Term
| Natural labor progression (4) |
|
Definition
stretching of uterus & vagina; impulse >> hypothalamus
>> post pituitary gland produces oxytocin
uterus contracts, cervix dilates |
|
|
Term
| Causes of prematurity (3) |
|
Definition
multiple babies (uterus stretched out)
trauma (causing placenta to separate from uterine wall)
medically induced (or C-section) |
|
|
Term
| Medically induced causes of prematurity (4) |
|
Definition
pre-eclampsia (>>baby ↑BP); mom at risk
baby c poor vitals
IUGR (intrauterine growth restriction) |
|
|
Term
|
Definition
| intrauterine growth restriction: baby <10th percentile in wt/length for GA |
|
|
Term
| Risk factors for premature delivery (6) |
|
Definition
previous preemies
inadequate prenatal care
<16yo; drug/alcohol use during pregnancy (esp marijuana)
high stress
<1 yr since last birth |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Premature birth frequency |
|
Definition
|
|
Term
|
Definition
| small for gestational age; <10th percentile |
|
|
Term
|
Definition
| large for gestational age (good for preemie); >90th percentile |
|
|
Term
|
Definition
| appropriate for gestational age; 10th-90th percentile |
|
|
Term
|
Definition
| low birth weight; 1501-2500g |
|
|
Term
|
Definition
| very low birth weight; <1501g |
|
|
Term
|
Definition
| extremely low birth weight; <1000g |
|
|
Term
| NICU language (GPTPrAbLC): G |
|
Definition
| Gravida; # of pregnancies |
|
|
Term
| NICU language (GPTPrAbLC): P |
|
Definition
| Para; # of pregnancy outcomes |
|
|
Term
| NICU language (GPTPrAbLC): T |
|
Definition
| Term; # of full-term births |
|
|
Term
| NICU language (GPTPrAbLC): Pr |
|
Definition
| Pr; # of pre-term pregnancies |
|
|
Term
| NICU language (GPTPrAbLC): Ab |
|
Definition
|
|
Term
| NICU language (GPTPrAbLC): LC |
|
Definition
|
|
Term
|
Definition
| appearance; pulse; grimace; activity; respiration |
|
|
Term
|
Definition
|
|
Term
| APGAR: resuscitation threshold |
|
Definition
| <6/10 resuscitation begins |
|
|
Term
|
Definition
1, 5, 10, 20 min p birth
(**if ≥8/10 by 5 min, no longer necessary to test) |
|
|
Term
|
Definition
|
|
Term
|
Definition
well baby nursery
min observation
warming isolette phototherapy, circumcision
most small community hospitals |
|
|
Term
|
Definition
intermediate level; provides IV meds, tube feedings, O2 support
neonatologists & neonatal nurses
regional (larger) hospitals |
|
|
Term
|
Definition
NICU
specialists beyond neonatologist
provides complex medical interentions, advanced diagnostic testing, sx, therapies |
|
|
Term
|
Definition
|
|
Term
|
Definition
| extracorporeal membrane oxygenation; long-term heart-lung machine for babies |
|
|
Term
| Common Medical Complications (11) |
|
Definition
Respiratory Distress Syndrome (RSD)
Bronchopulmonary Dysplasia (BPD)
Meconium Aspiration Syndrome
Periventricular Leukomalacia (PVL)
Germinal Matrix-IVH
Patent Ductus Arteriosus (PDA)
Hyperbilirubinemia (Jaundice)
Gastroesophageal Reflux Disease (GERD)
Necrotizing Enterocolitis (NEC)
Retinopathy of Prematurity (ROP)
Prenatal Cocaine Exposure |
|
|
Term
|
Definition
| condition 2º to pulmonary immaturity & inadequate pulmonary surfactant |
|
|
Term
|
Definition
| decr surfactant >> incr surface tension >> collapse of alveoli >> atelectasis >> decr lung fxn |
|
|
Term
|
Definition
decr surfactant
maternal diabetes
thoracic malformation
genetic factors |
|
|
Term
| Surfactant production: 23 wks |
|
Definition
