batshaw ch07 powerpoint [read-only] - napa valley · pdf filetitle: microsoft powerpoint -...

8/23/2017

1

Chapter 7Premature and Small-for-Dates Infants

Overview

• Causes of prematurity and being small for gestational age

• Physical characteristics of the premature infant

• Complications and illnesses associated with preterm birth

• Methods used to care for low birth weight infants

• Results of outcome studies

Chapter 7 slides in Children with Disabilities, Seventh Edition, Online Companion Materials.Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Definitions of Prematurityand Low Birth Weight

• A preterm or premature infant is one born before the 37th week of gestation

• Low birth weight (LBW): weight < 2,500 grams

• Very low birth weight (VLBW): < 1,500 grams

• Extremely low birth weight (ELBW): < 1,000 grams

• Micropreemie (infant weighs less than 800 grams)

• Small-for-gestational-age infants• Either full term or premature• Birth weight below 10th percentile • May appear malnourished due to intrauterine growth

restriction


Definitions of Prematurityand Low Birth Weight (continued)

• Assessment of gestational age• Helps distinguish an appropriate-for-gestational age infant

from a small-for-gestational-age infant• Calculated from projected birth dates, or EDC• Uterine size (measured by clinical and ultrasound

examination) and noting when fetal activity first develops• Influences treatment approaches, neurodevelopmental

assessment, and outcomes

• Physical and behavioral characteristics of the premature infant• Presence of fine body hair (lanugo) and smooth, reddish

skin, along with the absence of skin creases, ear cartilage, and breast buds

• Reduced muscle tone and activity; increased joint mobility


8/23/2017

2

Incidence of Preterm Births

• Occurs in about 13% of all pregnancies worldwide

• Preterm births responsible for majority of neonatal deaths and nearly one half of all cases of neonatal-onset neurodevelopmental disabilities (including cerebral palsy)

• Incidence of preterm births has declined 1% since 2006, but overall has risen 16% since 1990


Causes of Premature Birth

• Increased obstetric intervention (C-sections)

• Use of assisted reproduction techniques (in vitro fertilizations)

• High number of multiple pregnancies (fertility drugs)

• Increased substance abuse in urban areas

• Rise in idiopathic preterm delivery rates due to adverse effect of low socioeconomic factors and maternal education level

• Maternal infections

• Adolescent pregnancies


Complications of Prematurity

• Respiratory problems• Hyaline membrane disease (also called respiratory distress

syndrome); decreased production of surfactant that normally keeps the alveoli stable, permitting the exchange of oxygen and carbon dioxide

• Bronchopulmonary dysplasia; infants who require supplemental oxygen and/or mechanical ventilation beyond 28 days postnatal age

• Neurologic problems • Intraventricular hemorrhage (bleeding into the brain)• Periventricular leukomalacia (damage to hearing from

antibiotic use)


8/23/2017

3

Complications of Prematurity (continued)

• Auditory toxicity• Increased risk for hearing loss due to frequent use of

medications that can be toxic to the auditory system

• Apnea and bradycardia• Apnea is defined as a respiratory pause lasting 15–20

seconds; disorder of respiratory control and related to immaturity of central nervous system

• Sudden infant death syndrome (SIDS)• Occurs more than twice as frequently in premature infants• Apnea monitors used for premature infants with significant

apneic spells• Recommended that infants sleep on their backs



• Cardiovascular problems• Patent ductus arteriosus (PDA): fetal vessel that diverts

blood flow from the lungs; in infants with PDA this vessel does not close, so the lungs are not oxygenated

• Gastrointestinal problems• Necrotizing enterocolitis (severe injury to a portion of the

bowel wall) • Gastroesophageal reflux disease (GERD): syndrome in

which the contents of the stomach are regurgitated back into the esophagus



• Ophthalmologic problems• Abnormalities in retinal vascular development lead to

retinopathy of prematurity (ROP)

• Immunologic problems • Immature immune system; premature infant at risk for

generalized bacterial and fungal infections

• Other physiologic abnormalities• Increased risk for brain damage• Glucose and electrolyte instability• Anemia of prematurity• Transient deficiency of thyroid hormone production


8/23/2017

4

Medical and Developmental Care of Low Birth Weight Infants

• Preterm and SGA infants are best managed and cared for in high-risk obstetrical centers with neonatal intensive care units (NICUs)

• New approach to NICU care • Differs from traditional care based on medical protocol and

procedures• More relationship based, individualized, developmentally

supportive• Involves observation of and response to infant behavior• Actively involves parents in infant’s care


Medical and Developmental Care of Low Birth Weight Infants (continued)

• Survival of LBW infants• Advances in technology of NICUs and their application to

the premature infant have helped to reduce mortality • Since 1960, survival of LBW infants has increased from

50% to more than 90%


Care After Discharge from the Hospital

• Clinical criteria for discharge based on • Infant able to feed well by mouth/consistent weight gain• Infant maintaining a stable body temperature outside of an

isolette• Infant no longer experiencing episodes of apnea and

bradycardia

• Premature infants may be more irritable, cry more often, and have poorer sleep–wake cycles; require more frequent feedings

• Home care visits by nursing and/or social work staff important for family support after infant discharge


8/23/2017

5

Early Intervention Programs

Early intervention programs benefit neurodevelopment of most premature infants through 3–5 years of age

• Intervention strategy includes group meetings for parents, home visits, and (after 24 months chronological age) attendance at a multidisciplinary child development center

• Many of these children still need special education services to maintain the benefits of early intervention


Neurodevelopmental Outcome

• By school age, the developmental status of preterm children who had birth weights above 1,500 grams is not very different from full-term infants

• Children with birth weights below 1,500 grams have an increased risk for developmental disabilities

• School-age children born very preterm or ELBW are at greater risk of developing executive function deficits (attention-deficit/hyperactivity disorder, learning disabilities, autism)


batshaw ch07 powerpoint [read-only] - napa valley · pdf filetitle: microsoft powerpoint -...

Documents