Midterm 2 Flashcards

1
Q

What are epigenetics?

A

The study of changes in gene expression that are meditates by the environment

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2
Q

How did the Dutch Hunger Winter affect the children who were born to mother who were pregnant with them during this period? How did the time of the pregnancy affect the outcome?

A
  • the Dutch hunger winter caused families to be malnourished thus a reduction in caloric intake for pregnant women.
  • Metabolic restriction in early pregnancy permanently alters the child’s metabolism.
  • Mothers near the end of pregnancy: their babies were well fed in the beginning, then had a loss in caloric intake so the babies were birthed small and stayed small for their lives.
  • Mothers that experienced the hunger winter in the beginning of their pregnancies were malnourished during the first trimester:
    • however, then they were well-fed during the rest so babies were born at a normal weight.
    • BUT as they aged, there were higher rated of obesity, diabetes, and heart disease.
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3
Q

What is associated with smaller stature as adults?

A

Malnourishment in the last trimester

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4
Q

What can malnourishment in the first trimester lead to?

A
  • elevated risk of obesity, heart disease, and diabetes
  • presumably because the fetal cells adapted to limited nuitrients which would have immediate benefits but led to long term issues
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5
Q

Explain Meaney et at.’s studies on maternal behavior in rat pups.
What does poor mothering have? What can we learn from the cross fostering component of this study?

A
  • The study looks at the changes in gene expression in rates with inadequate maternal care (attentive vs inattentive mothers)
  • Inattentive mothers have stressed offspring.
    • Their genes were highly methylated, & DNA that is methylated will not actively transcribe
  • Rats born to attentive mothers then raised by an inattentive foster mom, had genes that were highly methylated which goes to show that the first week of life is critical
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6
Q

Oberlander observed epigenetic changes in the fetal cord blood that were linked to maternal depression & anxiety in the 3rd trimester. What were these changes? How did this relate to stress-induced cortisol levels in 3 month olds?

A
  • Greater maternal depression and anxiety during the 3rd trimester was associated with increased DNA methylation within the glucocorticoid receptor gene measured in fetal cord blood
  • this measure of DNA methylation was related to increased infant cortisol response to stress at three months
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7
Q

Oberlander chart

A

Prenatal exposure = maternal depression & anxiety during the 3rd trimester,

Epigenetic effect = increased DNA methylation within the NR3C1 gene promoter in fetal cord blood,

Outcome = increased stress-induced cortisol levels in 3 month old infants

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8
Q

Prenatal stress poses risks for the child’s outcomes. What are some of the concerning outcomes?

A
  • epigenetic changes in the fetus
  • epigenetic changes in structures of the mother’s body that support fetal development (placenta)
  • epigenetic changes in the mother that may affect infant caregiving
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9
Q

What did researchers find when they studies monozygotic twins as part of a longitudinal study at the Spanish Cancer Center?

A
  • Twins born from a single egg (monozygotic)
  • pattern of DNA methylation was highly similar in infant pairs
  • differences in DNA methylation increased with age
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10
Q

Blastocyst

A

a ball of cells that forms early in pregnancy, about five to six days after sperm fertilizes the egg

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11
Q

Amniotic Fluid

A
  • protects the fetus from infection
  • cushions the fetus’ movements and helps it move
  • regulates fetal body temperature
  • helps the fetus’s digestive and respiratory systems develop
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12
Q

Source of Amniotic Fluid

A
  • initial source: amniotic cells
  • 2nd trimester: fetal urine is the main contributor - other contributors: diffusion across membranes; fetal respiration
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13
Q

Period of the embryo

A

the period extends from the time the organism becomes attached to the uterus to the 8th week of pregnancy.

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14
Q

Period of the fetus

A

begins in the 9th week after conception, with the first signs of the hardening of the bones, and continues until birth

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15
Q

Placenta

A
  • provides nutrients and oxygen to your baby through the umbilical cord
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16
Q

Umbilical cord

A
  • one vein that carries food and oxygen from the placenta to the fetus
  • two arteries that carry waste from the fetus back to the placenta
  • the umbilical cord is filled with a substance called Wharton’s jelly that cushions and protects these blood vessels
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17
Q

Cephalocaudal development

A

Areas near the head develop before areas further down on the body

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18
Q

Proximodistal development

A

center outward - structures near the torso develop more rapidly than those in the periphery

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19
Q

Age of Viability

A
  • the age at which a baby can survive with medical assistance in the event of premature birth
  • between 22 and 26 weeks
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20
Q

What are the protective functions of the amniotic fluid?

