Prematurity and High-Risk Infants

Intro

15 million preterm births per year; 80% between 32-37 weeks

Review of preterm causes:

1. maternal infection, particular ethnicities, black ethnicities, multiple births, or some substance uses, including caffeine

less thank 28 weeks- need neonatal ICU

re born around that 28-week age, what we find is that some of these infants are going to have a lot of issues with their lungs, potentially some issues with their eyes. And then you can see down here at 30 weeks, we have that flexor tone that really starts to develop. So that's why a lot of these preterm babies look very hypotonic. They look very gravity dependent. They don't have that nice flexor tone, that tucked in posture, because they haven't really had an opportunity to develop it yet. And then as late as 38 weeks, there is still myelination happening in the brain. And that's really what's helping that connectivity and the signals that are being sent from one part of the brain to the other and from the brain to the body. So when we don't have that good myelination, we're not really having effective signals that are getting sent from different parts of the brain to the body in reverse as wel

womb vs nicu

womb: quiet, muffled, consistent temp, no pain, darm

nicu: fighting gravity cause no flexion posture, loud noises (machines), potential iv and other lines in them, painful procedures, ha e to breathe, temp changes, artificial scents, sounds very loud to infant and can cause damage to ear, light, disrupted sleep

sounds

AAP less than 45 decibels consistent, no more than 65 decibel to be exposed to

average nicu sound 49 but at times can go to 57 can damage ear

premature babies 2-10% having hearing disorders compared to 0.1% in term babies

stress

use an isolettevs open crib

put a blanket over isolette coverhelp muffle sound

eyes

before 32 weeks cant control how much light comes into eye

blanket over isolette

shade their eyesduring assessment and interventions

cyclic lighting

plan PT around awake time

NICU care:

1. o there are four different levels of ICU care in the NICU depending on how much care a baby needs. So it goes from level one all the way up to level four. So level one is really just your newborn nursery. Some mild sort of support that the baby might need all the way up to you know, the most complex critically-ill patients. These are really hospitals that are going to be able to have surgical subspecialties. They're going to have a lot of medical subspecialties. And another thing that they're going to be able to provide is ECMO, which we'll talk a little bit more about soon.