Neonatal Course: Advancing Prematurity Care

Neuroprotective feeding practices in the NICU  

• Advocacy and education  
• Family-centered care  

Comprehensive Evaluation of Feeding and Swallowing  

• Clinical bedside evaluation...chart review, identifying high-risk Infants...pre-feeding assessment, breast/bottle trials, collaboration with team  

• Instrumental assessment...indications and timing, MBSS, FEES, interpreting results, developing feeding plan with medical team and family  

Individualized Feeding Plan  

• Family-centered  
• Pre-feeding stimulation and therapeutic feeds  
• Breastfeeding  
• Bottle feeding  
• Practice challenges  
• Discharge planning case studies  
• Success stories...challenges  

Challenges and Requirements 

• Uncover the unique challenges of breastfeeding premature infants. 
• Explore the impact of gestational age, medical conditions, and nutritional needs. 

Skin-to-Skin Contact and Early Initiation 

• Emphasize the importance of skin-to-skin contact and early breastfeeding initiation in the NICU. 
• Delve into best practices for facilitating these vital bonding experiences. 

Expressing, Collecting, and Storing Breast Milk 

• Explore methods and technologies for efficient milk management. 
• Ensure safe handling, expressing, collecting, and storing of breast milk for premature infants. 

Interdisciplinary Collaboration 

• Recognize the significance of interdisciplinary collaboration in creating a supportive breastfeeding environment in the NICU. 

Assessment and Adjustment 

• Utilize appropriate assessment tools to monitor feeding progress and nutritional needs of premature infants. 
• Make necessary adjustments to the breastfeeding plan for optimal care. 

Empowering Parents for Home Care 

• Equip parents with the knowledge and skills needed to continue breastfeeding and provide care for their premature infants at home after NICU discharge.

Primary Principles of Neonatal Pain 

• Regardless of past assumptions, neonates feel pain. 
• Assessment of severity and the effects of analgesia can be measured in the neonate. 
• Neonatal morbidity may be increased by prolonged or severe pain. 

Pain Measurement in Neonates 

• Reliable and validated pain scales. 
• How do we measure pain in a neonate 
• Physiologic measurements (vital signs, clinical signs, serum samples) 
• Behavioral measurements 

Developmental Consequences of Pain 

• Physiologic development 
• Anatomic Development 
• Neurodevelopment 

Pharmacologic Regimens for Pain 

• Choosing effective and safe analgesics 
• Drug doses appropriate for age and gestation 
• Known Pharmacokinetics 

• Known Pharmacodynamics 

Non-Pharmacological Treatment for Pain  

• Avoiding or minimizing painful or stressful procedures 
• Swaddling during procedures or stressful events 
• Skin to Skin 
• Nonnutritive sucking 
• Oral Sucrose 

Effectiveness of Pain Management 

• Reassess pain 
• Document the effectiveness of pain relief 

Neonatal Withdrawal 

• Neonatal opioid withdrawal syndrome (NOWS) 
• Neonatal abstinence syndrome (NAS) 

Education Component for Providers and Families  

• Written guidelines and protocols for the management of pain in neonates 
• Healthcare providers have the responsibility to identify, prevent, and manage pain in neonates. 
• Sedation is not a pain relief and could mask the ability to respond to painful stimuli. 

Limitations of the Research and Potential Risks 

• Limited studies on pain management in neonates 
• Barriers related to multiple reasons (fear of use, misconceptions of pain in a neonate, long-term effects of analgesic use, etc.) 

Interprofessional Collaboration   

• Review current standards for levels of neonatal care   
• Identify Interprofessional NICU team members   
• NICU physical design layouts and environmental considerations  

Effective Communication   

• The art of shared decision-making   
• Achieving health equity  
• Unmasking implicit bias   
• Strategies and approaches for effective communication 

Supporting Families   

• Building and maintaining relationships   
• Resiliency skills: Equipping families 
• Empowering families: Enabling self-management   
• Best practices for guiding families 

Sucking Reflex 

• Begins in utero 
• After birth at term...coordinated suck-swallow-breathe reflex 
• Interruption in sequence in premature birth 
• Reflexes and movement patterns...influenced by environmental, physiological, neurological, and behavioral factors. 

Posture and Mobility 

• Affects feeding patterns and impact a baby's posture and mobility 
• Function of the mouth and body are inextricably linked 
• Understanding this connection and avoid treating either aspect in isolation 

Neonatal Movement Patterns 

• Foundation in the development of the baby's oral motor skills 
• Subsequent feeding progression and feeding journey beyond the NICU 
• Best practices in caring for premature infants include intentional touch and handling 
• Optimal base for oral motor and respiratory patterns 
• Functional movement patterns and positioning for optimal development 

Guideline Comparison  

• Dive into the neonatal nutrition guidelines.  
• Spotlight differences in practices and resources.  
• Analyze current products with guideline recommendations.  

Micronutrient Insights  

• Understand the role of each micronutrient.  
• Identify the risk of deficiency and toxicity.  
• Navigate dosing challenges and monitoring limitations.  

Preterm Neonates: Dosing and Products  

• Explore the latest research on dosing in preterm neonates.  
• Uncover product limitations and applications.  
• Apply knowledge to patient case scenarios.  

Patient Case Scenarios  

• Assess for deficiency and toxicity.  
• Evaluate lab data and create monitoring plans.  
• Tackle shortage management for complex cases.  

Electrolyte Disturbances  

• Focus on intrauterine growth restriction.  
• Spotlight recent product shortages and challenges.  
• Tackle issues with multivitamins, calcium gluconate, and cysteine. 

Hypoxic Ischemic Encephalopathy (HIE) 

• Definition of HIE and its prevalence in full-term newborns 
• Pathophysiology of HIE, including the cascade of adverse biochemical events 
• Evolving nature of HIE and the progression to irreversible neuronal injury 

Different Causes of Neonatal Encephalopathy

• Risk factors and potential causes leading to neonatal encephalopathy 
• Identification of prenatal, intrapartum, and postnatal factors contributing to HIE 
• Importance of recognizing and addressing these causes promptly 

Management Approach for HIE

• Early recognition and assessment of HIE in newborns 
• Immediate and ongoing medical interventions to mitigate hypoxic-ischemic injury 
• Therapeutic hypothermia and other emerging treatments for HIE management 
• Interdisciplinary approach involving obstetricians, neonatologists, and other healthcare professionals 

Potential Outcomes of HIE

• Long-term consequences of HIE on neurodevelopment 
• Impact on cerebral palsy, mental retardation, learning disabilities, and epilepsy 
• Strategies for early intervention and rehabilitation to improve outcomes 

Consideration of family support and counseling in the context of potential outcomes 

The Neonatal Seizure Landscape...Pathophysiology and Clinical Manifestations of Seizures 

• Common conditions associated with neonatal seizures 
• Differentiating abnormal movements and seizures...a crucial skill for early diagnosis 

Path to Diagnosis 

• Conventional electroencephalogram for diagnosis and continued monitoring 
• Amplitude-integrated electroencephalogram for screening and diagnosis 
• Advanced imaging to aid in the determination of cause and assessment of injury 

Easing the Seizure Burden...Treatment Approaches 

• Common medications used to treat seizures in the neonatal population 
• Strategies for mitigating effects of neonatal seizures on long-term outcomes 
• Limitation of current evidence and potential risks