1
Q
What are the 5 stages of lung development?
A
- Embryonic: Weeks 3 to 7
- Pseudoglandular: Weeks 5 to 17
- Canalicular: Weeks 16 to 25
- Saccular: Weeks 24 to 40
- Alveolar: 36 Weeks to Childhood
**there is some overlap between the stages
2
Q
What is the Embryonic stage of lung development?
A
Embryonic: Weeks 3 to 7
- Initial budding and branching of the lung buds from the primitive foregut.
- At the end of the embryonic stage, the larynx, trachea, lung primordia, lobe of the lungs, and bronchopulmonary segments have formed.
3
Q
What is the Pseudoglandular stage of lung development?
A
Pseudoglandular: Weeks 5 to 17
- This stage is primarily responsible for the generation of the bronchial tree.
- At the end of this stage, the respiratory tree has developed as far as the terminal bronchioles, with the formation of the arterial system, cartilage, and smooth muscle.
- Respiration is not possible during this phase because the respiratory bronchioles have not yet developed, and therefore infants born during this period are unable to survive.
- The diaphragm also develops during this stage.
4
Q
What is the Canalicular stage of lung development?
A
Canalicular: Weeks 16 to 25
- This stage marks the division between the conducting and respiratory units in the respiratory tree.
- At this time, the gas-exchanging portion of the lung is formed and vascularized.
- At the end of this stage, some respiration is possible so some infants can survive if provided with intensive care.
5
Q
What is the Saccular stage of lung development?
A
Saccular: Weeks 24 to 40
- During this stage, the gas-exchange surface area of the lungs significantly expands.
- The important blood-air barrier is established.
- Specialized cells of the respiratory epithelium appear at this time, including type I alveolar cells across which gas exchange occurs, and type II alveolar cells that secrete pulmonary surfactant.
- This surfactant is important in reducing the surface tension at the air-alveolar surface, allowing expansion of the terminal saccules.
6
Q
What is the alveolar stage of lung development?
A
Alveolar: 36 Weeks to Childhood
- During this stage, the terminal saccules, alveolar ducts, and alveoli increase in number.
- At term, the lungs are functional, although not just simply a smaller version of the adult lung.
- The number of airway generations and their branching pattern is complete at birth but the most peripheral airways are short and contain transitory saccules that will eventually form into alveoli.
- In fact, over 85% of alveolarization takes place after birth
7
Q
What happens to lungs without surfactant?
A
without surfactant:
- lungs have very high surface tension,
- predisposing them to alveolar collapse and
- respiratory distress syndrome (RDS).
8
Q
What kind of respiratory support will infant born before 33 weeks need?
A
- either a ventilator or a CPAP machine,
- due to lung immaturity
9
Q
What medication is given antenatal if premature birth is anticipated to accelerate fetal lung maturation?
A
- routine practice that when premature birth is anticipated, a course (two doses) of antenatal corticosteroids are given to the mother accelerate fetal lung maturation.
10
Q
What is Continuous Positive Airway Pressure (CPAP)?
A
Continuous positive airway pressure (CPAP)
- is a non-invasive form of respiratory support that applies continuous pressure on an infant’s airway, so that at the end of expiration, some air remains in the lungs and the alveoli do not collapse.
- CPAP helps reduce surface tension, prevent atelectasis, and maintain adequate lung volume, particularly functional residual capacity (FRC) and tidal volume.
- This reduces the infant’s reliance on tachypnea as a way to eliminate carbon dioxide.
** CPAP does not work for all infants.
To be successful on CPAP as a mode of respiratory support:
- have a respiratory drive and
- adequate respiratory muscles to support and
- sustain good respiratory effort and tidal volumes.
11
Q
What is mechanical ventilation?
A
- Mechanical ventilation is an invasive form of respiratory support that assists or replaces spontaneous breathing.
- Because of the associated pulmonary pathophysiology, infants with BPD can and often do experience hypoxia, hypercapnia, and apnea, and therefore may require mechanical ventilation.
