Today’s Presenters

Cori Beth Nancy Tina Ginny

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Part C Technical Assistance Consultant

Pediatric Occupational therapist for Fairfax-Falls Church Infant Toddler Connection

Physical Therapist who works with Prince William County’s EI program & at Prince William Hospital specializing in the NICU

Physical Therapist & local system manager from Prince William County

Talks on Tuesdays

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February

Prematurity Webinar Take 2!

12pm-1pm

3“Technical Difficulties”

Purpose

• Provide information about prematurity

• Identify challenges

• Discuss eligibility determination

• Review Impact of prematurity on development

• Share local system experience

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Definitions

Extremely Premature

Very Preterm

Late Preterm

Premature

28 weeks 32 weeks 34-36 weeks 37 weeks

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Prematurity Population

• Approximately 100,000 babies are born in Virginia each year

• 10-12% of these are premature

• 10,000 – 12,000 babies per year

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Child Count Statistics

December 1, 2010 Child Count• 919 children less than age one• 6,341 children birth through age two• 1754 (28%) premature or low birth weight

Annual Count12,145 children received EI services between Dec. 2, 2009 & Dec. 1, 2010

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Issues and Challenges

Found Ineligible

Not Referred

Referred Too Soon

Families Not Ready

Re-referred Later

Not Referred Later

Physicians Stop Referring

Which issues and challenges have you faced?

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EI Prematurity Workgroup

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EI Prematurity Workgroup

Families

Strengthen Communication and Collaboration

Revise Eligibility Criteria | Education of Three Groups

EI Providers

Referral Sources

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EI Prematurity Workgroup Projects

Brochure for Parents

Subgroup for training of EI providers

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Early Intervention Eligibility

• Diagnosed condition with a high probability of resulting in developmental delay

• 25% or greater developmental delay

• Atypical Development

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Additions to List of Diagnosed Conditions

• 28 weeks or less gestational age

• 28 days or more in the NICU

• Periventicular leukomalacia

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Eligibility: Developmental Delay

Adjusting Babies Age For Prematurity

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Inadequate Assessment Tools

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Eligibility: Atypical Development

How do you use the atypical development category in determining eligibility for

premature babies?

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Impact of Prematurity on Development

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Early Sensory Experiences Affect Brain Development

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Tactile System

• Fetus responds to touch 8 to 10 weeks after conception

• First develops in the parts of the body used for exploration

• Most mature sensory system at birth

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Tactile System

• Avoidance reactions predominate in utero

• Approach behaviors predominate in the full term newborn

• Tactile contact associated with greater emotional stability

• Association of tactile information with other senses occurs later in infancy.

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The Vestibular System

• Detects movement, gravity, head position

• One of the first systems to become functional

• Fetus receives strong vestibular input the first 2 trimesters

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Taste and Smell

Importance in Newborn– Recognition of mother– Development of attachment– Stimulates sucking and facilitates feeding

The fetus practices swallowing in utero

Experience primarily related to feeding

Clear taste preferences in newborns

May show preferences/avoidances to some fragrances

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Auditory

• Responds to sound by the 2nd trimester

• Full term neonate able to respond selectively to a variety of sounds.

• Shortly after birth, full term infants show preference for their mother’s voice.

• Excessive noise levels documented in NICU

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The Visual System

• Processing of visual information develops later in the fetus

• Vision is the only system not dependent on external stimulation for development in utero.

• By 32 weeks infants attracted to reddish objects

• Full term neonates have sophisticated visual processing abilities

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The Visual System

Preterm infants have a higher incidence of• Myopia (blurred distance vision)• Strabismus (abnormal alignment of one or both eyes)• Visual- perceptual and fine motor delays

Exposure to direct light may negatively effect the development of vision and other neurosensory systems

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What is this infant experiencing?

Think about ways this infant’s world now differs from his life in the womb.

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Synactive Theory of Infant DevelopmentHeidelise Als

Hierarchical interaction and interdependency of five subsystems

Self -

Regulation

Attention / Interactive

Behavioral State Organization

Motor Organization

Physiological Stability

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Signs of Stability (Self Regulation/Approach)

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Irritability

Gaze aversion

Hyper alertness with a staring and wide open eyes

Roving eye movements

Glassy-eyed appearance

Sleeplessness and restlessness

Behavioral

Signs An Infant Is Not Ready For Interaction

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Signs An Infant Is Not Ready For Interaction

Sudden change in toneFlaccidityStiffness

“sitting on air” Arching

Finger splayingGrimacing/frowning

JitterinessFrantic movements

Motor Signs

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Color changesBlueness around the mouthSkin mottlingChange in respiratory rate or rhythmChange in heart rateCoughingSneezingYawningVomitingBowel MovementHiccups

Physiological

Signs An Infant Is Not Ready For Interaction

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Question

How have you used and infant’s motor, behavioral, and physiological signs of

stability and stress to guide intervention?

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Motor Development

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Hypotonia

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Atypical Patterns

The premature infant does not achieve the full amount of flexor tone seen in the full term infant. 35

Atypical Patterns

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Additional Signs of Pathology in Motor Development

• Stiff legs or arms with little or no movement

• Difficulty lifting head

• Arching of neck and trunk when on their back

• Asymmetries

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What motor patterns do you observe in this infant born at 23 weeks GA (chronological age 16 mos., adjusted age 12 mos.)?

What Do You See?

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What do you see in this position?

What Do You See?

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Asymmetry

Additional Factors to Consider when Determining Eligibility 40

Additional Factors to Consider when Determining Eligibility

Sensory Processing

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Additional Factors to Consider in Determining Eligibility

Feeding

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Prince William Experience

Typical “for preemie” vs. atypical

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Prince William Experience

40% increase in birth to one child count

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Thank You!

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