premature healthrisk
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| Bronchopulmonary dysplasia (BPD) | Chronic lung disease.
Premature infants born 10 weeks early and are less than 2 lbs at birth are at highest risk.
involves abnormal development of lung tissue
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| BPD results from: | Results from:
- (main cause)underdeveloped lungs and/or lack of surfactant
- infants on high levels of O2
-respiratory therapy needed for underdeveloped lungs increases risk in premature infants
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| BPD general symptoms | -rapid breathing or labored breathing
-wheezing
-bluish discoloration of the skin around the lips and nails due to low oxygen in the blood
-poor growth
-repeated lung infections that may require hospitalization
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| BPD outcomes | - increased risk of upper respiratory complications after discharge
- recovery slow but most infants recover and live active normal lives
- some need continued breathing treatments or supplemental oxygen or ventilation after discharge
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| BPD med management | diuretics- reduce fluid in lungs
bronchodilators- relax muscles in air passageways
corticosteroids- reduce inflamation
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| Ototoxic factors | harmful effect of a drug, or chemical substance, or infection, or noise level on either the cochlear or vestibular system or in some cases both systems.
damage to inner ear.
can lead to temp. or perm. hearing loss, tinnitus, &/or loss of balance/dizzy
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| rate of hearing loss in premature infants | 2-15%
of those cases 20%-25% of them are due to ototoxic drugs or viruses/infections
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| Post ototoxic exposure can lead to | increased risk of hearing loss between 24-30 mo.
certain antibiotic commonly used to treat bacterial infections in NICU (could be harmful to auditory system)
severe hyperbilirubina (jaundice)
more than 5 days of mechanical
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| ototoxic risk factors | environment in NICU- too busy and loud for sensitive infants
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| Retinopathy of prematurity (ROP) | abnormal blood vessel development in the retina of the eye
infants bron prematurely before 31 weeks gestation and weighing less than 2.5 lbs
400-600 infants each year become legally blind from ROP
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| Causes of ROP | Blood vessels of retina complete development at time of normal birth
ROP occurs when abnormal blood vessels grow in premature infants and spread throughout the retina. these blood vessels are fragile and can leak, causing scarring in retina (stage 1-5)
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| 5 stages of ROP | stage 1- mild abnormal blood vessel growth
stage 2-moderately abnormal blood vessel growth
stage 3-severely abnormal blood vessel growth
stage 4-partially detached retina
stage 5-completely detached retina and the end stage of the disease
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| ROP treatment | early treatment has been shown to improve baby's chances of normal vision- laser therapy or cryotherapy may be used to prevent complications of advanced ROP - it can stop abnormal blood vessel growth
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| other complications of ROP | infants w ROP are considered to be a higher risk for developing certain eye problems later in life - retinal detachment, myopia (near), strabismus (crossed eyes), amblyopia, and glaucoma
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| intraventricular hemorrhage (IVH) | mild to severe bleeding into the ventricles of the brain that causes damage to brain cells. bleeding can occur bc blood vessels in a premature baby's brain are fragile and immature that they can easily rupture
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| IVH is most common in | premature infants born more than 10 weeks early and babies with respiratory distress syndrome and unstable BP
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| IVH includes | apnea
bradycardia
pale or blue coloring
low tone
weak suck
high pitched cry
anemia
possible seizures and swelling or bulging of the frontanelles (soft spots between bones of baby's head) (if hydrocephalus)
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| 4 grades of IVH | 1&2: small amount of bleeding, typically no long term problems
3&4: more sever. blood leaks into brain tissue which clots and can block flow of cerebral spinal fluid (CSF) causing hydrocephalus (requires shunt)
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| IVH prognosis | severe bleeding often leads to developmental delays and issues with movement control and/or cerebral palsy. up to 1/5 babies may die due to severe bleeding
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| OT role | focus on developing improves newborn sensory modulation and initiating newborn handling to promote physiologic stability
positioning/tone
increase occupational performance (sleep, feeding, developmental milestones) as well as co-occupations
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| "Baby steps" program | bridge between being at NICU and home, working with family to simplify necessary health routines for baby and maximize the developmental skills of infants
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