A
  • protects the fetus from infection
  • cushions the fetus movement and helps it move
  • regulates fetal body temp
  • protects from maternal falls or sudden blows
  • helps the fetus’s digestive and respiratory systems develop
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21
Q

How do the placenta and umbilical cord function to promote fetal development?

A

Placenta:
- The placenta connects to the umbilical cord through thousands of microscopic “fingers” of tissue (chorionic villi) containing a network of blood vessels that connect to the fetus’ circulatory system.

When the mother’s blood comes in contact with the villi, nutrients are exchanged for waste through the villi walls. The villi also act as a partial filter, preventing some viruses and bacteria from reaching the fetus.

Umbilical Cord
- One vein that carries food and oxygen from the placenta to the fetus
- Two arteries that carry waste from the fetus back to the placenta
- The umbilical cord is filled with a substance called Wharton’s jelly that cushions and protects these blood vessels

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22
Q

When does clef lip and cleft palate emerge in development? When are they usually repaired?

A
  • the cleft lip develops 4-7 weeks.
  • the palate (roof of the mouth) develops 5-9 weeks.
  • a cleft lip may be repaired at 3-6 months of age.
  • a cleft palate tends to be repaired at 9-12 months of age (so it doesn’t interfere with language development)
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23
Q

What are some of the things the fetus does in the womb? Do these actions aid development?

A
  • embryo makes spontaneous movements at about 5-6 weeks after conception, bending its head and spine then movements become more complex
  • weeks later it will move even more and the movements will become smoother and more coordinated
  • swallowing movement begins at 11 weeks
  • sucking movements begin at 15 weeks
  • fetal breathing begins at about 10 weeks
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24
Q

Is there any reason to think that early experience shapes taste preferences? Explain the evidence.

A

Yes, mennella et al. (2001) - mothers drank carrot juice for 3 weeks near the end of their pregnancy

  • Babies whose moms had carrot juice preferred the carrot-flavored cereal further the same was seen with breastfeeding
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25
Q

Does the fetus have a sense of touch? Do they respond to light? Voices?

A
  • yes, the fetus touches its body, the umbilical cord, and sucks its thumbs
  • at 26 weeks old, the fetus heart rate and movement increase if a bright light is held against the mother’s abdomen
  • change in heart rate and changes in movement when there is sound
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26
Q

What voices preferences might we see in newborns?

A
  • Fetus responds to both male and female voices but there are differences in how the infant responds to the voice of its mother versus a female stranger
  • prefers the language that they were exposed to in utero (native language)
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27
Q

Describe the “Dr. Seuss” book reading study

A
  • Tested: when just 2.5 days-old
  • Testing procedure: baby sucked in one pattern on the pacifier they would hear the familiar story if they sucked in a different pattern they would hear the unfamiliar story
  • Finding: infants sucked in the pattern that would allow them to hear the familiar story - even when both stories were read by another woman
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28
Q

What was the difference between the two supplements (Atole and Fresco) used in the Guatemala food supplementation study? Were outcomes different for the two supplements? Explain.

A
  • Fresco is a sugary drink
  • Atole is gruel (mixture of vegetable and protein mixture) that was combined with skin milk and sugar
  • Found that caloric intake increased the same amount in both villages bc more drinks (Fresco) was consumed than gruel (Atole)
  • this increased calorie improved outcomes
  • those women who increased their calorie intake over the pregnancy by atleast 20,000 calories cut their risk of delivering a low-birth weight baby in half
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29
Q

How did providing iron-folic acid supplements to anemic women in Nepal improve child outcomes?

A

The children who received iron-folic acid supplements were tested at 7-9 years of age and they tested higher on working memory, inhibitory control and fine motor function

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30
Q

Staple foods have been fortified with iron, Vitamin A, folic acid. What is the advantage of doing so?

