Premature Infants & the NICUMedical & Psychological Issues

November 13, 2007

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

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

Causes of Prematurity Social, biological, &

environmental factors

Causes of Prematurity

Prenatal care, no drugs, & healthy diet reduce chances

Most premature births occur in middle-class women

The Premature Infant

Immature organ development Difficulties adapting to the extrauterine

environment Physical appearance

Lanugo Absence of fat Elongated head

Premie Development

Three stages of premie development Early premie

Developing premie

Older premie

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

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

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

Prematurity & Later Development

Growth & health

Cognitive development

Prematurity & Later Development

Socio-emotional & behavioral development Temperament

Bonding & attachment

Behavior problems

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

Parenting a Premature Infant

Other family members Fathers

Grandmothers

Siblings

Parenting a Premature Infant

Family-focused interventions Support groups Teach parents to care & stimulate child Provide intervention beyond NICU stay

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

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)