Developmental Disorders Flashcards
Define incidence.
Incidence is the number of new cases in a given time frame.
Define prevalence.
The number of individuals who currently have the disease in a particular area.
How many weeks are considered full term?
37-42 weeks
For gestational age, what is considered pre-term? what is considered post-term?
Pre-term: < 37 weeks
Post-term: > 42 weeks
How long can an infant survive in-utero?
22-weeks gestation
How long do we “correct” for prematurity? How do we “correct” it?
We correct premature infants’ age for up to one year. Depending on how many weeks or months early the infant was born, you subtract the number of weeks or months from their true age.
Why do we use APGAR?
To determine whether a neonate needs recussitation.
What does APGAR stand for?
Appearance, pulse, grimace, activity, and respiration.
If you are 7-10 on the APGAR, what does that indicate? 4-6? 0-3?
7-10 means the baby is normal; 4-6 means the baby is moderately depressed; and 0-3 means the baby needs immediate recussitation.
What is full-term birth weight?
2500 grams - 4100 grams (5.5 lbs - 9.0 lbs)
What is considered low birth weight (LBW)?
Below 2500 grams (5.5 lbs)
What is considered very low birth weight (VLBW)?
Below 1500 grams (3.3 lbs)
What is considered extremely low birth weight (ELBW)?
Below 1000 grams (2.2 lbs)
What does SGA stand for? According to length and weight percentiles, where will these infants fall?
Small for gestational age; they will fall below the 10th percentile.
What does LGA stand for? According to length and weight percentiles, where will these infants fall?
Large for gestational age; they will fall above the 90th percentile.
If an infant is consistently below the 3rd percentile for length and weight, what are they considered?
Failure to thrive (FTT)
If an infant has fetal alcohol syndrome and cannot put on weight, even with a steady caloric intake, would that be considered organic or non-organic, in regard to FTT? If an infant is not receiving enough caloric intake, would that be considered organic or non-organic?
The first would be organic because these are growth-inhibiting disorders; it doesn’t matter that the child is being fed, they will not gain weight or grow. The second would be non-organic because this is environmental neglect that is limiting weight gain and growth.
What is the treatment for children suffering FTT?
Increase their caloric intake
What is Meconium staining and how can it be life-threatening to the neonate? If this occurs, is there anything done to help during the birthing process?
Meconium comes from the large intestine of the fetus/newborn at the time of birth. During vaginal birth, infants can aspirate on meconium, especially if they are LGA. Aspirating on the meconium can cause damage to the neonate’s respiratory system and could lead to hypoxia/anoxia. If this occurs, the infant will receive suctioning and clearing of their airway right away.
How can we prevent a fetus/newborn from aspirating on meconium?
If a mother has a C-section, it is not likely that the baby will aspirate because you are decreasing the birthing process and difficulty of delivery, especially if the infant is LGA.
What is Erb Palsy?
Paralysis of the UE due to a traction injury to the brachial plexus during the birthing process.
What are the 3 types of Erb Palsy? Briefly describe them and the positioning of the infant during birth.
Erb Duchenne palsy: involve C5-C6 nerve roots; typically occurs due to shoulder dystocia, which involves the shoulder being stuck under the mother’s pubic symphysis.
Whole-arm palsy: C5-T1 nerve roots
Klumpke palsy: C8-T1 nerve roots; typically occurs due to shoulder hyperabduction, most likely occurring from an occiput-posterior positioning of the infant during birth.
With a child that has Erb Duchenne palsy, what position of the UE will be displayed after birth? Klumpke palsy?
Erb Duchenne palsy: the elbow is extended, shoulder IR and adducted, wrist pronated, and fingers flexed.
Klumpke palsy: wrist and long fingers flexed, with the hand intrinsics involved as well.
What is the prognosis for Erb Duchenne Palsy? Klumpke Palsy?
If the child has not achieved elbow flexion in an anti-gravity position by 3 months of age, the recovery process will be poor. Most gains are made prior to 18 months. For Klumpke palsy, the prognosis has a poorer outcome in the long-term.
What are Teratogens?
Chemicals in the environment that affect fetal development.