- Unfortunately, mechanical ventilation, while it does effectively treat hypoxia, hypercapnia, and apnea, also increases pulmonary damage: the very damage that is contributing to hypoxia, hypercapnia, and apnea.
- Mechanical ventilation is a good example of a therapy that has many benefits but that also increases an infant’s vulnerability.
12
Q
Infant was born at 26 weeks of gestation. What is her stage of lung development?
A
- born during the saccular phase of lung development (24-40)
- which is about the midpoint of fetal development, when the lung volume increases markedly due to saccule development, and subdivision of the saccules into alveoli commences.
- During this time, surfactant production is just beginning.
- Jasmine’s lungs are not fully developed and also lack surfactant.
- This will put her at risk for respiratory complications that may require respiratory support.
13
Q
If infant was born at 23 weeks gestation, how would this affect her lung development/risk?
A
- she would be in the canalicular stage of lung development (16-25)
- Her lungs would be underdeveloped and lacking in surfactant.
- infant would most definitely experience respiratory distress and need respiratory support.
14
Q
What is the long term consequence of RDS?
A
- bronchopulmonary dysplasia (BPD) or chronic lung disease (CLD).
15
Q
What is bronchopulmonary dysplasia (BPD) associated with (2)?
A
- increased mortality and morbidity and
- significant long-term cardiac, respiratory, sensory and neuro-developmental sequelae
16
Q
What is the “Old BPD” characterized as?
A
- is characterized mainly by lung damage and fibrosis caused by oxygen toxicity and mechanical ventilation.
- Over the years, advances in gentler modes of ventilation, surfactant administration, antenatal corticosteroid administration and developmentally supportive care have changed the presentation of BPD
17
Q
What is “New BPD” characterized as?
A
- is characterized by interruption of normal lung development resulting from interference with alveolarization and pulmonary vascular development in extremely preterm infants.
18
Q
Has Old BPD been replaced by new BPD?
A
- Old BPD has not been replaced by new BPD; rather,
- they are two different types of lung injury that present with different gestational age infants and different physiological and clinical pictures.
19
Q
How does infection/inflammation affect development of BPD?
A
- Lung inflammation, infection, and injury predispose the lung to increased susceptibility to volutrauma and oxidant-induced lung injury.
- The cycle of inflammation can produce significant pulmonary injury during periods of rapid growth and development.
20
Q
How does oxygen toxicity affect the development of BPD?
A
- Oxygen produces free radicals (molecules that are toxic to cells/tissue).
- Antioxidants protect against free radicals but if there is increased free radical production (high 02 concentrations) or decreased antioxidant levels (common in preterm infants), the lungs become susceptible to damage and oxidative stress.
21
Q
How does antenatal corticosteroids affect the development of BPD?
A
- Accelerates the development of type 1 (gas exchange) and type II (surfactant) alveolar cells.
22
Q
How does mechanical ventilation affect development of BPD?
A
- BPD is a result of barotrauma (alveolar rupture/damage due to pressure) and volutrauma (over-distention/stretch) of alveoli in infants who are receiving positive pressure ventilation.
- Using the lowest pressures possible decreases the risk for BPD, although some infants require higher pressures for survival.
23
Q
How does fluids and nutrition affect the development of BPD?
A
- Infants who are born small for gestational age (SGA) or intrauterine growth restricted (IUGR) are already at increased risk for BPD/CLD at birth due to undernourishment in utero and compromised lung development.
- After birth, adequate nutrition is also very important as inadequate nutrition results in catabolism, which increases the effect of oxygen and barotrauma on the developing lungs.
- Fluid balance is also key as fluid overload also increases the risk for BPD/CLD.
24
Q
What risk factors, both prenatal and postnatal, have placed Jasmine at an increased risk for developing BPD?
A
- preterm (born at 26 weeks gestation)
- mother had a prenatal infection
- potential for infection with cerclage insertion
- required weeks of mechanical ventilation
- oxygen supplementation
- history of a PDA
25
What care, both prenatal and postnatal, can help to minimize or prevent BPD?
