Term
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Definition
| born prior to 37 wks gestation |
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Term
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Definition
| 37 wks to 41 and 6/7 wks gestation |
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Term
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Definition
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Term
| normal birth weight (NBW) |
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Definition
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Term
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Definition
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Term
| very low birth weight (VLBW) |
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Definition
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Term
| extremely low birth weight (ELBW) |
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Definition
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Term
| small gestational age (SGA) |
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Definition
| >2 SD below mean for gestational age |
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Term
| large gestational age (LGA) |
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Definition
| >2 SD above mean for gestational age |
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Term
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Definition
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Term
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Definition
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Term
| Respiratory distress (RSD) = Hyaline membrane disease (HMD) |
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Definition
| caused by pulmonary surfactant deficiency; mortality due to RDS is dec. due to better prenatal identification of ELBW infants, steroid therapy, and improvements in mechanical ventilation; incidence is inversely related to gestational age (90% of 26 weekers, 25% of 34 weekers, more prevalent in males) |
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Term
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Definition
| cessation of breathing for 20 sec; caused by immaturity but can also be a secondary finding in many neonatal conditions; very common- incidence and severity inversely related to GA (25% under 1800 g or 34 wks, 100% under 28 wks) |
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Term
| Bronchopulmonary dysplasia (BPD) = Chronic lung disease (CLD) |
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Definition
| a need for supplemental oxygen at 26 wks CGA w/ abnomral radiographic findings and a hx of mech. vent.; causes: iatrogenic (putting infants on vents.), acute lung injury from prolonged oxygen exposure and mech. vent.; most often seen in ELBW; incidence (5-10% VLBW, 25-30% of infants requiring vent support, 40-45% ELBW); hospitalized at 2x the rate of other premies; can dev. mild cognitive deficits, poor motor coord., CP, dec. visuo-perceptual fxns |
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Term
| Perinatal asphyxia and hypoxic ischemic encephalopathy (HIE) |
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Definition
perinatal asphyxia: insult to the fetus or newborn due to lack of oxygen or lack of perfusion to various organs of sufficient magnitude and duration to produce more than fleeting fxnal and biomech. changes; incidence of 1-1.5% live births
encephalopathy: altered level of consciousness |
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Term
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Definition
| consequence of severe asphyxia; different location/pattern of injury in full term vs. perterm infants (full term: injury to border zones b/t end fields of major cerebral arteries such as parasaggital cortex w/ resultant UE to LE proximal weakness and resulting in spastic QUADRIPLEGIA; preterm: 2 most common sites for injury are corners of lateral ventricles and white matter around Foramen of Monroe impacting descending fibers from motor cortex and resulting most commonly in spastic DIPLEGIA) |
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Term
| Intraventricular hemorrhage (IVH) |
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Definition
| infants <32 wks at greatest risk; 25-30% of infants <1200 g; immature capillaries in germinal matrix respond to pressure changes and hypoxia w/ inc. blood flow; bleeding may or may not extend in to brain parenchyma |
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Term
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Definition
| subependymal or germinal matrix hemorrhage; no major consequence |
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Term
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Definition
| intraventricular bleeding w/o ventricular dilation; no major consequence |
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Term
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Definition
| intraventricular bleeding w/ ventricular dilation; may have major motor, cognitive, and lang. impairment esp if shunting required |
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Term
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Definition
| intraventricular and intraparenchymal (white matter) hemorrhage; may have major motor, cognitive, and lang. impairment esp if shunting required |
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Term
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Definition
| rest period immediately post IVH; watch for symptoms and discuss w/ neonatal team; referrals for EI and DFC |
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Term
| Periventricular leukomalacia (PVL) |
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Definition
| 2-10% infants <1500 g but mostly seen in sickest/smallest infants; injury to white matter due to changes in cerebral blood flow post IVH; swiss cheese looking brain (holey) |
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Term
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Definition
| IVH, hypotension, infection, apnea, ischemia |
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Term
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Definition
| spastic diplegia, vision and hearing loss, intellectual impairment |
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Term
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Definition
| need intervention in both NICU and beyond d/c esp if shunted; parents esp fearful and benefit from repeated assessment w/ emphasis on developmental strengths and weaknesses; assoc w/ term sequelae which may not manifest until well beyond d/c so imperative to do developmental f/u |
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Term
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Definition
| sign of neurologic insult requiring immediate medical attn; occurrence in first 3 days of life more concerning; clinical presentation very different in neonate vs. older child/adult (lip smacking, chewing, abnormal gaze, generalized jerking movements (clonic), slow repetitive jerking 2-3x/sec, posturing limbs in ext (tonic), swimming or bicycling); meds: ativan, phenobarbitol, dilantin |
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Term
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Definition
| liver unable to handle RBCs; physiologic jaundice; if left untreated, can have neurologic effects (kernicterus); treated w/ phototherapy or transfusion if severe; implications for PTs: causes dec. level of arousal which may impair feeding |
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Term
| Retinopathy of prematurity (ROP) |
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Definition
| damage to blood vessels which supply the retina; more prevalent in infants w/ lower GA and BW; dz process peaks b/t 34-40 wks CGA |
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Term
| Fetal alcohol syndrome (FAS) = Alcohol related birth defects (ARBD) |
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Definition
| most common cause of mental retardation; triad of Sx including growth deficiency, cardiac defects, and CNS disturbances w/ accompanying dysmorphology |
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Term
| Neonatal abstinence syndrome |
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Definition
