Transcript Prematurity and the NICU - University of Florida College

Premature Infants & the NICU
Medical & 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
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Lanugo
Absence of fat
Elongated head
Premie Development
 Three stages of premie development

Early premie
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Developing premie
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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
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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
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Low income
Lower education
Minority cultural backgrounds
 Coping strategies

Finding meaning in experience was superior t
other coping methods 18 months postdischarge
Parenting a Premature Infant
 Other family members

Fathers

Grandmothers

Siblings
Parenting a Premature Infant
 Family-focused interventions
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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
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Provide child-rearing advice
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Be link between families and staff

Provide grief counseling, when needed
Role of Pediatric Psychologist
 Participation in follow-up clinics
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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)