- Ultimately preventing preterm birth would prevent BPD
prenatal care prevention:
- antenatal corticosteroids
- antibiotics to treat infections
- maternal health and well-being
postnatal care prevention:
- minimize invasive ventilation
- minimize hyperoxia
- administer surfactant
- ensure early detection and treatment of PDA
- administer caffeine
- provide developmentally supportive care
26
What is sudden infant death syndrome?
- the sudden death of an infant less than one year of age
27
What are safe sleep practices?
- For the first six months, infants should sleep in their caregiver’s room in a separate crib.
- Ensure the crib meets safety regulations.
- If a crib is not available, use an alternate sleep surface that is firm, flat, and placed on the floor, such as a drawer or a basket. Waterbeds, pillows, air mattresses, and couches are not safe.
- There should be no quilts, bumper pads, stuffed animals, pillows, or other items in the crib.
- Infants should always sleep on their backs.
- infants should not be left to sleep in car seats or carriers.
- Do not overheat the infant.
- Swaddling is not recommended. If the infant is swaddled, ensure that their mouth and nose are not covered, use light blankets, and stop swaddling when infants show signs of rolling over.
- Keep the environment smoke-free.
- Keep the environment alcohol- and drug-free.
- Bed-sharing is not recommended—adult beds are not made with infant safety in mind.
- Breastfeed or provide breast milk if possible.
28
What are 3 risk that are increase cause of bed-sharing?
- SIDS,
- entrapment, and
- suffocation.
29
If families are going to bed-share, what important education should be taught?
- always place the infant on their back,
- put the mattress on the floor and away from walls,
- keep the baby far away from any pillows, duvets, and heavy blankets,
- do not swaddle,
- place the baby on the outside of the bed rather than between two adults,
- sleep in a “c-shaped” position facing the baby,
- ensure no other children or pets share the bed, and
- never leave the baby alone on an adult bed.
30
What does it mean by infants with BPD is very "labile"?
- meaning that it can change quickly without much warning.
- One of the reasons for this lability is that the lungs of infants with BPD are often damaged or underdeveloped to the extent that there is very little in the way of respiratory reserve
31
What are some reasons for labile respiratory status of infants with BPD (2)?
- lungs of infants with BPD are often damaged or underdeveloped to the extent that there is very little in the way of respiratory reserve
- from the effects of hypoxia on pulmonary blood vessels.
32
How does BPD affects infants blood gases?
- Typically their pCO2 will be elevated. Recall that the accumulation of CO2 is a result of hypoventilation, owing to damaged (inflamed, scarred, atelectatic, hyperinflated) alveoli.
- Initially, the elevated pCO2 produces an acidotic pH, often below 7.30.
- Over time, the kidneys compensate for the chronic respiratory acidosis by retaining HCO3-, a base.
- The combination of excess CO2 (acid) and increased HCO3- (base) results in a neutralized pH. In other words, over time, the pH returns to normal or near normal.
- This process is known as compensation and, in infants with BPD, results in a compensated respiratory acidosis. Jasmine’s most recent blood gas is a good example of compensated respiratory acidosis.
33
Why should infants with BPD need to be carefully weaned from respiratory support and supplemental oxygen?
- Atelectasis, scarring, and pulmonary arteriolar changes all conspire to keep infants with BPD dependent on supplemental oxygen and respiratory support.
- As a result, infants with BPD are quite dependent on the very treatments that are contributing to ongoing pulmonary damage.
- In addition, pulmonary reserves are minimal.
- This means that minor deterioration in lung function and/or minor withdrawal of treatment can initiate major setbacks for these infants.
- For example, weaning oxygen too quickly can result in pulmonary vasoconstriction.
- This leads to decreased perfusion of pulmonary vascular beds, and as a result of the poor pulmonary perfusion, hypoxia.
- The hypoxia may be severe enough to require more supplemental oxygen than the infant was receiving prior to being weaned.
34
What nursing care and support could you provide to infant that might help her to be able to decrease her oxygen requirements (3)?
- Minimize oxygen consumption by providing appropriate warmth.
- Manage pain and stress.
- provide developmentally supportive care.
- Monitor blood gases, O2 saturation (via pulse oximetry), hemoglobin, and hematocrit.
