Infant and NICU feeding assignment S24
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School
Texas A&M University, Kingsville *
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Course
STAT 5350
Subject
Medicine
Date
Apr 3, 2024
Type
pptx
Pages
10
Uploaded by MagistrateOctopusMaster1028
Infant and NICU Assignment
Review the following videos/slides and answer the questions associated in your own version of this PPT or a separate document
Case 1 Kaleb
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Kaleb is a former preemie (now 41 weeks GA in the NICU) who experienced a grade III Interventricular hemorrhage and has a VP shunt. Kaleb is an infant was born at 26 weeks gestation. He also had an instance of NEC for which a small section of his bowel was resected. He now has a diagnosis of gastrointestinal adhesions and strictures as a result of his NEC. In addition, he has a small ASD (cardiac diagnosis) which his team is planning to repair at a later time, but are monitoring him closely from a cardiac perspective. He was intubated for 7 weeks until 33 weeks gestational age (orally intubated). He then transitioned to CPAP until 35 weeks gestational age. He transitioned to high flow nasal cannula and remained on high flow NC from 35 until 37 weeks. •
At 39 weeks gestation he transitioned to 2 L Oxygen via a “regular” nasal cannula and still remains on this. He currently has an NG in place, but previously had an OG in place until 35 weeks gestational age.
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He is currently 41 weeks gestational age and is working advancing his oral feeding skills and readiness while still admitted in the NICU.
Kaleb First Question:
1 ) Medical comorbidities: 10 points
Review Kaleb’s medical history and interventions discuss any co occurring medical conditions and their potential impact on Kaleb’s feeding and swallowing abilities, currently AND in the future. Also discuss how any of the medical interventions he received have the potential to influence his feeding and swallowing abilities (both now and in the future). You may need to look up some medical conditions and that is ok (just use reputable sources, your text NIH, published research etc.) Integrate that information into your answer while considering GA, when SSB coordination emerges and Kaleb’s developmental and medical course of treatment to date.
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Kaleb
Pre-Feeding Description:
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You are consulted as SLP to determine if Kaleb is ready to trial oral feeding, below is a description of what you see upon arrival to Kaleb’s room in the NICU:
Upon arrival to the NICU you notice Kaleb is receiving care (diaper change, etc) from his mother and is tolerating that well. She is able to pick up Kaleb from his crib, hold him in the rocking chair. He is alert, awake, calm, and his vitals remain stable, he is comfortable and does not show stress cues. Mom holds him in a traditional cradle style in her arms and offers him a pacifier. You notice he roots, opens his mouth and latches. He exhibits NNS on the pacifier, in suck bursts of 3-7 before a pause and is able to maintain the pacifier in his oral cavity. His color is pink (no change from baseline) and his vital signs remain stable. He soothes to the pacifier. The mom then dips the pacifier in breastmilk, and you notice he is engaged ,interested and remains stable (nothing changes in terms of his color, his engagement and his vitals). He continues to demonstrate a strong and engaged nonnutritive sucking pattern. He is able to maintain the pacifier in his oral cavity.
Kaleb Second Question
2) Prefeeding Assessment: 15 points
Discuss the skills described in pre-feeding and let me know if you feel Kaleb is appropriate to attempt oral feeding (reference SOFFI, support your answers in the pre-feeding description provided):
--If YES, please discuss considerations for your initial thoughts for what positioning, flow rate, and the environment would follow best practice and support his success (assume family’s goal is to bottle feed and assess slides, text and SOFFI resources)
Michelle
Case 2
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Michelle
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Michelle is a 37 week infant who is “feeding and growing” in the NICU. She has no medical comorbidities and has had an uncomplicated NICU course of stay after being born at 34 weeks. She is on room air and you are consulted because she is having Apnea and bradycardia with feeding.
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Upon arrival to her room, she is being fed by her mother. You notice mom is using an Enfamil standard flow nipple and she is being held in a cradled position (traditional football hold). When you visually look at Michelle you see she looks a bit pale as the feeding progresses. She is squirming, wiggling and arching. Her O2 monitor then registers a dip in O2 level from 97 to 86.
Michelle Question #4
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What red flags or concerns do you see during her oral feeding? 10 points
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Think about synactive theory of development and link it to clinical findings…
Michelle- Question #3
3) Feeding Interventions : 15 points
What interventions should you consider to support Michelle’s success in this scenario based on what is described (link areas of concern to evidence based interventions)? Please also explain to me (as you would a parent) how these interventions have the potential to support feeding success for Michelle (both currently and set her up for success in the future):
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Open Ended Question •
Discuss the concept of synacitve theory, cue based, responsive feeding, and what the important of these practices Is in the discussion of neuroprotective care in the NICU (10 points)