| type II alveolar cells produced |
|
|
Term
| Surfactant production: 28 wks |
|
Definition
| type II cells begin producing surfactant |
|
|
Term
| Surfactant production: 32 wks |
|
Definition
| adequate amt of surfactant |
|
|
Term
| RDS: signs & symptoms (6) |
|
Definition
incr respirations
expiratory grunting
nasal flaring
cyanosis
hypoxia, hypercarbia
sternal & intercostal mm retractions |
|
|
Term
| RDS: treatment (4; ordered) |
|
Definition
O2
mechanical ventilation
surfactant administration
ECMO |
|
|
Term
| ECMO treatment for RDS: infant requirements |
|
Definition
infant must be ≥4.5 lb & ≥34 wks;
used 21 days max
(used c heparin) |
|
|
Term
| ECMO treatment for RDS: procedure |
|
Definition
de-O2 blood drained from heart to external pump;
blood pumped through membrane gas oxygenator;
O2 blood returned to baby |
|
|
Term
| ECMO treatment for RDS: complications (5) |
|
Definition
CNS damage
sepsis
seizures
cardiac complications
renal failure |
|
|
Term
| Prolonged mechanical ventilation >> (diseases) |
|
Definition
|
|
Term
|
Definition
| bronchopulmonary dysplasia |
|
|
Term
|
Definition
| condition resulting from abnormal healing of lung disease during neonatal period |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| BPD: prolonged mechanical ventilation >> (mech of pathology) |
|
Definition
thickened, hyper-reactive airways;
decr lung compliance;
incr airway resistance |
|
|
Term
| BPD: incr correlation c ... |
|
Definition
|
|
Term
| Meconium Aspiration Syndrome >> |
|
Definition
toxic to lungs >> decr O2 to brain;
compromised lung fxn |
|
|
Term
|
Definition
| periventricular leukomalacia |
|
|
Term
|
Definition
| symmetrical NON-HEMORRHAGIC ischemic lesion to brain near lat ventricles |
|
|
Term
|
Definition
|
|
Term
|
Definition
| decr O2 to brain perinatally |
|
|
Term
|
Definition
| poor suckling & hypertonicity of B LE |
|
|
Term
|
Definition
| address 1º cause; minimize further damage |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Hemorrhage in germinal matrix >> intraventricular space |
|
|
Term
| Germinal matrix-IVH: brain damage 2º to... |
|
Definition
|
|
Term
| Germinal matrix is near... |
|
Definition
branches of ant & middle cerebral aa,
internal carotid a |
|
|
Term
| Most common brain lesion in preemies = |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
isolated germinal matrix hemorrhage
(highest fxning child; 5% chance of neuro damage) |
|
|
Term
|
Definition
intraventricular hemorrhage c normal ventricular size
(15% chance of neuro damage) |
|
|
Term
|
Definition
intraventricular hemorrhage c ventricular dilation
(35-40% chance of neuro damage) |
|
|
Term
|
Definition
intraventricular dilation c parenchymal hemorrhage
(100% chance of neuro damage) |
|
|
Term
|
Definition
<32 wk gestation,
<1500 g,
pneumothorax,
tracheal suctioning,
poor breathing |
|
|
Term
|
Definition
| one-time event! (like CVA) |
|
|
Term
|
Definition
(brain injury does not progress, but musculoskeletal symptoms do get worse)
neurological disability,
vision deficit,
learning disability,
seizure |
|
|
Term
|
Definition
patent ductus arteriosus;
failure of ductus arteriosus to close after birth |
|
|
Term
|
Definition
| blood flow between aorta & pulmonary a. |
|
|
Term
|
Definition
RA >> RV >> pulm a >> Ductus Arteriosus >> desc aorta >> LE
AND
RA >> LA (via Foramen Ovale) >> LV >> aorta >> brain/UE |
|
|
Term
| First Breath's effect on fetal circulation: |