- Assess colour, HR, RR, work of breathing, and air entry.
- Maintain fluid balance.
- Wean appropriately and monitor closely.
- Encourage long periods of skin-to-skin contact.
35
What is your judgment about Jasmine’s current condition? Summarize how you think she is doing.
- Jasmine’s lungs seem to be just barely meeting her needs with supplemental oxygen.
- Her blood gases demonstrate that while ventilation is adequate, her CO2 is slightly elevated, but her kidneys are able to compensate.
- Her respiratory rate and indrawing suggest increased work of breathing.
- Her desaturation illustrates poor reserve and limited ability to cope with increased oxygen demands.
- Jasmine is doing OK without CPAP, but could easily deteriorate.
36
What are some of the other potential problems that could be causing Jasmine’s deterioration?
- worsening BPD
- sepsis
- feeding intolerance—too much volume may be putting pressure on Jasmine’s diaphragm and causing difficulties breathing
37
Is there information normally obtained in a physical assessment of an infant that we don’t have in this case?
- urine output
- blood pressure
- peripheral pulses
- central and peripheral perfusion
- amount and frequency of feeding
38
What are the causes of BPD-associated pulmonary hypertension (3)?
- Decreased lung growth and alveolarization with concurrent decreased pulmonary vascular growth, which results in decreased pulmonary capillary surface area
- Low birth weight
- Inflammation/infection
- Prenatal injury—IUGR, preeclampsia, infection, oligohydramnios, reduced placental blood flow
39
Is Jasmine demonstrating any clinical responses that would suggest that she may be developing pulmonary hypertension?
- Jasmine’s pulmonary vasculature could definitely be causing pulmonary hypertension.
- Jasmine’s cardiovascular system must work harder to overcome the increased pressure within the lungs.
- In response, the right side of the heart works harder to move the blood through these arteries and it becomes enlarged.
- Eventually, overworking the right side of the heart may lead to right-sided heart failure.
developing pulmonary hypertension and/or CHF:
- increased weight,
- puffy hands and feet,
- indrawing,
- restlessness,
- decreased tolerance of handling, and
- increasing oxygen needs
**all suggest that she may be developing pulmonary hypertension and/or CHF.
40
What are some feeding challenges arising from pulmonary reserve for infants with BPD (3)?
- tire easily
- have weak sucking abilities
- may experience respiratory distress while feeding
41
What are some common feeding challenges for premature infants (3)?
- Disorganized suck and swallow,
- immature oral musculature, and an
- inability to engage in nutritive sucking
42
Whats oral aversion? How is it developed?
- Negative perioral experiences may also undermine infants ability to feed orally.
- develops in some infants who have frequent, repeated, and unpleasant experiences with these procedures.
- Oral intubation, oral suctioning, and insertion of oral gavage feeding
43
What are some Positive Pre-feeding Experiences (3)?
- Providing positive pre-feeding experiences to preterm infants can be initiated right after birth.
- It is important to consider reducing as many negative medical interventions around the face and mouth as possible, use as little tape on the face as possible,
- elicit rooting reflex and non-nutritive sucking (soother), transition from orogastric feeding tubes to nasogastric tubes as soon as possible, and provide opportunity to smell and taste mother’s milk.
- Skin-to-skin contact, oral care with breastmilk, and positive touch to face, cheeks, and lips can also be very effective in promoting positive oral experiences.
- Many NICU’s are encouraging the use of “scent cloths” for infants in the NICU.
- We know that smell is one of the earliest senses to develop and that infants can recognize the scent of their mother very early on.
- Scent cloths are usually small pieces of soft fabric such as flannel that mothers (or other caregivers) can wear against their skin or sleep with for approximately 6–8 hours.
- The cloth is then placed under or near the infant’s head. Having the scent of a parent nearby can help reduce stress and promote bonding.
- Other positive experiences we can provide when the infant is ready is having them nuzzle/latch on a recently pumped breast (as to not overwhelm them with let-down/milk flow) and provide drops of breastmilk on lips or soother during gavage feedings.
44
What is positive initial feeding experiences?