| results from materal narcotic use; drug withdrawal Sx; characterized by multisystem challenges including neurologic, GI, respiratory, and autonomic dysfxn; manifests as tremors, autonomic instability, irritability, shrill crying, and feeding difficulties |
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Term
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Definition
| 5 items to describe HR, respiratory effort, muscle tone, reflex irritability, and skin color; typical score is 7-10; low apgar alone is NOT evidence of neurologic damage from hypoxia; apgar <3 after 10 min inc. risk for CP |
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Term
| For asphyxia to cause neurologic insult, must have: |
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Definition
1. profound metabolic acidemia w/ cord pH of <7.0
2. apgar of 0-3 for >5 min
3. evidence of multisystem organ failure and neurologic signs (seizures, tone changes) |
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Term
| Impacts of preterm delivery and NICU env't on parent-infant relationship |
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Definition
| not birth experience parents anticipated, parents feel guilt, delayed bonding, interference w/ breast feeding, lack of privacy |
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Term
| Fxnal skills required of neonate |
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Definition
| feeding, sleeping, growing, interacting w/ caregiverse and env't, moving body in space, maintaining control during medical and nursing procedures |
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Term
| Developmentally supportive care |
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Definition
| provides a welcoming, supportive, and comfortable family env't; offers consistency in care providers; assessess needs and best interests of each infant individually (tries to provide a plan of care that matches what each baby is ready or able to process) |
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Term
| Synactive theory of development |
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Definition
| infants attempt to maintain a balance in their physiologic, motor, state, attn/interaction, and self-regulatory systems; inapprop. stimulation can lead to disruption in the balance among these subsystems |
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Term
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Definition
| Do no harm (understand monitoring systems and read infants' behavioral signals); understand differences b/t preterm and full term; provided approp. assessment and intervention strategies; provide parent education |
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Term
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Definition
| normal HR is 120-160 bpm; alarm if HR <100 or >200; normal RR is 20-60; alarm is fail to breathe for >15-20 sec |
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Term
| Infant oxygen saturation level |
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Definition
| normal is 90-100%; alarm if <85% |
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Term
| APPROACH behavioral signals in preterm infant |
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Definition
| indicate sensory stability and readiness: regular HR, RR, O2 sat; relaxed limbs; quiet alert state (IV); smooth quality of mov't |
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Term
| AVOIDANCE behavioral signals in preterm infant |
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Definition
| indicate sensory overload: changes in HR, RR, O2 sat; muslce tone changes; poor quality of mov't (jerkiness, jittery, tremors); gaze aversion; state changes; hiccups; sneezing; yawning; finger splaying; sitting on air; mottling of skin |
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Term
| Preterm infant characteristics |
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Definition
| smaller and lesser dev. brain, less able to cope w/ hostile setting, poor state control, lack of physiologic flexion, relative hypotonicity, dominated by gravity and unable to move against it |
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Term
| Full term infant characteristics |
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Definition
| in utero up to 18 wks longer, brain 4x as large and better dev. than that of a 24 wk old, better state regulation and coping mech., physiologic flexion, have ability to move against gravity |
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Term
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Definition
| deep sleep: eyes closed, no mov't, state changes unlikely, DO NOT DISTURB |
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Term
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Definition
| light sleep: eyes closed, REM, low activity level, random mov'ts and startles |
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Term
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Definition
| drowsy or semi-dozing: eyes open or closed, variable activity level, mildly reactive to stim. but responses delayed, state changes common following stim. |
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Term
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Definition
| quiet alert: eyes open, minimal motor activity, able to focus on and seek out source of stim., most ideal state for PT intervention |
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Term
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Definition
| active alert: eyes open, considerable motor activity |
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Term
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Definition
| crying: intense crying, difficult to console |
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Term
| Motor characteristics of infants w/ CNS dysfxn |
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Definition
| demo poverty/paucity of active mov't, cramped synchrony describes stiff mov'ts which lack complexity, variability, and reciprocal mov't patterns (i.e. spastic CP); demo asymmetry of mov't |
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Term
| High risk profile: irritable and hypertonic infant |
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Definition
| overstimulated, limited capacity to self calm, poor tolerance for handling and position changes, extensor patterns, poor mid-line orientation, feeding challenges |
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Term
| High risk profile: disorganized infant |
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Definition
| fluctuating tone and mov't, easily overstimulated and distracted, able to feed well and interact when calm and swaddled but becomes irritable and hypertonic if overstimulated |
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Term
| Why are preterm infants ill equipped for oral feeding? |
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Definition
| lack of physiologic flexion, general hypotonia, lack of subcutaneous fat including fat pads in cheeks, ability to coord. sucking/swallowing/breathing is not consistently present prior to 34 wks |
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Term
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Definition
| provide oral motor stimulation program including non-nutritive sucking, proper positioning and alignment, external support to jaw and cheeks to inc. force gen. and dec. spillage, provide externally imposed rest breaks to assist the infant w/ maintaining physiologic stability, provide approp. nipple selection |
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Term
| Movement therapy requirements |
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Definition
| medically stable and able to tolerate mov't w/o physiological changes; majority of therapists use a neurodev. treatment (NDT) approach; goals are to improve strength, endurance and postural control; activities should be fxnal in nature |
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Term
| What is Developmental F/U Clinic (DFC)? |
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Definition
| multidisciplinary clinic created to provide ongoing assessment and evaluation of developmental skills in high risk neonates |
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