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Premature Infants & the NICUMedical & Psychological Issues
November 13, 2007
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Description
250,000 newborn infants admitted to NICU’s annually in US
Most are born premature, at low birth weight, or both
Premature infant = born prior to 37th week of gestation
Low birth weight = less than 5.5 pounds
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Description
Majority of Infants born as early as 25 weeks gestation survive
5-7% of North American infants are born prematurely
Most are hospitalized until approx. their due date
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Causes of Prematurity Social, biological, &
environmental factors
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Causes of Prematurity
Prenatal care, no drugs, & healthy diet reduce chances
Most premature births occur in middle-class women
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The Premature Infant
Immature organ development Difficulties adapting to the extrauterine
environment Physical appearance
Lanugo Absence of fat Elongated head
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Premie Development
Three stages of premie development Early premie
Developing premie
Older premie
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Impact of NICU
Lack of patterning to stimulation Infants can learn to “tune out” stimuli
Social signals may receive no response Fail to learn effective ways of eliciting
responses from caregivers Social signaling may be diminished or
extinguished through lack of response
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Positive Changes in the NICU
Minimize unneccesary contact Relocate or quiet noisy equipment Shield infants’ isolettes from light Provide day-night cycles in terms of light &
activity Supply pleasant visual and auditory
stimulation Provide gentle touch
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Transition to Home
Anxiety about assuming full responsibility of care for the infant
Infant may be less than optimally responsive & still may be medically fragile Infant irritability Parent fatigue Parent concern for infant’s developmental
progress
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Prematurity & Later Development
Growth & health
Cognitive development
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Prematurity & Later Development
Socio-emotional & behavioral development Temperament
Bonding & attachment
Behavior problems
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Parenting a Premature Infant
Social risk factors Low income Lower education Minority cultural backgrounds
Coping strategies Finding meaning in experience was superior t
other coping methods 18 months post-discharge
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Parenting a Premature Infant
Other family members Fathers
Grandmothers
Siblings
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Parenting a Premature Infant
Family-focused interventions Support groups Teach parents to care & stimulate child Provide intervention beyond NICU stay
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Role of Pediatric Psychologist Support & services provide to family
Devote attention to PARENT needs
Organize parent support groups
Provide child-rearing advice
Be link between families and staff
Provide grief counseling, when needed
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Role of Pediatric Psychologist
Participation in follow-up clinics Assess developmental status of child Refer for early intervention services Design IFSP, when warranted Address parenting & family concerns (e.g.,
maternal depression, marital conflict, sibling adjustment)