- Once the infant is stable and showing oral readiness cues, we can thoughtfully attempt first oral feedings, preferably at the breast (if that is the parent’s goal).
- The key in this stage is that the experience is positive—there is absolutely no value put on volume.
- If the goal is exclusive breastfeeding, we should start with providing only breast experiences if possible.
- Establishing breastfeeding can be hampered when an infant’s mother is not present and available during optimal feeding times, and when an infant’s mother is present, the infant might be too tired to breastfeed.
- Coordinating the infant’s and mother’s schedule in order to facilitate breastfeeding is not always easy.
45
What is feeding progression?
- Infants like Jasmine require a plan for feeding that is multidisciplinary and includes parental input and communication. If the goal is exclusive breastfeeding, the plan might look different than if exclusive bottle-feeding or mixed feeding is the end goal. What is the most important is that the experience is positive for the infant. There is evidence of serious long-term impact in infants who have experienced stress and trauma around feeding, such as anxiety about eating, difficulties with new textures, and hypersensitivity to taste. Infants may leave the NICU feeding fully orally, but in follow-up clinics show a high number of problematic feeding behaviours, including feeding refusal.
- Organizing nursing care activities in such a way as to minimize the energy that infants expend crying and being handled before feeding will facilitate successful feeding attempts. Minimizing activity before a breast or bottle feed and limiting the duration of feeding to approximately 30 minutes also helps. When assessing stability during and after breast or bottle-feeding, assess an infant’s saturations, colour, work of breathing, episodes of apneas and bradycardia, organization of sucking and swallowing, tone, and activity.
- “Pacing” is another important aspect of feeding infants with BPD. Pacing means paying attention to individual infant cues and removing the source of fluid as needed so that an infant does not become unstable. Pacing, in essence, is helping the infant to coordinate their suck-swallow-breathe (SSB) patterns. The normal pattern in term infants is suck-swallow-breathe, suck-swallow-breathe and so on. Preterm infants have an immature ability to coordinate suck-swallow-breath patterns. You will notice they might suck-suck-suck-swallow-breath-breath-breath or suck-swallow-swallow-suck-suck-swallow-breathe-breathe-breathe. If you are feeding an infant and you notice there is a lot of sucking or swallowing but not a lot of breathing, you will need to help externally pace that infant by tipping the bottle down or removing it from their mouth. The important thing to consider with “pacing” is that we want to intervene prior to the infant running into trouble. The goal is to maintain stability, not respond to distress. This is a simple technique that can significantly improve the quality and comfort of the feed for infants. A breastfed infant will need less pacing than a bottle-fed infant as the flow of milk from the breast is more controlled by the infant.
- Positioning for feeding can also be critical to the success of the feeding experiences. Preterm infants often do best swaddled in an elevated side-lying position, supported by pillows. If necessary, you can offer the soother initially to organize SSB coordination. If the infant is breastfeeding, ensure the mother is in a supported and comfortable position. If bottle-feeding, offer the bottle in a horizontal position as it reduces the effects of gravity and decreases the flow.
- The flow of milk also has an impact on the feeding experience, with a higher flow resulting in more of a challenge to the infant’s SSB patterns. In terms of breastfeeding, the flow depends on the mother’s milk supply and the baby’s ability to transfer milk. If the flow of milk from the breast it too high, we can suggest pre-pumping some of the milk prior to feedings, providing pacing, or potentially using a nipple shield. The flow of milk from a bottle is controlled by the flow of the nipple. Generally, it’s better if the flow is low initially, as it allows much more time for breathing, reduces the likelihood of feeding-induced apnea, physiologic compromise, stress, and fatigue. The flow from a nipple is also controlled by the position of the bottle; as previously stated, the more horizontal the bottle, the lower the flow.
46
When should mom start pumping? How often?
- start pumping early and often, ideally within the first six hours after birth and
- then every three hours after that (even during the night).
47
What is the supply and demand basis for breastmilk?
- Pumping early and often is the most effective way to establish sufficient and ongoing milk supply.
- Breastmilk is produced on a supply-and-demand basis, and therefore emptying the breast signals the body to produce more milk.
