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Risk Factors For Cerebral Palsy Related To Prematurity

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Question:

How might her time in the NICU and the specific complications she had affect her outcome today? If you had seen Ryleigh for physical therapy when she was in the NICU, what would have been the focus of your treatment?

 

Answer:

Ryleigh is a 3-year-old female child who was born at 26 weeks of gestation. The normal time of a child birth is after 37 weeks of birth. Therefore, Ryleigh was born 11 weeks before her full maturation. At 26 weeks the maturation of a child is completed. Most of the brain development remains incomplete in the case of a premature baby born at this age. At this age of birth, Ryleigh might have breathing problem for having the premature lung. Difficulty in breathing is known as respiratory distress syndrome (RDS) (American Pregnancy Association, 2012). Ryleigh was having breathing difficulties as her lung development was not completed, so she was also likely to have Bronchopulmonary dysplasia. Ryleigh is likely to have brain related complications as she was born at the stage when the size of the brain triples, during the third trimester. Ryleigh was diagnosed to have Retinopathy of prematurity or ROP, and she was likely to have this disorder as by four months of pregnancy the fetus's retina begins to develop vascularization. During the development, the blood vessels tend to grow outward from the central part of the retina, and it becomes completed few weeks before birth, but in Rayleigh's case, the process of blood vessel's growth was incomplete (Carter, 2016). She was also diagnosed with failure to thrive; it is because she was born at 11 weeks before her birth time. In premature infants another disorder is sometimes seen, that is Necrotizing Enterocolitis (NEC), which is the necrosis of bowel in the gastrointestinal tract, thereby damaging tissues in the intestine. It is likely to happen to Raleigh as she was having a breathing difficulty, which led to insufficient oxygen supply to the intestine, thereby making the environment feasible for bacteria to infect and damage tissue. However, Ryleigh was also diagnosed with upper respiratory tract infection soon after her birth (Carter, 2016). During her development after birth, she was diagnosed to have cerebral palsy; it is because she had difficulty during her birth. Her brain was not fully developed during her birth; therefore, during birth the brain damage is significant. The brain damage led to the damage to the motor nerves and thereby causing physical impairment of Ryleigh. It affected her body movement and muscle coordination.

Ryleigh was born at 26 weeks of gestation, thus, she was 11 weeks premature baby and was diagnosed with several difficulties at and after her birth. Therefore, she was transferred to NICU, and her difficulties were assisted by the health care professionals in the Neonatal unit. The neonatal department provided developmentally supportive humanized care to Ryleigh. In the developmental stage, Ryleigh was the case of having breathing difficulty and oxygen deficiency, which was creating other complications. The incomplete brain development of Ryleigh led to the cerebral palsy. During her NICU stay she also faced intraventricular hemorrhage, it leads to bleeding in the brain and causes due to the immature blood vessel's intolerance of changes in circulation after birth. It is the most prominent cause of her health outcome, cerebral palsy. The bleeding in the brain led to the damage of motor neurons, thereby causing physical impairment of Ryleigh (Harrison, 2016). It is the major reason Ryleigh is facing movement problem and needs a wheelchair. Spastic cerebral palsy is the reason for which Ryleigh feels trouble to clear her arm to prop in prone, and her hand fisted while pushing up onto forearms and extending arms. Due to the affected motor nerves and muscle injury Ryleigh can stand with her arms while remaining her knees in extension. She is also unable to shift her weight for cruising along the furniture. The reason is mainly the difficulty in transmitting essential impulses from brain to the muscle to coordinate movement, due to the undeveloped and early neurological difficulties. That is the source of the disorder is related to the level of brain functioning (Chaudhari, 2011). The effect adversely affects the muscles and physical movements because the neurological injury is happened during the developmental phase of the motor system. Due to the incomplete development of brain and motor nervous system, all other complications were developed which Ryleigh is facing in recent days.

Ryleigh was brought to the NICU after she was born in a premature stage at 26 weeks of gestation. Therefore, being a neonatal physician the priority after examining her would be the physical examination of the developmental stage of the brain and other organs and after that undertaking precaution against the manifestation of the damages due to the premature birth and incompletely developed brain functioning (Cerebral Palsy Daily Living, 2011). During the physical examination, the reason for the neurological injury would be prioritized for identifying the possible manifestation of cerebral palsy and other complications of Ryleigh.

 

Reference List

American Pregnancy Association,. (2012). Premature Birth Complications. Retrieved 29 January 2016, from https://americanpregnancy.org/labor-and-birth/premature-birth-complications/

Buccino, G., Arisi, D., Gough, P., Aprile, D., Ferri, C., Serotti, L., ... & Fazzi, E. (2012). Improving upper limb motor functions through action observation treatment: a pilot study in children with cerebral palsy. Developmental Medicine & Child Neurology, 54(9), 822-828.

Cerebral Palsy Daily Living,. (2011). The NICU & Beyond. Retrieved 29 January 2016, from https://cpdailyliving.com/the-nicu/

Chaudhari, S. (2011). Neonatal Intensive Care Practices Harmful To The Developing Brain. Harmful Neonatal Intensive Care Practices, 48. Retrieved from https://medind.nic.in/ibv/t11/i6/ibvt11i6p437.pdf

Harrison, H. (2016). Risk Factors for Cerebral Palsy Related to Prematurity. Prematurity.org. Retrieved 29 January 2016, from https://www.prematurity.org/research/helen-brainscans.html

L. Carter, S. (2016). Motor Impairment and Cerebral Palsy in Preemies. Childrensdisabilities.info. Retrieved 29 January 2016, from https://www.childrensdisabilities.info/cerebral_palsy/cerebralpalsy.html

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