Neonatal Care Quiz

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Questions and Answers

What is one of the consequences of the NICU environment on infants?

Disruptions in sleep due to harsh sounds (correct)

Improved sleep cycles without intervention

Increased sensitivity to light

Enhanced ability to localize sound much earlier

Which environmental change is NOT recommended for improving NICU conditions?

Using mothers' clothing to provide familiar scents

Clustering medical care to minimize disturbances

Dimming lights during rest periods

Increasing the volume of medical equipment alarms (correct)

What classification is used for infants weighing below the 10th percentile?

ELBW

LBW

VLBW

SGA (correct)

Which of the following practices is beneficial for improving weight gain in NICU infants?

Using kangaroo care to encourage bonding Signup and view all the answers

Which method is commonly used to assess gestational age in infants?

Dubowitz clinical assessment Signup and view all the answers

What was the prevailing philosophy of care in neonatal units from the early 1900s to 1950?

A dogmatic hands-off policy to minimize intervention Signup and view all the answers

Which important contribution to neonatal care was made by Virginia Apgar in 1958?

Proposing that newborns require their own medical caregiver Signup and view all the answers

What significant advancement in neonatal care occurred during the 1960s and 70s?

Increased technological and medical advancements improving survival rates Signup and view all the answers

Which organization added neonatology as a subspecialty in 1970?

American Academy of Pediatrics Signup and view all the answers

What does the NIDCAP observation focus on within the context of neonatal care?

Behavioral responses of the newborn in care environments Signup and view all the answers

What does AGA stand for in terms of birth weight classification?

Appropriate for gestational age Signup and view all the answers

Which of the following is NOT considered a medical complication seen in the NICU?

Gestational Diabetes Signup and view all the answers

Which state of consciousness is characterized by the baby being fully asleep and not responding to sensory stimuli?

Deep sleep or quiet sleep Signup and view all the answers

What complication is specifically related to the risk of severe brain damage in premature infants?

Periventricular Leukomalacia Signup and view all the answers

At what gestational age do infants typically start to develop full control over their states of arousal?

36 weeks Signup and view all the answers

What is one objective of developmental intervention in the NICU?

To limit impairment in muscle tone and postural adaptation Signup and view all the answers

Which assessment is specifically designed for preterm infants?

NAPI Neurobehavioral assessment for preterm infants Signup and view all the answers

During a developmental assessment, what should therapists observe?

The infant's range, variety, and duration of states Signup and view all the answers

What may necessitate multiple visits for a developmental assessment?

Increases in stress levels of the infant Signup and view all the answers

Which intervention goal is NOT appropriate for infants in the NICU?

Achieving independence from caregivers as soon as possible Signup and view all the answers

Which intervention is specifically designed to provide sensory experiences to infants in the NICU?

Sensorimotor Stimulation / Intervention Signup and view all the answers

What aspect of the baby's condition should be monitored closely to understand their medical progress?

Frequency and severity of apnea and bradycardia Signup and view all the answers

What type of information is crucial for developing a complete therapy assessment?

Medical chart, nursing, physician staff, and family input Signup and view all the answers

In terms of medication effects, what is an important consideration for an infant in the NICU?

Medications can impact alertness and wakefulness Signup and view all the answers

Which of the following is NOT a method of intervention in the NICU?

Speech Therapy Protocols Signup and view all the answers

What is a key aspect of optimal NICU care as defined in the 20th century?

Family focused approach Signup and view all the answers

Which theoretical framework is specifically mentioned as guiding therapy in the NICU?

Dynamic Systems Theory Signup and view all the answers

What main role does physical therapy play in the NICU?

Enhance the development of self-regulatory skills Signup and view all the answers

What is NOT a strategy of developmental care in the NICU?

Increasing noise levels Signup and view all the answers

What are the key components in assessing individual developmental needs under NIDCAP?

Behavioral cues and environmental events Signup and view all the answers

Which of the following characteristics is typical of a preterm infant?

Perceived as unattractive by caregivers Signup and view all the answers

Which of the following best describes the autonomic organization of the fetus?

Physiological functioning Signup and view all the answers

What is a significant risk factor for bonding between preterm infants and their families?

Work required to engage with infants Signup and view all the answers

Which of the following methods is NOT included in promoting family-centered care?

Isolating parents from care activities Signup and view all the answers

The levels of Newborn Intensive Care include which of the following?