What can occur if a mother has deficient amounts of Folic Acid during pregnancy?
There may be issues during the folding of the fetus’s neural tube.
What is anencephaly? What is the prognosis?
It is a neural tube defect because the cephalic end of the tube fails to close. This will result in the absence of the forebrain and cerebrum, scalp, and skull. Prognosis typically involves the infant being stillborn or they will usually die within hours or days after birth.
What is microcephaly? What is the prognosis?
Circumference of the head is significantly smaller than average for age and gender. The face continues to develop at a normal rate while the head fails to grow. Typically involves a poor prognosis for normal brain function; motor abilities range from clumsiness to quadriplegia and we suspect a decreased life expectancy.
What is porencephaly? What is the prognosis?
Cyst-like cavities forms in the cerebral hemisphere. This could be due to a bleed or stroke inutero or of an infection. Prognosis depends on the location of the lesion, but we often see a hemiplegic type presentation, delayed development, seizures, hydrocephalus, and ID.
What is Lissencephaly? What is the prognosis?
Lack of normal convolutions in the brain because of defective neuronal migration during development. Many die before the age of 2, range of near normal development and cognition to no significant development past a 3-5-month-old level.
What does STORCH stand for? What does it represent?
Syphilis, toxoplasmosis, other (HIV, enterovirus, influenza, chicken pox, Epstein-Barr), rubella, cytomegalic inclusion disease, and herpes.
Infections
What is syphilis, how is it given to the infant, and what is the clinical picture?
It is an STD and is transferred to the fetus through the placenta of the mother. 25% fetal death occurs by the second trimester and 25% die soon after birth. Of those that survive, 25% show signs of jaundice, anemia, pneumonia, skin rash, and bone inflammation; 75% show no signs at birth, but later manifest abnormalities of teeth, blindness, skeletal anomalies, ID, and sensorineural deafness.
What is toxoplasmosis, how is it given to the infant, and what is the clinical picture?
Toxoplasmosis involves a protozoan found in cat feces. If a mother handles cat feces while pregnant, she can contract the protozoan that will be passed through the placenta. Affected infants typically have LBW, an enlarged liver/spleen, jaundice, and anemia.
How do infants acquire HIV, and what is the clinical picture?
Infants acquire virus inutero, through transplacental transfer or through mothers’ breast milk. Infants will have opportunistic infections, pneumonitis, microcephaly, and neurologic abnormalities.
What is rubella, how is it given to an infant, and what is the clinical picture?
Togavirus can multiply in the upper respiratory tract and pass into the bloodstream. The transmission occurs while inutero. It may cause spontaneous abortions, blindness, deafness, ID, LBW, rash, heart defects, enlarged liver/spleen, microcephaly, and cataracts.
What is cytomegalic inclusion disease, how is it given to the infant, and what is the clinical picture?
It is a virus that is transmitted through intimate contact. It may cause intrauterine death or premature death. The transmission occurs while inutero. An infant can present with LBW, jaundice, rash, deafness, diseases of the retina, and developmental delays.
What is herpes, how is it given to the infant, and what is the clinical picture?
It is a virus that is transmitted to the fetus during the birthing process, rather than through the placenta. If mild, the infant can have a disease of the skin and mucous membranes of the eyes and mouth. If severe, it will involve all the body organs, retinal disease, and developmental delay.
What are examples of Teratogens?
Alcohol, smoking, drugs (Acutain, Thalidomide, Marijuana, Tranquilizers).
What is phocomelia?
It is the developmental anomaly of the absence of the upper portion of one or more limbs.
What Teratogen causes phocomelia, and the attachment of the feet or hands to the trunk?
Thalidomide
What does neonate mean?
Newborn
When is surfactant produced? When is peak production?
Not until the 29th week of gestation; peak production occurs at 34 weeks.
When are alveolar development and lung maturation complete?
Not until the 35th week of gestation.
If an infant is born premature, what will happen to their respiratory function?
Since the infant may not reach peak production of a surfactant or achieve alveolar development and lung maturation, it can lead to issues related to survival. The infant can experience hypoxia, anoxia, inadequate oxygen delivery, and alterations in BP.