A

It improved the nutritional status of a population, for example, rice fortification

31
Q

What is spina bifida? Explain how food fortification has affected the incidence of this disorder.

A
  • Spinda bifida: involves disruption in the complete closure of the neural tube
  • Food fortification allows for an increase in folic acid ( a b vitamin)
32
Q

Thalidomide and Rubella only posed extreme risks at certain points in the pregnancy. When did they post risks and what were some of the adverse outcomes?

A
  • if Thalidomide was taken between 20-36 days after fertilization then it increased the incidence of birth defects involving the ear, eyes, upper limbs, lower limbs, internal organs
  • If a woman contracts rubella (a highly infectious disease) during the first three months of pregnancy then there’s a 50-90% chance for the child to have congenital rubella syndrome - hearing loss, congenital heart disease, vision loss due to cataracts clouding
33
Q

Why is Dr. Kelsey an important figure?

A
  • Dr. Frances Kelsey is the reason that thalidomide was not approved in the US, she was a new hire & rejected the application bc there was not sufficient evidence for the drugs safety
34
Q

What is congenital rubella syndrome? What led to the drop in cases?

A
  • Hearing loss, vision loss, congenital heart disease
  • Vaccines for rubella were first licensed in the US in 1969, now infants are given the rubella vaccine as part of a series of routine immunizations
35
Q

Although most babies born early, do not have neurodevelopment disabilities, some do. What factors increase the risk?

A
  • Extreme prematurity
  • Very low birth weight (under 500 grams)
  • CNS infection (infection of the brain, meningitis)
  • Intraventricular hemorrhage (bleeding in the brain)
36
Q

Chronological Age

A

age from birth

37
Q

Conception (conceptual) Age

A

age from conception (often used in NICU)

38
Q

Corrected Age

A

age from expected due date(used for developmental assessments till age 2 then switch to chronological birth)

39
Q

In terms of gestational age - what is a normal full-term infant? Am extremely preterm infant?

A
  • Normal full-term infant is 38 - 42 weeks
  • Extremely preterm infant is less than 28 weeks
40
Q

Gestational age

A

the number of weeks since a woman’s last menstrual period

41
Q

What are some of the differences in muscle tone and coordination you might see in the first year of life if a baby is born preterm?

A
  • Slightly loose at the joints
  • Sitting comes later
  • Visual spatial perception is more difficult
  • Sensory motor processing may require more effort
  • May appear “clumsy” when learning new skills- if significant may benefit from OT
42
Q

How might a parent feel after the birth of a preterm baby? How can hospitals help?

A
  • Parents might feel responsible, and stressed
  • Psychosocial help for families can help such as emotional support or caring for the caregiver
43
Q

How can pain be managed in the NICU?

A
  • Sucrose and Sweet Liquids
  • Medication
  • Breast-feeding
  • Non-nutritive sucking (pacifier)
  • Swaddling
  • Facilitated tucking
  • Skin-to-skin contact (kangaroo care)
  • Sensorial saturation (massage, touch, voice, smell)
44
Q

What is the key idea of family-centered care?

A

Recognizes the family as vital members of the NICU caste team

45
Q

What is kangaroo care? Describe the studies that have shown it has positive effects.

A
  • Method of holding a baby that involves skin- skin contact
  • Collected saliva samples,
  • Skin to skin contact decreased cortisol (stress) levels in both the b=parent and the infant
  • And the parents oxytocin levels increased (positive feelings)
  • Adding singing helps too
46
Q

What are the current recommendations regarding kangaroo care?

A
  • Preterm babies should receive kangaroo care for at least an hour a day (more time is encouraged)
  • If the baby is not well enough for kangaroo care, developmentally appropriate touch is recommended
47
Q

What did Field and colleagues find when they massaged preterm infants?

A

Weight gain was greater for the massage therapy group compared to the standard care control group

48
Q

Research has shown that full-term infants benefit when parents read books to them. Why does book reading seem to be beneficial?

