Late preterm and dev care 2009

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The late preterm infant group is at risk of being forgotten!

The late preterm infant group is at risk of being forgotten!

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  • 1. Developmentally Supportive Care and the Late Preterm Infant
    • Michele Prentice
    • Developmental and Family-centred Care Project Officer
    • Neonatology Services
    • Mater Mothers’ Hospitals
    • Brisbane
    • 2009
  • 2. The Late Preterm Infant
    • Definition
    • Review of the literature
    • Brain development and early life experience
    • Developmental care
    • Behavioural cues
    • Positioning
    • Implications for practice
  • 3.  
  • 4. The Late Preterm Infant (continued)
    • Definition (replaces “Near Term Infant”):
    • Infants born between
    • 34 and
    • 36 weeks + 6 days.
    • (others may use 32-34 wks)
    • Reference: American National Institute of Child Health and Human Development. 2003
  • 5. Literature Review
    • Merriman, 2009 “Serious neurological risks”
    • Petrini et al, 2009 “Increased Risk of Adverse Neurological Development”
    • Chyi et al, 2008 - 140,000 babies [USA; 2000 – 2004] ....
    • ↑ x 3 times cerebral palsy if preterm
    • ↑ developmental delay
    • ↑ mental retardation .... Therefore ....
    • “ delivery less than 39 weeks not desirable”
    • Hubbard et al, 2007 “A little baby with big needs”
    • Stellwagen, 2007 “...may look like a full-term baby”
    • Levitt, 2006 “Early events affect growing brains”
    • (interview: www.developingchild.net)
    • Hawley et al, 2000 “Starting Smart” (Zero to Three)
  • 6. Brain Development & Early Experiences...
    • Brain function altered...
    • Neurochemistry changes -> -> -> ->
    • Brain structure altered... “building” & “pruning”
    • -> -> -> Architecture -> -> ->
    • PERMANENT CHANGES in STRUCTURE AND FUNCTION
    • Early touch, pain, hearing, muscle tone, motor function, stress reactivity and competence
  • 7. Risks
    • Hyperbilirubinaemia
    • Hypoglycaemia
    • Hypothermia
    • Immature self-regulation
    • Sepsis
    • Airway instability
    • Apnoea and bradycardia
    • Respiratory distress
    • Excessive sleepiness
    • Excessive weight loss
    • Feeding intolerance
    • Weak sucking
  • 8. Cue Based Care: What is it?
    • To follow the principles of Developmental Care it is important to grasp an understanding of what state a baby is in and the optimal times to interact with them, which leads to a need to understand their behaviour cues. These are their way of communicating.
  • 9. Cue Based Care: How do we understand Behaviour Cues?
    • Behaviour cues are...
    • the signs and signals given to us by babies
    • They are their way of communicating
    • ... when they are calm,
    • ...when they need time out and
    • ...when they are ready to interact.
  • 10. Understanding Behaviour Cues Summarised:
    • A calm baby will show signs such as: - puts hand to mouth - curls up - will grasp & hold a finger or toy - will bring hands together - will softly close eyes
  • 11. Understanding Behaviour Cues: Cues for a Calm Baby *pictures used with permission of the author, Developmental Care Plan, Royal Women’s Hospital Melbourne.
  • 12. Understanding Behaviour Cues Summarised:
    • A baby that needs time out shows: Motor signs - splays fingers - has a stiff arching posture - is flailing and disorganised - the sitting on air sign (arms & legs in air)
    • Autonomic sign - Yawning
    • Attention / Interaction signs - turns away / looks away - Hyper alert (staring wide eyed) Other Signs - crying - fluctuating heart rate - oxygen desaturation - colour changes - closes eyes
  • 13. Understanding Behaviour Cues: Cues a baby needs time out *pictures used with permission of the author, Developmental Care Plan, Royal Women’s Hospital Melbourne.
  • 14. Understanding Behaviour Cues Summarised:
    • A baby is ready to engage when it: - is smiling - has a relaxed posture and face - is cooing / babbling - is making eye contact
  • 15. Understanding Behaviour Cues: Cues a baby is ready to Engage *pictures used with permission of the author, Developmental Care Plan, Royal Women’s Hospital Melbourne.
  • 16. SIDS
    • the prevention campaign:
    • 1) put baby on back to sleep from birth
    • 2) sleep baby with face uncovered
    • 3) cigarette smoke is bad for baby
    • 4) safe sleeping environment for baby, night & day: safe cot, safe mattress, safe bedding
    • Why?
    • Since the SIDS and Kids Safe Sleeping Campaigns began in the early 1990's...
    • >4,000 Australian babies saved
    • reduced the rate of SIDS by 84%.
    • www.sidsandkids.org
  • 17. Infant Positioning *pictures used with permission of the author, Developmental Care Plan, Royal Women’s Hospital Melbourne.
  • 18. Infant Positioning when awake:
    • Prone (“tummy time”):
      • Clean, flat surface (pad on floor)
      • No sharp angles (furniture) nearby
      • Pillows NOT recommended
    • Side Lying:
      • put a pillow at the baby’s back only
      • to support position
      • to encourage hands in view
    • Supine (back):
      • Create a nest using a rolled blanket and ensure it remains close to the baby’s body and under legs
  • 19.
    • Key points...
    • Supervision of infant is MANDATORY
    • Flexed and curled up positions are encouraged as these reflect the environment of the womb
    • Ensure:
      • - shoulders forward
      • - hands towards midline in supine & side lying
      • - hips and knees tucked
      • - alternate positioning of head side-to-side
      • when asleep (supine)
  • 20. LPI’s are special!
    • Essentially a preterm infant in a term infant’s body
    • ↓↓↓
    • Poor immunity
    • Poor feeding
    • Parents unprepared, stressed
    • Delayed discharge home or...
    • difficulty with normal care at home
  • 21. IMPLICATIONS FOR PRACTICE
    • Midwives
    • Neonatal Nurses
    • Parents
    • Multidisciplinary Team
    • GP Practice/ Community Health agencies
    • Follow Up? (Service provision is poor)
    • Early Intervention Services?
  • 22. The Late Preterm Infant
    • POOR OUTCOMES
    • MISS OUT ON SERVICES
    • PROBLEMS AT SCHOOL AGE
    • FUTURE DIRECTION OF RESOURCE ALLOCATION AND FUNDING ?
  • 23.