48
Why is it important to teach mom to hand-express?
- Initially, hand-expression may be more effective that pumping for expressing colostrum,
- but it is also helpful to teach parents to hand-express as it has been shown to increase milk production when combined with pumping.
49
What are some ways to support pumping and milk production (3)?
- encourage skin-to-skin contact,
- provide lactation consultation (if available),
- encourage self-care,
- proper nutrition and hydration, and
- provide access to hospital grade breast pumps.
**Using breast compression or hand-expression techniques can be helpful in increasing milk supply.
50
How is breastmilk store?
Once expressed:
- milk is safe for 4 hours at room temperature,
- 48hours in the refrigerator,
- up to 3 months in a refrigerator freezer, and
- 12 months in a deep freezer.
Once thawed:
- frozen milk is good for 24 hours in the fridge.
Parents should be instructed to transport frozen milk:
- in a cooler with ice packs to ensure no thawing happens during transport.
Once EBM has been warmed up,
- it should be fed immediately and
- discarded after 1 hour if not consumed.
51
What are the risk of using diuretics for infant with BPD?
- in the past, infants with BPD were routinely treated with diuretics such as Lasix (short-term use) and thiazides in combination with a potassium-sparing diuretic such as spironolactone (long-term use).
- improvements such as reduction in edema appear to be short term and when weighed against the associated potential side effects (ototoxicity, electrolyte disturbances, metabolic bone disease) many units are choosing not to use diuretics in the routine management of BPD.
- Diuretics are sometimes used for symptomatic improvement in the acute management of pulmonary edema for selected patients.
- Similarly, long-term thiazides use for ventilator-dependent infants with established BPD may be warranted on a case-by-case basis.
- These decisions needs to be balanced with the risks (which can be long-lasting) and the lack of evidence for long-term benefit.
52
Why is caffeine used for infant with BPD (3)?
[ discussed before: use of caffeine for treatment of apnea of prematurity ]
- strong evidence that caffeine is beneficial in the prevention of BPD.
The mechanism of action is not completely understood but is thought to be related to a combination of
- stimulation of breathing,
- decreased need for mechanical ventilation, and
- anti-inflammatory and diuretic effects.
- The timing of caffeine administration is important with significant improvements shown in infants who start treatment on postnatal days 1–3
53
Why is bronchodilators used for infant with BPD?
- BPD has an element of airway reactivity and airway smooth muscle hypertrophy, and therefore bronchodilators have been used as a treatment option.
- Unfortunately, there is insufficient evidence to conclude long-term benefits and suggest routine use of bronchodilators in infants with BPD
54
What are the risks of using corticosteroids for infant with BPD?
- The use of corticosteroids has been extensively studied in preterm infants with BPD and is associated with lower rates of failure to extubate and lower risk of BPD, PDA, ROP, and neonatal mortality.
-Unfortunately, their use is not without side effects, including intestinal perforation, hypertension, growth failure, hyperglycemia, and abnormal neurodevelopment, including cerebral palsy.
- Decisions to use corticosteroids are made on a case-by-case basis, weighing the potential positive outcomes with the potential side effects.
- Dexamethasone is a common corticosteroid that has been used in this population but it is not recommended for routine use (especially in the first week of life).
- In infants who remain ventilated after the first week of life, with increasing oxygen requirements and worsening lung disease, the decision might be made to try a course (7–10 days) of low-dose dexamethasone as the potential benefits appear to outweigh the potential adverse effects.
- Low-dose hydrocortisone (physiologic replacement) beginning in the first 24–48 hours after birth in infants who are at the highest risk for developing BPD (that is, less than 28 weeks) may also be considered
55
Who are included in the feeding team to help improve infant feeding experience (3)?
feeding team:
- Occupational therapist
- Speech and language pathologist
- lactation consultant
56
What are some of the side effects of diuretic therapy that infant is at risk for (3)? What are the nursing implications?