A

Linguistic aspect
- the language used in books is far richer than the language of everyday speech – exposure to grammatically rich constructions

Interactive aspect
- tend to elicit more interactive communication between infant and caregiver including more frequent verbal responses, eye-contact, touch and fee

Parental aspect
- reduces parental stress and gives parents a sense of control

49
Q

Summarize the studies that have looked at parental book reading in the NICU

A
  • Lavriviere and Rennick (2011) found that 86% of parents found reading enjoyable and found that 69% mentioned that it helped them feel closer to their babies
  • Parents were more likely to report reading thre or more times a week after discharge than a histyoric control group
  • Nari et al (2021) shoed early language benefits
  • The NICU reading group lost less ground of falling behind in language compared to the control group without reading intervention
50
Q

What are the three stages of the birth process? In what position would we expect the head? What is a breech presentation? A Cesarean delivery?

A

First stage of Labor
- Average 12 hours for first birth
- The contractions result in dilation of the cervix and moves fetus down the neck of the uterus

Second stage of Delivery
- Pushing accurs
- Crowning occurs
- Baby exits birth canal

Third stage of Expulsion of placenta and umbilical cord \

Breech presentation
- Fetus is turned arpund so the butt and feet are positioned first
- Attempt to turn baby around

Cesarean Delivery
- Does not imapct future vaginal birth
- Rates very widely among countries

51
Q

What is an Apgar score? How is it determined? When is it given?

A

Appearance (skin color – pinkish? bluish?)
Pulse (Heart rate)
Grimace response (cries, coughs, pulls away)
Activity (spontaneous movement? floppy?)
Respiration

  • Rated at 1 and 5 minutes after birth
  • Given at score of 0-2 on each item
  • Good Health: 8 and above
  • 1 minute score: how baby dealt with birth
  • 5 minute score: adjustment to life outside womb
52
Q

Pacing and stepping

A
  • stimualtion= hold baby under arms with feet on floor
  • response= makes stepping motion
  • Disappears by 2 months
53
Q

Sucking

A
  • Stimulation= object or substance in mouth
  • Response= sucking
  • Disappears by 4 months
54
Q

Rooting

A
  • stimulation= touch on cheek or mouth
  • Response=turns toward touch
  • Disappears by 4 months
55
Q

Palmar Grasp reflex

A
  • Stimulation= object placed in palm
  • Response= holds tightly
  • Disappears by 4 months
56
Q

What is the Brazelton Neonatal Behavioral Assessment Scale designed to do? When is it typically administered?

A

The clinician describes the newborn’s strengths and needs, and at the same time models affective interaction with the infant for example engagement with objects, faces, and voices

57
Q

Define temperament

A

child’s emotional and behavioral style of responding to the world

the child displays her temperament style from birth

58
Q

Thomas and Chase used scores on the nine dimensions of temperament to categorize infants into three broad temperament categories: Easy, Difficult, Slow-to-warm up. Describe the characteristics that go along with each of these three categories.

A

Easy babies (40% of infants)
- adjust easily to new situations
- quickly establish routines
- are generally cheerful and easy to calm

Difficult babies (10% of infants)
- irregular in biological functions
- are irritable
- likely to react intensely and negatively to new situations or try to withdraw from them

Slow-to-warm-up babies (15% of infants)
- low in activity level and their responses are typically mild
- tend to withdraw from new situations but in a calm way
- require more time than easy babies to adapt to change

59
Q

How does the length of time crying per day vary for low and high criers? At what age does crying tend to peak?

A
  • High criers cry for 5-6 hours
  • Low criers cry for 20-30 minutes and tends to peak at 2 months
60
Q

How might you soothe a crying infant?

A

talk softly and hug it

61
Q

How often should babies be fed? When should solid foods be introduced?

A
  • Feed whenever baby hungry
  • Solid food introduced at 6 months
62
Q

What are the five states of infant arousal? How much time does the infant spend in REM and NRem sleep? Why is REM sleep important?

A

Waking activity and crying
- frequent bursts of uncoordinated body activity, irregular breathing; face may be relaxed, tense, or crying (newborn: 1-4 hrs)

Quiet alertness (Alert inactivity)
- body relatively inactive, eyes open and attentive, breathing is even (newborn: 2-3 hrs)

Drowsiness
- falling asleep or waking up; eyes open and close; glazed look; breathing is even but somewhat faster than NREM sleep
(newborn: varies)

Regular (NREM) sleep
- full rest, little body activity, breathing slow and regular, eyes closed- no eye movement (newborn: 8-9 hrs)

Irregular (REM) sleep
- gentle limb movements, occasional stirring, breathing is irregular, facial movements and smiles; some eye movements (newborn: 8-9 hrs)

Rem sleep is important for brain development because it selectively prunes newly formed dendritic spines and strengthens new synapses

63
Q

What are some of the physical factors associated with SIDS? What is the safest position for sleeping?

