All
T/F: Pain may lead to poor nutritional intake, delayed wound healing, impaired mobility, sleep disturbances, withdrawal, irritability, and other developmental regression
True
- Vomiting
- Irritability
- Poor weight gain
- Dysphagia, abdominal
- substernal pain
- esophagitis
- Respiratory symptoms - cough, laryngitis, and wheezing
- Dental erosions, pharyngitis, sinusitis, and recurrent otitis media can also be present as age
- incidence lower in breastfed infants compared to formula-fed infants
- higher risk: neurologic impairment, certain genetic disorders, esophageal atresia, chronic lung disease, cystic fibrosis, prematurity
Gastroesophageal reflux disease (GERD)
- 2/3 healthy infants will have this issue
- passage of gastric contents into esophagus
- Normal physiologic process that occurs several times a day in infants, children and adults
- transient relaxations of lower esophageal sphincter independent of swallowing
- typically after meals and causes few or no symptoms
- may be associated with regurgitation, spitting up, and even vomiting
- content generally nonacidic and improves with maturation
Gastroesophageal reflux (GER)
Acidic, coming back up and causing problems
- these babies will cry and scream
- Cant lay them flat
- will stop eating when it hurts
- will lose weight
- have cough and wheezing when getting older
GERD
Stage of arousal:
- eyes open or closed
- facial grimace or hyperalert appearance common
- large ranges, constant movements of extremities seen
- trunk extension often seen
- behavioral signs of stress present * *
- increased HR and RR
Active alertness
Clinical presentations:
- High pitched cry, irritability, sleep wake disturbances, hyperactive primitive reflexes, transient tone alterations, feeding difficulties, GI disturbances, autonomic dysfunction, failure to thrive, seizures
NAS
- Lifestyle modifications to minimize symptoms
- feeding changes and positioning therapy
- modifying maternal diet
- changing formulas
- reducing feeding volumes
- increasing frequency of feedings
- thickening feedings
- pharmacotherapeutic agents
- surgical intervention
- fundoplication - gastric fundus is wrapped around the distal esophagus
Management of GER/GERD
How soon after birth do symptoms of withdrawal for NAS usually occur?
Within 72 hours after birth
- Signs and neurobehaviors seen in newborn after abrupt termination of gestational exposure to substances taken by the mother during pregnancy
Neonatal abstinence syndrome/neonatal withdrawal (NAS)
Stage of arousal:
- no movement of body or eyes
- optimal for growth and recovery
Deep sleep
Based on maternal history, maternal and infant toxicology lab tests, and clinical examination of the infant
Diagnosis of NAS
What is the gold standard test for babies in the NICU ?
The test of infant motor performance (TIMP) ***
- Nonnutritive sucking
- positioning/swaddling
- gentle handling
- demand feeding
- minimal stimulation
- environmental modifications
** difficulty with state organization
Supportive therapeutic modalities for NAS
- Impairments in body function and structure that contribute to activity limitations and participation restrictions
- developmental status of the infant
- infants individualized responses to stress and self regulation
- needs for skilled positioning and handling
- environmental adaptations to optimize growth and development
Purpose of PT examination and eval in NICU
Stage of arousal:
- Eyes closed
- crying
- stressed facial expression
- extremity and trunk movements seen
- Increased HR and RR
Crying
Type of tx:
- Reduce light and noise
- Clustered care with limited interruptions during sleep
- Culture of parent participation in caregiving including use of kangaroo motor care/skin to skin holding, frequent visitation, and infant interaction
- Pain management
Developmental care
Type of care where PT, OT, SLP, RT, and nurse go in at the same time so they do not interrupt multiple times throughout the day.
Cluster care
Type of tx:
- Positioning with extremities and head in midline, arms and legs flexed close to the body
- massage ideally provided by parents in form of firm touch
- graded movement experience timed with infants readiness for social engagement
Direct interventions
- Neurologic function
- neurobehavioral functioning
- Motor behavior
- Oral motor function
- Test of infant motor performance (TIMP)
- infants as young as 34 weeks of gestation
- most widely used assessment of infant functional motor behavior in the NICU
Testing in the NICU
Stage of arousal:
- Body jerks and eye movements seen
- HR and RR responses to noise and lights noted on bedside monitors
Light sleep
Weighted positional hands in the NICU to help baby sleep and feel like it is actually physical touch
Zaky
- Positioning
- Massage
- Physical activity
- Facilitated movement
- Discharge planning
Direct interventions by physical therapists ***
Type of tx:
- Family support
- education and readings on developmental cues and developmental supports available at home
- referral to NICU follow up programs and early intervention
Discharge planning
- Infant on the parents/caregivers bare chest
- shown to foster attachment, improve maternal confidence in caring for premature infant, and improve odds of breastfeeding at discharge
- Reduced stress and depression
- more mature neurobehavioral profiles
- motor development
- overwhelming data supporting the benefits and limited risks
Kangaroo mother care (skin to skin holding)
Stage of arousal:
- Eyes open and eye contact made
- relaxed face and facial expressions
- movement smooth
- ready for interaction
Quiet alertness