- Fluid and electrolyte imbalances are the major side effects associated with diuretic use. Regarding fluid and electrolyte balance, sometimes these infants get into a cycle of hyponatremia (due to diuretics), which is treated by adding sodium to either feeds or IV fluid. Too much supplemental sodium can lead to fluid retention, which is treated by increasing diuretic doses. This can lead to hyponatremia …and so on. To avoid this problem, clinicians should avoid over treating both hyponatremia and fluid over retention.
- Liver and renal damage can occur with long-term use.
- Lasix has been associated with ototoxicity, which can lead to hearing damage.
- Metabolic bone disease (osteopenia) has been associated with long-term diuretic use due to renal calcium excretion.
57
Describe why the management of infants like Jasmine can be viewed as a “balancing act,” particularly in terms of fluids, calories, and respiratory status. Think about the cardiopulmonary sequelae of BPD.
- Caring for Jasmine involves weighing and balancing risk and benefits.
- Once begun, weaning of Jasmine’s oxygen is closely evaluated for efficacy and tolerance.
- Close observation and monitoring and frequent re-evaluation of goals and progress are required.
- Because nurses know infants like Jasmine well, they play a key in evaluating weaning. Fluid balance is critical in infants with BPD.
- The often need fluid restricition, yet we know the importance of adequate nutrition in improving long-term outcomes.
- Infants like Jasmine often have many additives to their milk such as human milk fortifier (HMF)(if receiving breastmilk), liquid protein, medium-chain triglyceride (MCT) oil among others.
- This helps us to increase the nutritional value without increasing the volume.
58
How could you support Jasmine to be successful at feeding orally (3)?
- Provide positive oral experiences from birth.
- Provide pacing during feeds.
- Provide a multidisciplinary approach feeding—offer LC, OT, SLP if available.
- Alternate nipple and gavage feeding to decrease tiredness.
- Use an elevated side-lying position.
- Use appropriate flow of nipple.
- Reduce stimulation during feeds.
- Pace all care, including feeds, based on infant cues.
- Reduce stress and handling immediately prior to and after feeds.
- Increase supplemental O2 during feeds as needed.
59
A harm-reduction approach to families who plan on bed-sharing at home is not appropriate
false
- it’s important to adopt a harm-reduction approach and educate families to make informed decisions to minimize the associated risks.
- If families are going to bed-share, it’s important to always place the infant on their back, put the mattress on the floor and away from walls, keep the baby far away from any pillows, duvets, and heavy blankets, do not swaddle, place the baby on the outside of the bed rather than between two adults, sleep in a “c-shaped” position facing the baby, ensure no other children or pets share the bed, and never leave the baby alone on an adult bed
60
Oral feeding success is determined by the volume the infant can take.
false
61
What are some reasons preterm are more at risk for pulmonary compromise(3)?
- reduced surfactant
- reduce alveoli
- reduce capillaries
- increase distance between alveoli and capilaries
- small airways
- underdeveloped weak muscles
- underdevelop pulmonary vasculature
62
Whats TTN? caused by? leads to? risk factors? symmptoms?
- TTN: is a benign, self-limited condition that can present in infants of any
gestational age shortly after birth
- Caused by a delay in the clearance of fetal lung fluid after birth, which
- leads to ineffective gas exchange, respiratory distress, and tachypnea
- Risk factors: C/S, twins
- Symptoms may include:
○ Tachypnea
○ Grunting
○ WOB (nasal flaring, retractions)
63
What are the important advances in prevention and treatment of RDS?
- Antenatal steroids (Betamethasone)
- Surfactant replacement therapy
- CPAP and PEEP
64
What are the 5 cardinal signs of respiratory distrss?
- Indrawing
- Tachypnea
- Nasal flaring
- Grunting
- Cyanosis
65
What does infant with BPD is very labile?
- meaning that it can change quickly without much warning.
- Lability due to lungs being damaged to extent that there is little reserve and hypoxia/pulmonary vasoconstriction
66
What is the difference between old and new BPD?
- Classic/old/severe: seen less frequently due to the current treatment and management. Respiratory failure requiring treatment with supplemental oxygen and mechanical ventilation
- New/mild: new BPD is understood to reflect extreme lung immaturity with an arrest of alveolar growth and development and an inflammatory response to treatment induced injury