|
Definition
lungs open & pulm vascular resistance decr;
lungs release bradykinin >> constrict smooth mm of ductus arteriosus;
withdrawal of maternal prostaglandins >> DA closure;
DA closes between 12hr & 1 wk |
|
|
Term
|
Definition
| blood from aorta shunted through DA to pulm a. >> lungs work overtime |
|
|
Term
|
Definition
difficulty breathing,
failure to thrive (gain wt) |
|
|
Term
|
Definition
|
|
Term
|
Definition
| hypoxia delays closure of PDA |
|
|
Term
| Physiological jaundice 2º to excessive amt of ... |
|
Definition
| bilirubin (product of breakdown of Hgb) |
|
|
Term
| Hyperbilirubinemia: causes |
|
Definition
immature hepatic fxn,
incr in Hgb via bruising |
|
|
Term
| Hyperbilirubinemia: results |
|
Definition
|
|
Term
| Hyperbilirubinemia: treatment |
|
Definition
|
|
Term
|
Definition
deposits of unconjugated bilirubin in brain >> neuronal injury;
associated c Athetoid CP
(NOT common in USA) |
|
|
Term
|
Definition
gastroesophageal reflux disease;
retrograde mvmt of gastric contents into esophagus |
|
|
Term
|
Definition
| relaxed lower esophageal sphincter (hypotonicity can contribute) |
|
|
Term
|
Definition
prematurity
perinatal stress
delayed gastric emptying
diaphragmatic defects
NG tube |
|
|
Term
|
Definition
poor feeding,
excessive crying,
oral aversion,
apnea,
spit-up |
|
|
Term
| GERD: associated motor patterns |
|
Definition
incr cervical & trunk ext,
not happy in prone |
|
|
Term
|
Definition
|
|
Term
|
Definition
| necrotizing enterocolitis |
|
|
Term
|
Definition
| inflammatory disease of immature intestine >> acute intestinal necrosis |
|
|
Term
|
Definition
| mucosal injury to intestinal tract (often p sx) |
|
|
Term
| Most common cause of infant death during/after sx: |
|
Definition
|
|
Term
| NEC: signs & symptoms (4) |
|
Definition
respiratory distress (sup diaphragm)
apnea
bradycardia
distention/tenderness in abdomen |
|
|
Term
|
Definition
NPO
gastric suction
antibiotics
sx (enterectomy) |
|
|
Term
|
Definition
| retinopathy of prematurity |
|
|
Term
|
Definition
| abnormal blood vessel development in retina of eye (in a preemie) |
|
|
Term
|
Definition
supplemental O2 too high
<30 wk GA
hypoxia
IVH
RDS
PDA
vitamin E deficiency |
|
|
Term
|
Definition
abnormal eye mvmt
cross-eyed
white-looking pupils |
|
|
Term
|
Definition
I-V;
I = mild
V = retinal detachment (complete blindness) |
|
|
Term
|
Definition
| keep O2 between 50-70 mmHg |
|
|
Term
|
Definition
|
|
Term
| Prenatal Cocaine Exposure >> incr risk of ... (7) |
|
Definition
premature labor
spontaneous abortion
placental abruption
fetal distress
cardiac problems
low APGAR scores
cerebral damage |
|
|
Term
| Prenatal Cocaine Exposure: symptoms of withdrawal - after birth |
|
Definition
difficulty sleeping
tremors
irritability
inconsolable crying
poor motor skills |
|
|
Term
| Prenatal Cocaine Exposure: symptoms of withdrawal - later in life |
|
Definition
behavior problems
language delay
poor information processing
impaired motor planning
attention deficits
sensory integration dysfunction |
|
|
Term
| Elements of PT Observation in NICU (5) |
|
Definition
position of body, head, eyes, mouth, feet, etc
environment: lights, sounds, lines/tubes, diaper, blanket, temp
restful v. active
self-calming techniques
signs of stress (observational & physiological) |
|
|
Term
| Physiological signs of stress in NICU infant (3) |
|
Definition
HR ∆ >40bpm
RR ∆ > 15bpm
PO2 ∆ > 15 |
|
|
Term
