Infant Growth and Development Flashcards

1
Q

intra-uterine growth

A

embryonic and fetal
growth (assessed by birthweight)

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2
Q

gestational age

A

Post-menstrual age
* ie. number of weeks + days since 1st day of last menstrual period

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3
Q

What is full-term?

A

38-42 weeks post-menstrual age

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4
Q

What is considered pre-term?

A

<37 weeks

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5
Q

What is considered low birthweight?

A

<2500 g at delivery

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6
Q

How is newborn growth assessed?

A

Measurements of length, weight, head circumference are done at delivery and assessed using growth charts
* Throughout pregnancy women is measured for size and then compared to infant measurements → provides information about patterns of intra- uterine growth

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7
Q

When do adaptations happen which effect a newborn?

A

Adaptations occur in-utero to adverse circumstances
* increase short-term survival
* permanent alterations in structure or function occur during “critical periods” of development

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8
Q

What are the patterns for intra-uterine growth?

A
  • Small for gestational age (SGA): Weight for age <10th percentile
  • Appropriate for gestational age (AGA): Weight for age 10-90th percentile
  • Large for gestational age (LGA): Weight for age >90th percentile
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9
Q

What is the birthweight classification used for?

A

Method of describing the likelihood of adverse outcomes
* type of problem depends on birthweight classification and etiology (cause)

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10
Q

Factors affecting etiology of SGA

A
  • infant factors
  • placental factors
  • maternal factors
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11
Q

Infant factors affecting etiology of SGA?

A
  • congenital anomalies
  • genetic conditions
  • congenital infections
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12
Q

placental factors affecting etiology of SGA

A
  • small placenta
  • inadequate placental blood flow
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13
Q

maternal factors affecting etiology od SGA?

A

(“environmental”)
* smoking
* alcohol
* drugs
* undernutrition

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14
Q

Risks associated with SGA

A
  • hypoglycemia → not getting enough glucose outside of the uterus
  • inability to maintain temperature, if fat not laid down
  • ↓ immune competence
  • (neurologic & behavioral problems) → multi-factorial
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15
Q

what are long term risks of SGA related to?

A

Typically in utero adaptations

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16
Q

infant factors effecting etiology of LGA

A

genetics

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17
Q

Maternal factors affecting etiology of LGA

A

uncontrolled/poorly controlled diabetes
* Many LGA babies not at ↑ risk, but infant of a diabetic mother (IDM) is at ↑ risk

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18
Q

Risks associated with all LGA

A

birth injury both the mom and baby

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19
Q

Risks associated with IDM with LGA

A
  • hypoglycemia
  • hypocalcemia
  • respiratory, cardiac problems, congenital malformation (3-4 x risk)
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20
Q

What is IDM

A

Infants of Diabetic Mothers

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21
Q

How do growth charts work?

A

Variability at given age defined by percentiles which is proportion of population found below a specific value
* Age along x-axis; anthropometric (weight, length, head circumference) measure on y-axis
* Also weight for length: length x-axis; weight measure on y-axis

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22
Q

What is the expected pattern along the growth chart for an infant?

A

Maintenance of growth along “own” percentile
* Birthweight reflects prenatal growth factors, postnatal growth dependent on different factors including genetic potential
* Crossing percentiles between 0 and 24 months not uncommon

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23
Q

When is it important to do a follow up in an infants growth pattern?

A
  • flat growth line
  • sharp increase or decrease
  • below 3rd percentile
  • above 97th percentile weight for length
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24
Q

What are important considerations considering growth patterns?

A

Consider birthweight, previous growth pattern, gestational age, genetics, type of feeding, presence of a condition/disease

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25
Q

What is the expected pattern for infant growth?

A
  • Double birth weight by ~4 months
  • Triple birthweight by ~1 year
26
Q

Assessing growth in preterm infants

A

specific pre-term growth chart such as the Fenton Growth Chart and uses data starting at 22 weeks gestational age
* switch to full term charts when within gestational and measurement ranges using corrected age

27
Q

How is corrected age determined for pre-term infants?

A

Corrected age in weeks
* current age (weeks since birth) minus (40 weeks – gestational age at birth in weeks)
* assumes full term at 40 weeks

28
Q

What are the adaptations to post natal life?