Level I, II, III, IV Signup and view all the answers

Study Notes

NICU Overview

Neonatal intensive care units (NICUs) are specialized care settings for very young, small, and/or sick infants.
Early 1900s to 1950s: NICU care focused on a "hands-off" policy to prevent unnecessary handling.
1958: Virginia Apgar emphasized the newborn's right to their own medical care.
1970s: Neonatology became a subspecialty in pediatrics, leading to specialized care.
Advances in technology and medicine during the 1960s and 1970s led to improved infant survival in NICUs.
Developmental care in a NICU provides a supportive environment for the infant's development.
Optimal 20th-century NICU care is defined as developmentally supportive, family-focused, culturally sensitive, and evidence-based.

History of the NICU

Early 1900s-1950s: Philosophy of care in first NICU units emphasised careful handling to protect babies.
1958: Virginia Apgar proposed newborn should have own doctor.
1970: American Academy of Pediatrics (AAP) added neonatology as a subspecialty.
1973: Brazelton's Neonatal Behavioral Assessment Scale.
1975: Committee on Perinatal Health published guidelines for regional perinatal centres.

History of the NICU (continued)

Advances in 1960s and 1970s led to better survival rates.
NICU stays can sometimes have detrimental effects on development.
Ongoing research focuses on improving developmental outcomes within the NICU environment.

Levels of Neonatal Care

Different levels of care exist within the NICU.
Level I: basic care, stabilization and follow-up for healthy newborns or late preterm infants.
Level II: care for infants requiring advanced procedures such as ventilation or more specialized support.
Level III: comprehensive care for high-risk infants, including very low birth weight babies.
Level IV: Most intensive, specialized, and complex care for extremely low birth weight babies and infants with the most critical conditions.

Role of Physical Therapists (PTs) in the NICU

PTs in NICUs address functional and structural body integrity.
PTs promote postural and motor development.
PTs promote interaction between infants and the environment.
PTs support interaction with families, NICU staff and consultants.

Theoretical Frameworks for NICU Therapy

Dynamic Systems Theory
Neuronal Group Selection Theory
International Classification of Functioning, Disability, and Health
Synactive Theory
Developmental Care
Family-Centered Care
Als H. (1982). Synactive theory

Signs of Stability and Stress in Preterm Infants (Als H, 1982)

Autonomic: Smooth breathing, stable color, controlled digestion. Distress: Respiratory pauses, pallor, cyanosis, etc.
Motor: Smooth, controlled movements, Stable posture. Distress: Flaccid movements, hypertonic movements, etc.
State: Well-defined sleep states. Distress: Diffuse activity, fussing, etc.

Newborn Individualized Developmental Care and Assessment Program (NIDCAP)

NIDCAP observations occur every 7-10 days at a baseline.
Observations are taken over 10-20 minutes before feeding.
Observation of the environment and caregiver interactions are a key aspect.
Assessment includes signs of stability and stress to identify needs.
Recommendations for environmental modification, care giving and parental involvement are important.

Family-Centered Care in the NICU

Recognize loss/difficulty parents experience during/after pregnancy.
Encourage hope and positive outlook.
Foster parent-infant bonding.

Preterm Infants

Age of viability: 23-24 weeks.
Perceived as small and unattractive.
Less responsive and more difficult to calm.
Cry elicits negative emotions in caregivers.

Mother/Child Relationships with Preterm Infants

Less synchronous interactions.
Fewer games and decreased interactions between both parties.
Less gratification from infants and challenge to bonding.

Preterm vs. Term Infants

Term infants exhibit better behavioral functioning, more coordinated systems, and higher EEG/Evoked responses.
Potential developmental delays may be due to inappropriate sensory stimulation in NICU environment.

NICU Environment

The NICU environment is designed to reduce risks; however it can disrupt normal sleep cycles, cause stress reactions in infants.
Sound, light and medical procedures can disrupt sleep, cause stress responses, result in weight loss and/or adverse physiological effect.

Environmental Changes in the NICU

Dimming lights, covering isolettes, and day/night cycling help support the infant's health needs.
Clustering of medical care, kangaroo care, hammocks, putting twins together, minimize stress.
Environmental cues such as music, smell and clothing can influence the infant's behaviour and response to stress.

High-Risk and Low Birth Weight Infants

Classification based on weight: SGA (Small Gestational Age), LBW (low birth weight), VLBW (very low birth weight), ELBW (extremely low birth weight) - based on specific weight guidelines, gestational age, and pathology, factors that increase infants risk of future developmental issues.
The Dubowitz method is frequently used to asses gestational age.

