundice/Hyperbilirubinemia?

Accumulation of excessive bilirubin in the blood

True or False: Uncontrolled levels of bilirubin can result in neurological impairment

True

What is the treatment for Jaundice/Hyperbilirubinemia?

Phototherapy and monitoring blood levels

What is Anemia?

Erythropoietin (makes RBC) levels are inadequate to meet the needs of the body

What are some symptoms associated with anemia of prematurity?

- Poor tolerance for feeding
- Lethargy
- Poor growth
- Tachycardia and/or tachypnea

What is Bronchopulmonary Dysplasia (BPD)?

Chronic lung disease characterized by damage to the lungs alveoli (air sacs) leading to breathing difficulties

What can cause Bronchopulmonary Dysplasia?

Prolonged exposure to supplemental oxygen and positive-pressure ventilation

What are some symptoms associated with Bronchopulmonary Dysplasia (BPD)?

- Expiratory wheezing
- Increased airway resistance
- Decreased tidal volume
- Pulmonary hypertension
- Hypoxemia

True or False: Pulmonary infections are often the result of microaspiration

True

What is Patent Ductus Arteriosus?

Condition where the ductus arteriosus, a temporary blood vessels that connects the aorta (main artery) to the pulmonary artery (artery to lungs) remains open after birth

Why is the Ductus Arteriosus important in the womb?

Opening allows for transfer of blood from pulmonary artery to descending aorta which shunts the blood away from the lungs

True or False: At birth, the ductus arteriosus is supposed to close to allow for gas exchange to occur in the lungs

True

In neonates, if the ductus arteriosus does not close tightly right away, what can happen?

An array of problems

What is Necrotizing Enterocolitis?

Life threatening condition that affects the intestines of premature or sick infants. Causes inflammation and damage to intestinal lining, leading to tissue death and perforation

When does Necrotizing Enterocolitis most frequently occur?

During first 6 weeks of life in premature infants with very low birth weight

What is Retinopathy of Prematurity?

Abnormal vascular growth in the area of the eye surrounding retina causing blindness

What is the primary treatment option for Retinopathy of Prematurity?

Cryotherapy

When evaluating and assessing a NICU grad, what are some things to key in mind?

- Handle with gradual increases in stimulus
- Create a soft environment

What HR indicates a medically stable NICU graduate?

110-140 BPM

What Respiratory Rate indicates a medically stable NICU graduate?

40-60 breaths per minute

What Blood Pressure indicates a medically stable NICU graduate?

Systolic < 87
Diastolic < 68

What Hematocrit level indicates a medically stable NICU graduate?

Greater than 30%

What are some characteristics in NICU graduates that could indicate a future problem?

- Poor quality of movement
- Tight antagonistic muscles
- Tremors
- Low trunk tone
- Poor rooting and feeding

What are some Musculoskeletal Characteristics to consider when planning a positioning program?

- Increased extension
- Hips lack extension
- Hip ER > IR
- Knees lack extension
- Ankle DF > PF
- Elbows lack extension