A
  • Brain defects. Some infants are born with problems that make them more likely to die of SIDS. In many of these babies, the part of the brain that controls breathing and waking up from sleep hasn’t developed enough to work properly.
  • Sleeping on the back is safest
64
Q

What advice would you give someone who is trying to create a safe sleep environment for an infant?

A

no bed sharing

65
Q

Cultural values affect decisions about how we care for our infants. Give an example of this.

A

For example mayan mothers believe co-speeping promotes close parent-child bond

66
Q

Researchers have looked at whether infants only a few days old recognize their mother by sight. Describe two studies on this topic and what researchers found.

A

Bushnell et al., 1989
- 2-day-old infants
- presented with video of their mother’s face and another woman’s face
- looked at their mother about 63% of the time

Pascalis et al. (1995)
- 4-day old infants
- In this study, both women wore pink scarves so their hairline was covered
- Infants did not recognize their mother when her hairline was covered

67
Q

What did Quinn discover when he tested whether all infants show a preference for female faces?

A
  • The three month olds looks at the person that was the same sex as their primary caregiver
  • In conclusion infants are sensitive to characteristics that distinguish male and female faces
68
Q

How might we measure infant preference?

A
  • Looking time
  • response time
  • Habituation - stimulus then a new stimulus
69
Q

Explain how the habituation-dishabituation procedure might be used to test if infants can discriminate between two stimuli.

A

initially presenting stimuli to infants until they are habituated, and then presenting them with different kinds of stimuli to see if they dishabituate
- i.e., notice a change.

70
Q

Kelly et al. were interested in whether infants of different ages are better at discriminating between two strangers’ faces when the strangers are the same race as the infant (and the faces they tend to see). What did they find?

A

Nine-month-old Caucasian infants only recognized the Caucasian faces. This
finding suggest that the other race effect (better at recognizing faces of own race
emerges in infancy)

71
Q

Explain Anzures et al.’s DVD study. How did the two conditions of their study vary? What did they find?

A
  • One group’s DVD featured eight Asian women
  • Other group’s DVD featured eight Caucasian women

Parents told to play the DVD 8 minutes day for 3 weeks

TEST PHASE: Presented novelty preference test with another set of faces.

RESULT: Infants who viewed DVD of Asian women were able to recognize new
Asian faces in the novelty preference task.

So engaging experience with people of different races improves recognition of
other race faces

72
Q

When does visually guided reaching emerge? What is the average age for sitting? Are there variations?

A
  • Emerges at about 3 months
  • 3.8 months / 9.2 months
73
Q

Developmental care to infants in the NICU involves keeping the baby’s unique developmental needs in mind when providing care. How can clinical procedures be accomplished in a developmentally sensitive way? How can the physical environment of the NICU be designed to make it less stressful for the infant?

A

Providing Developmental Care in the NICU

  • Clinical care tailored to child’s individual needs
    -Caregiving activities should revolve around the infant’s sleep/wake cycles, arousal cues, unique needs
  • Use evidence-based techniques to manage pain
    • Sucrose and Sweet Liquids, Medication, Breast-feeding, Non-nutritive sucking (pacifier), Swaddling, Facilitated tucking, Skin-to-skin contact (kangaroo care), Sensorial saturation (massage, touch, voice, smell)

Physical environment
- Developmental Care
- Regulate light
- Regulate sound
- Non-nutritive sucking
- Womb sounds, parent voices, singing, smell

In terms of clinical procedures, using care that’s tailored to the childs needs is important. The caregiving activities should be centered around the babies sleep cycles and arousal cues. And using medication, breast-feeding and other thigns to help manage the pain. In terms of the physical environment, regulating harsh lights, regulating abrasive sounds, and strong smells help to make a safe, calm environment for the NICU babies. These things will provide comfort and help their physiological stability.