NICU Long Question PDF

**NICU Long Question:** X exhibits several risk factors that could potentially result in developmental challenges. **Risks (The Big Five) and Their Presence in the Case:** - Visual impairments - Epilepsy/seizure disorder - Mental disability - Cerebral palsy - Hearing loss **Infants...

**NICU Long Question:** X exhibits several risk factors that could potentially result in developmental challenges. **Risks (The Big Five) and Their Presence in the Case:** - Visual impairments - Epilepsy/seizure disorder - Mental disability - Cerebral palsy - Hearing loss **Infants Most at Risk:** - Birth weight \< 1200 grams - Gestational age \< 32 weeks - NICU admission \> 5 days - APGAR score \< 5/10 - Total hospital stays \> 25 days over 6 months - Chronic feeding difficulties Understanding and identifying risk factors is crucial in early intervention because it allows healthcare professionals to implement timely and targeted strategies that can significantly improve developmental outcomes for infants and young children. Audiology and speech-language pathology work together closely to support the development of infants. **Intervention and Management:** Therefore, X requires intervention and management to achieve optimal outcomes. Implementing NDSC, a comprehensive approach, is essential to improve the developmental outcomes of preterm infants. It is designed to minimize stress in the NICU environment. **NDSC Overview:** NDSC is a cornerstone of care in the NICU, dedicated to fostering the optimal development of infants, particularly those born prematurely or with medical complexities. In the NICU, NDSC encompasses a series of strategies and interventions designed to minimize the stress of the NICU environment and promote the neurodevelopment of these vulnerable infants. **Infant Behavioral Stages and NDSC:** (indicate readiness to interact, infants will act differently depending on gestational age/behavioural stages) - **In-tuned Stage (\36 weeks):** Infants actively interact, exhibit self-regulating behaviours, respond predictably, and depend more on caretaking than equipment in the NICU When a specific stage is identified, interventions and communication development should be tailored accordingly, with clear do's and don'ts to manage the stage effectively. **NDSC Guidelines (Lubbe, 2019):** \- Individualized care \- Handling \- Positioning \- Self-regulation \- Feeding \- Pain management \- Create an environment similar to intrauterine \- Family-centered care and education (parent-infant interactions) \- Staff education \- MDT (multidisciplinary team) collaboration and sharing **Benefits of NDSC:** \- Medical benefits \- Cost-effectiveness (limited resources) \- Improved growth, developmental, and social outcomes \- Long-term hospital benefits **NDSC Programs (Rosetti, 2001):** - [Directed at Infants:] Promote self-regulation, positioning, positive touch, containment, hearing screening, feeding, and communication intervention. - [Directed at Parents:] Provision of information, support and encouragement, training and guidance, referrals to professionals, and encouragement of KMC. - [Directed at Staff:] Provision of information, training, environmental changes (noise, light, handling), and assistance with discharge planning. **Roles of Different Healthcare Workers:** Speech-Language Pathologists: \- Feeding and swallowing \- Prefeed assessments \- Identifying risks \- Assisting with discharge plans \- NDSC programs \- Oral feeding \- Evaluation of breastfeeding \- Cup and bottle feeding **- Audiologists:** \- Hearing screening for risks \- Monitoring noise in the NICU \- Providing parental information and case history \- Confirming hearing loss \- Hearing stimulation **Implementation Strategies (White and Philbin, 2012):** **Noise Reduction:** \- Recognize that work activities generate substantial amounts of sound. \- Changes in unit practices can yield a reduction in sound levels without requiring financial investment. \- If infants are usually cared for on radiant warmers in the NICU, sound levels can be above 60dB. Placing them in incubators as soon as possible can reduce ambient sound levels. **Visual Stimuli Reduction:** \- Use dimmable lights. \- Position equipment away from the direct view of the infant. \- Use covers (close incubators). **Swaddling and Implementing KMC:** Kangaroo Mother Care (KMC) involves continuous skin-to-skin contact between the baby and the mother and is used in the NICU. **Benefits of KMC (Charpak et al., 2021):** \- Improved physiological stability \- Improved neonatal growth \- Enhanced weight gain \- Improved breastfeeding outcomes \- Enhanced bonding and attachment \- Reduces maternal anxiety and depression \- Regulates body temperature \- Reduces risk of infection \- Reduces mortality \- Improves neurodevelopmental outcomes **Competencies for NICU Early Intervention (Rosetti, 2001):** \- Infant specialist \- Facilitator and consultant \- Parent/caregiver educator \- Program developer and advocate **Framework for NICU (ASHA):** \- NDSC \- Family-based \- Culturally and linguistically sensitive \- Coordinated, comprehensive, and team-based **Signs of Stress and Disorganization (Lubbe, 2008):** \- Changes in skin colour \- Irregular heartbeat \- O2 deprivation \- Gagging, straining, hiccupping, yawning, sneezing **Graded Stimuli and NDSC:** NDSC -- for optimal development (directed at staff, parents, and infants) (Rosetti, 2001). **General NICU Goals:** \- Minimize stimuli \- Create developmentally appropriate environments Does this restructured format meet your needs? 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