A
  • Physiological – gastrointestinal function to learn to digest
  • Protective – mucosal barrier function noe exposed to environment
  • Biochemical – metabolism
  • Developmental (Mechanical/Motor) - feeding
29
Q

Gastrointestinal development prior to pregnancy

A

The gastrointestinal tract is formed prior to third trimester
* Third trimester: ingestion of amniotic fluid prepares gastrointestinal tract for nutrients
* Gastrointestinal motility mostly developed; coordination of peristalsis matures early infancy

30
Q

Digestion and absorption ability at birth

A

At birth able to digest components of breastmilk as efficiently as adults
* disaccharidases present in near-adult levels; lactate activity increased rapidly with feeding
* pancreatic amylase low so poor starch digestion
* fat digestion/absorption slightly lower than adult; short and medium chain better absorbed
* transporters present on brush border

31
Q

What is the glomerular filitration rate?

A

Rate at which electrolytes, water and waste products are transferred from the circulation into the kidney

32
Q

How does renal function adapt with post-natal?

A
  • Birth: ~30% adult level
  • 1 year: ~70% adult level
  • 3 years: 100 % adult level
33
Q

What is RSL?

A

renal solute load - Electrolytes and urea to be excreted

34
Q

What is normal for RLS?

A

Low RLS

35
Q

When does RLS increase?

A

Increased RSL with high protein
* increased water for excretion and/or reduced excretion of wastes

36
Q

Adaptation of protective GI functions

A

Development of mucosal gut barrier gradual in infancy

37
Q

What are the protective mechanisms of the infant gut?

A
  • gastric barrier, proteolysis, peristalsis, factors in breastmilk
  • mucosal coat and microvillus membrane
  • antibodies (IgG, sIgA), other substances
38
Q

What is the major metabolic change that occurs at birth?

A

The loss of a constant supply of glucose
* plasma glucose decreases at birth leading to a reduction in insulin and increase in glucoagn

39
Q

What is the adaptation during in utero to prepare the baby for loss of glucose at birth?

A

glycogen and triglyceride synthesis and storage during the third trimester is used during the metabolic adaptations at birth
* allows for glycogen breakdown, lipolysis, gluconeogenesis

40
Q

awareness newborn

A
  • birth: initially vigorous and alert 30-60 min
  • subsequent: 80% sleep, 20% active, inactive or crying
41
Q

How does tone of a newborn develop?

A

flexion develops from lower to upper limbs 28-40 weeks supporting the feeding response

42
Q

What is the firs thing done for a term newborn?

A

APGAR score: given 1 min after birth and then again at 5 min to quickly assess overall health and see if infant needs any medical attention with a score ranging from 0-10, 10 being rare
* 8-10 is good
* 5-7 may need some attention
* 0-4 need emergency medical attention

43
Q

What does AGPAR stand for?

A
  • Appearance: skin color
  • Pulse: heart rate
  • Grimace: response to stimulation
  • Activity: flecion (muscle tone)
  • Respiration: respiratory effort (2-strong, 1-weak cry, 0-no cry/not breathing)
44
Q

What are primitive reflexes?

A

involuntary movements that reflect normal nervous system development
* some important for normal feeding behaviour at birth
* gradually dissapear with maturity and should be gone by 6-12 month

45
Q

What are important primitive reflexes for feeding?

A
  • rooting
  • sucking
  • moro
  • head lag/step
  • grasping
46
Q

rooting reflex

A

head turning toward stroked face
* usually integrates about 3 months of age with more head control

47
Q

sucking reflex

A

reflexive, not voluntary
* in utero as well

48
Q

Moro reflex

A

“startle” reflex - arms more outward, than toward body, then might cry
* integrates about 3-5 months

49
Q

head lag/step reflex

A
  • head movement during pull to sit
  • stepping movement when held upright
50
Q

What movements/ reflexes are needed to breastfeed?

A

grasp nipple, suck, swallow, breathe

51
Q

What movements are needed for baby foods/purees?

A
  • tongue movement to move food back
  • upright posture/ head control
52
Q

movements need for finger feeds -self feeding

A
  • grasp, hand to mouth (hand-eye coordination)
  • tongue movement side to side
  • upright posture/ head control
53
Q

Movements needed for cup drinking

A
  • hands & object to mouth
  • tilt head & cup backward
  • control free flowing liquid
54
Q

Movements needed for table food

A
  • collect particles of food in bolus for swallowing
  • push food to side of gums/teeth for chewing
55
Q

developmental milestone at birth

A

grasp nipple, suck, swallow

55
Q

developmental milestones 4-6 months

A

grasps objects, improved head control, some vocalization (ah, goo)
* should be able to reach out and grasp objects

56
Q

developmental milestones 6 months

A

transfers objects hand-to-hand, hand to mouth, sits with support, 1st teeth (front), expresses food preferences

57
Q

developmental milestones 7-8 months

A

sits independently, more vocalization (mama, dada)

58
Q

developmental milestones 9 months

A

pincer grasp, cruising on furniture
* like a cheerio

59
Q

developmental milestones 12-15 months

A

walking, words, 1st molar