Medical Complications in the NICU

RDS (Respiratory Distress Syndrome)
BPD (Bronchopulmonary Displasia)
PVL (Periventricular Leukomalacia)
IVH (Intraventricular Hemorrhage)
HIE (Hypoxic-Ischemic Encephalopathy)
NEC (Necrotizing Enterocolitis)
ROP (Retinopathy of Prematurity)
Hyperbilirubinemia
Neonatal Seizures
Other complications like Fetal Alcohol Syndrome (FAS), Fetal Abstinence (Withdrawal), HIV-AIDS and Brachial Plexus Injuries

State Regulation in Babies

Babies have distinct states of arousal and consciousness (e.g., deep sleep, light sleep, active awake, crying).
Premature infants have difficulty regulating their states.

Brazelton States of Arousal

Brazelton identified and characterized six states of arousal in newborns.
Observations during an assessment note behaviors, the range and duration of those behaviors.

Examination/Assessment

Developmental assessments in NICUs help identify impairments and needs.
Adaptation of the the environment may aid in optimizing development.
Observations should be taken over several visits due to the fluctuations in infant status.

Tests and Measures

Tests and measures like Dubowitz, NIDCAP, NAPI, and TIMP support assessment of preterm infants.
Tests and measures like Dubowitz, NBAS, Morgan, oral-motor assessment, and NOMAS and NCAFS support assessment of full-term infants.

Intervention in the NICU

Evidence-based interventions can improve function, weight gain, and earlier discharge in NICUs.
Interventions like environmental modification, positioning, handling, sensorimotor stimulation, taping/splinting, hydrotherapy, oral motor therapy, and parent education are vital.

Therapy Assessment

Therapy assessments need to include medical chart information, nursing reports, parental history, prenatal history, birth history, and important episodes like apnea, bradycardia, and oxygen desaturation.
Assessing the infant's need for nutrition, medication affects and tolerance/response to medical procedures is key.

Parent Education

Educate parents about preterm baby behaviors, typical development, and expectations.
Assist parents in developing supportive strategies for their child.

Kangaroo Care

Kangaroo care involves skin-to-skin contact between parent and infant.
Encourages infant stabilization and parent-infant attachment and interaction.
Promotes positive outcomes in the NICU environment.

Positioning in Preterm Infants

Avoid postures of extension to prevent discomfort and imbalance.
Promote neutral head and neck positions
Slight chin tuck and scapular protraction support upper extremity flexion and hand midline positioning.
Blanket rolls and commercially available devices aid in supported position.

Prone Positioning

Unsupported prone position promotes shoulder retraction, neck hyperextension, and truncal flattening, and hip abduction and external rotation.
Place a thin roll under the chest to elevate the chest.
Shoulder protraction and more neutral neck alignment need to be encouraged.

Side-Lying Positioning

Decreased stress behaviors are noted than in supine position in infants.
The infant's respiratory system has been improved and placement in midline.
Reduced risk of gastro-esophageal reflux disorders (GERD).

Supine Positioning

Maximal observation and access to the infant by caregivers.
Forces of gravity lead to neck extension, trunk extension, scapular retraction, and an anterior pelvic tilt.
Does not generally promote calming or self-regulation in infants.

Supported Supine Positioning

Support needs to be provided as this position poses the most challenges to infants.
Support rolls around the infant to assist with midline symmetrical flexion in head and trunk.
Support with hands, legs, and posterior skull.

Observation

Therapists assess infant competence and identify when to terminate or continue a procedure to prevent negative reactions from the infant.
Collaboration with nursing to get understanding of baby's current medical status and any notable events.
Infant evaluated before, during, and after as a part of the observation process.

Observation (continued)

Repeated light and sound can assess the infant's stability as a part of the observation strategy.
This can be a helpful tool to determine the infant's readiness before handling.

Collaboration in NICUs

Collaborative relationships are a key element for optimal NICU experience.
PT's need to engage with medical and nursing staff and parents to improve the outcomes for the infant.

Level of Expertise

High level of therapist expertise is essential to understand physiological and behavioral changes in infants due to metabolic, neuromusculoskeletal, and cardiopulmonary complexities and risks.
Ongoing assessment and adjustment of procedures are needed in response to these changes.

Level of Expertise (continued)

Possible risks of routine care in NICU include hemodynamic complications, respiratory issues, cardiac, metabolic, orthopedic, integumentary concerns and risk of infection/inflammation.
Therapists need to be assessed for their experience and training to manage the higher-risk infants with complex and rapid changes.

Preparation to work in the NICU

The most appropriate preparation for working in a NICU should include practice observing healthy term infants and/or providing services in home or day care to provide familiarity with a normal environment for the infants and children.
Hands-on experience in directly providing NICU services in a supervised practical setting under the support of an experienced staff person.

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Description

Test your knowledge on neonatal intensive care units (NICUs) and their impact on infant health. This quiz covers historical practices, assessment methods, and significant contributions to neonatal care. Perfect for students and professionals in the field of pediatrics.