This week I received a photo of one of our NICU grads on his way to his first day in daycare.  It was a big day for the whole family.  For many of our graduates, the first day of "school" is a long-time coming.  For those of you who do not know this, many premature infants (and some term ones too) have long-term respiratory issues.  This makes them more susceptible to all kinds of respiratory illnesses.  For this reason (and others), it is usually recommended that NICU infants not be exposed to large crowds, sick people, small children, or daycare centers until their systems are more mature.

Why are they more susceptible?  Scientists and researchers have been asking that for years.  They also want to find out just how long this increased susceptibility lasts.  One study found that premature infants (30-34 weeks) had decreased lung capacity up to two years after birth compared to term infants and that premature infants' lung growth does not "catch-up" (Friedrich, et al., 2007).  A 2010 study on infants born at 25 weeks or less found:
"At 11 years of age, 56% of children born before 25⁺⁶ weeks of gestation had abnormal baseline spirometry,27% had a positive bronchodilator response, and 25% had a diagnosis of asthma (twice that observed in classmates). Among the 65% of extremely preterm children who had been asymptomatic over the previous 12 months, 48% had abnormal baseline spirometry, of whom 81% had prior bronchopulmonary dysplasia, emphasizing the need for continued monitoring of these children" (Fawke, et al., 2010).

This means that parents of preemies need to be vigilant about infection control (such as handwashing and exposure to others) and monitoring of their baby's respiratory status.  Immunizations and RSV prophylaxis (for those that qualify) are important things to discuss with your pediatrician.  

Little is known about more recent NICU grads' long-term respiratory function.  As Fawke, et al. (2010) pointed out, recent graduates are typically more immature, but have been exposed to "less agressive ventilatory support". 
We have come a long way in neonatology practice and we still have more to learn.  It is hoped that in years to come these statistics will be very different.....we'll have to watch and see.

Julie Hudson, MSN, RN
NCBH NICU

References

Fawke, J., Lum, S. Kirkby, J. Hennessy, E., Marlow, N., Rowell, V., Thomas, S. and Stocks, J. (2010).  Lung function and respiratory symptoms at 11 years in children born extremely premature:  The EPICure program.  American Journal of Respiratory and Critical Care Medicine, 182, 237-245.

Friedrich, L., Pitrez, P.M., Stein, R.T., Goldani, M., Tepper, R. and Jones, M.H.  Growth rate of lung function in healthy preterm infants.  American Journal of Respiratory and Critical Care Medicine, 176, 1269-1273.

We get many admissions to the hospital during the holiday season due to safety pitfalls.  The toddler’s environment at home may be safe and child-proofed, but what is the environment like when he/she visits Grandma or Aunt Sue?  The following are a few types of cases I can remember off the top of my head:

·        Young children taking older relative’s medicines

Many older relatives have their meds in baggies, or easy to open pill dispensers.  The meds may be in a purse, in the refrigerator, or dropped on the floor.  If a little one gets a hold of a strong heart medication, pain pill, or even certain kinds of vitamins, it can lead to tragic results.

·        Young children staying at homes that are not child-proofed 

When I worked in Arizona, we had so many cases of grandchildren drowning during visits.  The families would all say the same thing, “I only turned my back for a minute…”or, “We never thought he could open the door…”

·        Not using Sudden Infant Death precautions when traveling

I have seen where parents or grandparents make an “infant bed” by putting the baby in the middle of an adult bed and place pillows around the baby so she/he does not roll off.  Not every single baby will die if placed in that kind of environment, only a certain percentage will.  Are you willing to take that chance?  Invest in a portable crib like a Pack-n-Play and use it at home from time to time so your baby will be accustomed to it when you travel.

·        New environments causing new triggers for your child’s asthma

Smoke scented sofas, dusty old pillows/bedding, new cats/dogs, or even different regional trees/pollen may cause an asthma attack.  Keeping your child well controlled with their prescribed asthma controller medications is a big part of avoiding an asthma attack.  Bring and follow the doctor’s asthma action plan for your child.  Don’t forget to bring the asthma emergency medication and spacer with you on the trip.

When you think about it, how long did it take you to child-proof your home?  So, when you visit this holiday, take some time to secure your child’s environment.

I wish you and your family a safe and peaceful holiday season,

Cindy, RN

What is an Action Asthma Plan?

It is a plan drawn up by your child’s doctor to guide caretakers on how to manage your child’s asthma when you leave the hospital.  There are many different Asthma Action Plan sheets out there for families.  Many times, your doctor may prefer using his/her own Asthma Action Plan sheet to communicate specific actions that need to be followed for asthma management at home.

Are all Asthma Action Plans the same?

No, each child may have different medications, with different strengths, given at different times to manage their asthma.  The same child may even have their Asthma Action Plan changed as their condition changes (alterations will only be done by a doctor).

Although the plans are different, they have similar goals:

• Have one document to inform all caretakers (family, babysitters, school nurse, etc.) of the Asthma Action Plan
• Use an easy to follow sheet to guide caretakers on everyday, when child is starting symptoms, and bad asthma attack management.  (Many have a green, yellow, and red zone sheet to make it simple to follow)

How do I get my child an Asthma Action Plan?

• Call the doctor who manages your child’s asthma flare-ups.
• If your child is admitted to the hospital for asthma, be sure an Asthma Action Plan is provided before discharging home.
• Be sure to take the Asthma Action Plan to your child’s asthma doctor’s next visit so it can be adjusted or continued as needed.

To see an example of an Asthma Action Plan, go to the following link:

http://www.texasasthma.org/attachments/wysiwyg/539/AAPEnglishFinalelectronic-2.pdf

Please note:  This form is only valid if signed by your child’s doctor.

Take Care,
Cindy, RN

The new registration for the North Central Baptist Hospital pediatric asthma classes (Pedi Puffers) is 210 297-4080.  This number will connect you to the nursing station on the pediatric floor.  Staff will register you in the Pedi Puffer Asthma Class Notebook.  Please register each family member for the class your family will attend.  If you cannot attend, please call the nursing station to cancel so others may attend in your place.

Class Days:  Mondays-Wednesdays-Fridays-Saturdays

Class Time:  5:30 PM

Class Duration:  1 to 1.5 hours

Location:  2^nd floor Pediatric Playroom (cafeteria side of the hospital)

*  Please Note:  We allow older asthmatic children (must be cleared by hospital staff ) to attend this adult based class if they are not infectious and are able to sit still during instruction.  Other arrangements will need to be made for young children, as they will not be able to attend this group asthma class with you.  Don’t forget to ask about our Dusty’s Funbook for your younger asthmatic children.  It is a booklet that teaches about their asthma through coloring and puzzles.  What a perfect activity to do while you are in class!

Take Care, 
Cindy, RN