Pediatrics > Prematurity > Flashcards

Prematurity Flashcards

(51 cards)

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1
Q

What weeks are classified as the ovum, embryo, and fetus?

A

Ovum: 1-2 weeks
Embryo: 3-8 weeks
Fetus: 9-40 weeks

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2
Q

What is the order of development from oocyte to fetus?

A

oocyte -> ovum -> zygote -> blastocyte -> embryo -> fetus

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3
Q

What are typical infant vitals?

A
  • > 37 weeks
  • axillary temp: 98.6-99.8
  • HR: 80-140 bpm
  • RR 40-60 bpm
  • weight: 6-9lbs
  • vision: about 8in
  • physiological flexion and dorsiflexion to tibia (possibly)
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4
Q

What are premature infant vitals?

A
  • <37 weeks
  • axillary temp: 98.6-99.8
  • HR: 120-160 bpm
  • RR 60+ bpm
  • weight: 2-5lbs
  • POOR physiological flexion and dorsiflexion
  • disorganized infant reflexes and sensory systems
  • transient tachypnea, apnea, and bradycardia
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5
Q

What are the 6 big changes an infant must go through when transitioning from the womb to the outside world?

A

1) World change from “water” to air (massive sensory input)
2) Baby MUST breathe before umbilical cord is cut
3) Baby MUST eat/digest own food
4) Maintain own core temp
5) Learn to excrete own waste
6) Learn to suck/swallow

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6
Q

What are the birth weight categories?

A

LBW: 3-5lbs
VLBW: 2-3lbs
ELBW: 1-2lbs

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7
Q

What is one of the main risk factors for overall health in infants?

A
  • birth weight
  • lower birth weight is a main predictor of decreased health and development
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8
Q

What is SGA, LGA, and IUGR?

A

Small for gestational age: below the 10th percentile implies non-pathology

Large for gestational age: > 90th percentile (diabetic mothers)

Intra-uterine growth restriction: reduced birth weight, poor development outcomes implies pathology

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9
Q

What are the functions of the Gyri and Sulci of the brain and how do these differ in premies?

A

Function:
- increase surface area for growth/development of neural connections

Premies:
- decreased Gyri and Sulci
- looks more like a “smooth” brain

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10
Q

What are the 5 categories for the APGAR and what is the highest score?

A

Activity
Pulse
Grimace
Appearance
Respiration

10 is the highest/Best score possible

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11
Q

What are characteristics of premature infants?

A
  • poor flexion/repertoire of movement and antigravity movement
  • dorsiflexion to <40 degrees
  • no physiologic “contractures”
  • varying vitals
  • reflexes either hyper or under active
  • muscle tone develops in a caudal->cephalo pattern (should be cephalo->caudal)
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12
Q

What are the goals for PT with premies?

A

1) maintain steady vitals w/ positioning, calming, self soothing, non-nutritive sucking
2) developmental positioning to minimize alterations in tone, prevent contracture, minimize reflexes
3) provide optimal positioning for visual, social, fine, gross, and cognitive development

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13
Q

What are some priorities when examining premature infants?

A

Observation:
- tone
- positioning
- reflexes
- behavioral assessment

Outcome measures
Infant “State”

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14
Q

What are some ways to observe tone?

A
  • heel to ear
  • scarf sign
  • popliteal angle
  • ventral suspension
  • pull to sit
  • slipping through axilla
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15
Q

What are some outcome measures to use for premature infants?

A
  • GMA
  • TIMP-2
  • HINE
  • HINT
  • Finnegan
  • Pain (FLACC, CRIES)
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16
Q

What are the ideal “states” for an infant?

A
  • quiet alert
  • active alert
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17
Q

What are signs of stress in an infant?

A
  • yawning
  • crying
  • tremorous activity
  • cycling movements (cramped synchronous movements)
  • hand placement
  • stiffening (rule out seizures)
  • sneezes/coughs
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18
Q

What is the FLACC used for, what age, and what is a better score?

A
  • Used as a pain rating scale
  • age from infant to 7 years old
  • lower scores = better scores
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19
Q

What is the TIMP-2 used for and what age?

A

Great for premies to assess posture & selective motor control from these categories:
- anti-gravity hip flexion
- orientation to sound
- roll from leg response

age 34 weeks to 3.5 months

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20
Q

What is the HINE used for and what age?

A
  • provides prognostic information on the severity of motor outcome
  • age 2 to 24 months
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21
Q

What are 2 outcome measures for early detection of cerebral palsy?

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A
  • GMA (good for predicting CP) + HINE
22
Q

What are the NICU levels best used for?

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A

LVL 1: ability to resuscitate but no specialties
LVL 2: Specialty neonatal care& likely turn away infants <32 weeks gestation
LVL 3: Comprehensive care to extremely high-risk infants & ECMO

23
Q

What is Respiratory Distress Syndrome (RSD)?

Study These Flashcards
A
  • prematurity causes pulmonary immaturity and deficiency of surfactant
  • low surfactant INCREASES surface tension, alveolar collapse, diffuse atelectasis and decreased lung compliance

treatment includes administering surfactant, O2 supplementation, assisted ventilation, and ECMO

24
Q

What is Bronchopulmonary Dysplasia (BPD)?