| Observational cues - engagement (7) |
|
Definition
babbling
smiling
pink skin
smooth mvmt
wide, bright eyes
open, relaxed hands
reaching toward caregiver |
|
|
Term
| Observational cues - disengagement (7) |
|
Definition
lip grimacing
fussing, crying (esp. hiccups)
red/pale skin
arching back/tense UE
gaze aversion
fisting/splayed fingers
pushing away |
|
|
Term
| Self-calming techniques (6) |
|
Definition
swaddling
shushing
sidelying
midline orientation of body & UE
skin-to-skin
facilitated tucking (swaddling c escaping limb) |
|
|
Term
| Standardized exams used in NICU (6; 3 for pain assessment) |
|
Definition
Neuro Assess of Preterm & Full-Term Newborn Infant (Dubowitz)
NIDCAP
TIMP
PIPP
NIPS
CRIES |
|
|
Term
|
Definition
| newborn individualized developmental care & assessment program |
|
|
Term
|
Definition
| test of infant motor performance |
|
|
Term
|
Definition
| premature infant pain profile |
|
|
Term
|
Definition
| neonatal infant pain scale |
|
|
Term
|
Definition
crying
requires additional O2
incr vital signs
expression
sleeplessness |
|
|
Term
| Dubowitz test aspects (2) |
|
Definition
good correlation c infant's motor skills @ 1 yo
<15 min to assess |
|
|
Term
|
Definition
no handling - all observation
PT educated NICU team and parents |
|
|
Term
|
Definition
PT/OT specific
32 wk - 4m GA |
|
|
Term
| NICU intervention techniques (6) |
|
Definition
minimize sounds
minimize light
incr skin-to-skin contact
therapeutic handling
proper positioning for motor development
kangaroo care |
|
|
Term
| Proper positioning for motor development: Optimal alignment (6) |
|
Definition
PHYSIOLOGICAL FLEXION:
head midline c chin tuck
shoulders protracted
hands midline
trunk flex c post pelvic tilt
LE flex
hips in slight ER |
|
|
Term
| Consequences of poor positioning: musculoskeletal |
|
Definition
| poor alignment >> tight mm >> poor mm patterns >> decr developmental motor skills |
|
|
Term
| Craniostenosis/Craniosynostosis (4) |
|
Definition
premature fusion of ≥1 sutures
>> incr ICP
NO ear shift
treatment = sx |
|
|
Term
|
Definition
scaphocephaly/dolicephaly
plagiocephaly
brachycephaly |
|
|
Term
| scaphocephaly/dolicephaly = |
|
Definition
| incr AP diameter (football shape) |
|
|
Term
|
Definition
| unilat posterolateral head flatting (+ ear shift ant ipsilat to flattening) |
|
|
Term
|
Definition
| incr R/L diameter (most difficult to correct) |
|
|
Term
| Kangaroo Care: benefits for baby (3) |
|
Definition
improved thermoregulation, respiratory patterns, O2 sat
calmed behavior state
decr apnea, bradycardia, length of hospital stay |
|
|
Term
| Kangaroo Care: benefits for parents (3) |
|
Definition
incr maternal milk & breast feeding success
positive way to view baby
more sensitive to baby's mvmt/needs |
|
|
Term
|
Definition
| improved neurodevelopmental assessments at 6m compared to non-kangaroo care babies |
|
|
Term
| Education: healthcare providers (3) |
|
Definition
proper positioning for routine care & procedures
positioning for development & self-calming
recommendations for smooth transition home c continued outpt therapies |
|
|
Term
|
Definition
encourage to be active in child's care
teach parents baby's cues
teach parents how to help baby self-comfort, regulate, and organize
EMPOWER parents early & daily in becoming partners in their baby's care |
|
|
Term
| The 5 Ss of infant calming |
|
Definition
swaddling
side/stomach position
shushing
swinging/jiggling
sucking |
|
|