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A
  • Chronic lung disease with persistent areas of increased densities on chest radiographs *interstitial fibrosis resulting from alveolar collapse
  • VLBW & ELBW infants require ventilation
  • lots of work to breathe due to increased airway resistance
25
What is are the grades of Periventricular Leukomalacia?
Grade 1: areas of increased periventricular echogenicity w/o any cyst formation persisting for >7 days Grade 2: pericentriolar echogenicity has resolved into small periventricular cysts Grade 3: extensive periventricular cysts in the occipital and fronto-parietal region Grade 4: periventricular echogenicity in the deep white matter developing into extensive subcortical cysts (multicystic encephalopathy) *grades 1 & 2 usually resolve*
26
What are the grades of intraventricular hemorrhage (IVH)?
Grade 1: isolated germinal matrix hemorrhage Grade 2: IVH w/ normal sized ventricles Grade 3: IVH w/ acute ventricular dilation Grade 4: IVH w/ hemorrhage into the PV-white matter
27
What is Hypoxic Ischemic Encephalopathy (HIE) usually caused from?
- usually a nuchal cord - decreased supply from umbilical cord - primarily an energy failure issue (not enough energy to the brain) *hypothermia therapy usually helps w/ this*
28
How does Neonatal Abstinence Syndrome (NAS) occur?
- addictive drug abuse while pregnant
29
What are some main hormones that are affected with NAS?
Increase: - corticotrophin - acetylcholine - noradrenaline Decrease: - dopamine - serotonin *also an increase in hyperalgesia and allodynia*
30
What are some outcomes from women using cannabis during pregnancy in an infant?
- decreased HR, RR, BP
31
What are some outcomes from women using cannabis during pregnancy in a child?
- increased impulsivity - hyperactivity - destructive behaviors - memory dysfunction - decreased IQ
32
What are some outcomes from women using cannabis during pregnancy in an adolescent?
- higher rates of drug use - decreased concentration - decreased memory - depression/schizophrenia/anxiety disorders
33
What is a test for NAS?
Finnegan - >8 means there is a need for follow up and intervention
34
What is Necrotizing Enterocolitis (NEC) and what causes it?
Acute inflammatory disease of the bowel leading to necrosis of the bowels - occurs frequently in the first 6 weeks of life - symptoms include vomiting, abdominal distension, bloody stools *Occurs from being fed formula vs breast milk in the early stages of life*
35
What is a risk factor for Retinopathy of Prematurity (ROP) and what does it lead to?
Risk factor: - VLBW - babies born before 30 weeks gestation *can lead to blindness*
36
What is Hyperbilirubinemia?
Jaundice - accumulation of excessive amounts of bilirubin in the blood - liver is still immature to completely break down - IF not treated, can cause CP w/ GFCMS LVL 5 due to moving from the blood to the brain
37
What are signs of neonatal seizures and what can cause them?
Signs: - stiffen, asymmetric, eyes deviate to 1 side Causes: - HIE - IVH - anatomical defects - hypoglycemia - drug withdrawal
38
What is Fetal Alcohol Spectrum Disorder and what are some characteristics?
Alcohol that rapidly crosses the BBB and placenta of the fetus - heavy drinking during pregnancy Characteristics: - wide set eyes - flat nasal area - thin lips - growth deficiency - cardiac defects - microcephaly - dysmorphology
39
What is Patent Ductus Arteriosus (PDA)?
A hole in the heart between the pulmonary artery to the aorta in the fetus - used to help circulate blood because lungs do not work yet *IF this does not close, endometosin is used. If still doesn't close then surgery is needed*
40
When does the Foramen ovale and Ductus Arteriosus close?
Foramen Ovale: should close by month 3 Ductus Arteriosus: within first 10-12 hours after birth
41
What is an Obstetric Brachial Plexus Injury and what are some risk factors?
Brachial plexus injury due to traumatic delivery Risk Factors: - large babies (macrosomia) - multiple babies (twins) - difficult presentation - forceps breach - prolonged labor
42
What are the two brachial plexus injuries and how are they positioned?
Erb's Palsy (C5-6): - shoulder adduction - shoulder IR - elbow extension - elbow pronation - wrist flexion Klumpke's Palsy (C8-T1): - shoulder adduction - elbow flexion - wrist flexion - claw hand w/ tight interossei (extrinsic "+" position)
43
What is Cystic Fibrosis and what are some signs and symptoms?
Genetic disorder that affects glands causing them to produce mucus in the lungs Signs & symptoms: - salty skin - coughing/wheezing - multiple lung infections - SOB - slow growth - big appetite - loose stools - painful stomachs - slender kids
44
What is Shaken Baby Syndrome and what is the triad associated with this?
Forcefully shaken baby that leads to brain damage usually b/c the baby wont stop crying Triad: 1) subdermal hematoma (creates pressure & ischemia) 2) Retinal hemorrhage 3) Encephalopathy *100% of shaken babies have CP*
45
What is the main goal of PT in the NICU?
Competence - self regulation - maintain positions - gain weight
46
What are the 4 main interventions?
- encasement/swaddling - graded sensory-motor input - non-nutritive sucking - Positioning
47
What is the most ideal position for a baby in the NICU?
side lying
48
What is the supine position used for?
- early WB through LEs (hook lying) - towel roll to decrease effects of reflexes - facilitate use of UEs for object exploration, visual regard
49
What is side lying used for?
- begin tolerating rolling - ideal for sleeping - dampens TLP/S reflex - helps w/ cranial molding & weight gain - ideal for HR, RR, BP, O2 - trunk elongation and scapular protraction - disassociating b/w upper and lower trunk
50
What are the pros and cons of the prone position?
Pros: - stretches hip and knee/rectus femoris - facilitates active extension and head control - eye hand awareness & proprioception Con: - breathing may be difficult - not possible w/ ventilator babies and cardio-pulm issues
51
What is sitting used for?
- active head control - trunk control - WB through spine, UE, LE - frees hands for exploration - disassociation of trunk from UE and LE - tracking - cognition (smarter babies)
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